Relation between epidural analgesia and perinatal outcomes on Robson class 2a

: The use of epidural analgesia represents the gold standard for pain management during labor, however, the influence of the use of epidural analgesia on delivery mode and neonatal outcomes is not fully understood. Moreover, the rate of induction of labor worldwide is increasing dramatically.

: This study aimed to analyze the impact of epidural analgesia on the mode of parturition and perinatal outcomes among individuals classified as Robson class 2a.

A retrospective cohort study was conducted on every Robson class 2a individual who delivered from January 1, 2022, to December 31, 2023, at the University Hospital of Modena in the north of Italy. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were the effect of epidural analgesia on the duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission.

Overall, 809 individuals were included in the final analysis, and 456 of them (56.4%) received epidural analgesia on request. Among individuals with and those without epidural analgesia, the cesarean delivery rate was 25% and 20.4% (P=.12), the vaginal delivery rate was 65.6% and 69.4% (P=.25), and the operative vaginal delivery rate was 9.4% and 10.2% (P=.72), respectively, without statistically significant differences. Furthermore, no significant difference was found in the neonatal outcomes between the 2 groups. Individuals with epidural analgesia had longer induction (P<.001) and second stage (P=.004) times than those without. These findings were confirmed by multivariable logistic and multinomial regression analyses. In the multivariable logistic regression, the increased induction time was associated not only with epidural analgesia (P<.001) but also with body mass index at delivery (P=.027), the gestational age at induction (P<.001), post-term pregnancy (P<.001), and induction indications of gestational diabetes or an estimated fetal weight >95th percentile (P<.001). Similarly, the increased duration of the second stage was associated not only with epidural analgesia (P=.026) but also with neonatal weight (P=.005) and induction indication for gestational diabetes or estimated fetal weight >95th percentile (P=.034).

Epidural analgesia was among the factors that increased both the induction and second stage of delivery times. However, epidural analgesia did not impact the mode of delivery and perinatal outcomes in Robson class 2a individuals.