| Purpose:Analyze the effects of different interventional timings of epidural analgesia(Epidural analgesia,EA)on the progress of labor and maternal and infant outcomes in primiparous women,aiming to find a more appropriate timing of interventional labor analgesia,and provide reference for clinical work.Method:The primiparous women who gave birth in Northern Jiangsu People’s Hospital from November 2019 to November 2020 were selected as the research object.The total number of 1157 cases was divided into EA group(557 cases)and control group(not implemented in epidural analgesia group,600 cases).The EA components were group A(dilation of the uterine orifice<2cm,295 cases),group B(2cm≤dilation of the uterine orifice <3cm,171 cases),and group C(dilation of the uterine orifice ≥3cm,91 cases).The general data of the mothers in each group,the time of labor,the application rate of oxytocin,the delivery outcome,the amount of postpartum hemorrhage and maternal complications was collected and do the retrospective analysis.Result:(1)The results of general data of each group showed that there were no differences in age,number of pregnancies,gestational weeks of delivery and BMI of each group(P>0.05).(2)Comparison of the stage of labor in each group: there was no difference in the time of the third stage of labor in each group(P>0.05).The first stage of labor,the second stage of labor and the total stage time of labor in EA group were generally longer than those in another group,which showed a significant difference(P<0.05).In EA group,the data which was collected as the time of the first labor stage in group A was longer than that in group C(P<0.05).But the data which between group A and group B,and between group B and group C was not significantly different(P>0.05).As for the time of the second stage and the total stage of labor,no statistical difference was found between group A,B and C(P>0.05).(3)Comparison of maternal oxytocin application: the oxytocin application rate in EA group was much more higher than that in control group with the statistical difference(P<0.05).The ratio of oxytocin in groups A and B was found that higher than that in group C(P<0.05),but the data did not show a statistical difference between group B and group C(P>0.05).(4)Comparison of maternal delivery outcomes: the conversion rate of cesarean section of EA group was generally higher than that in control group which hint a statistical difference(P<0.05).The data of the conversion rate of cesarean section in groups A and B was generally higher than that in the control group(P<0.05),while statistical difference was not found between group C and the control group(P>0.05).Meanwhile,between groups A,B and C,there was no statistical difference(P>0.05).(5)Comparison of postpartum blood loss: there was no difference in postpartum blood loss between EA group and control group(P>0.05).(6)Comparison of neonatal outcome: there was no difference between EA group and control group in neonatal birth weight,neonatal 1,5,10 minute Apgar score and neonatal asphyxia rate(P>0.05).(7)Comparison of maternal complications: the incidence of fever and urinary retention in EA group was significantly higher than that in control group(P<0.05).The incidence ratio of fever and urinary retention between groups A,B and C among EA groups was found no statistical difference(P>0.05).Also,the ratio of pruritus and lower limb numbness between EA group and control group was not show the difference(P >0.05).No adverse reactions such as hypotension,nausea,vomiting and headache occurred in all primiparas.Conclusion:(1)The implementation of EA can extend the time of the first,second and total labor stage,and at the same time increase the risk of transitioning to cesarean section.When the uterine dilation is less than 3cm,the risk is significantly increased.(2)The application rate of oxytocin in EA patients is higher than that in non-EA patients.When the uterine orifice dilation is less than 3 cm,the oxytocin application rate is significantly higher than that of the uterine orifice dilation ≥ 3 cm.(3)The implementation of EA has no effect on postpartum hemorrhage and neonatal outcome,but the risk of fever and urinary retention will be higher than those who have not implemented EA.(4)When the dilation of the uterine orifice is ≥3cm,although the time of labor is prolonged,the rate of transit to cesarean section does not increase,and the risk of maternal complications does not increase compared with other patients undergoing EA,and it does not affect the neonatal outcome,which is more appropriate timing of EA intervention. |
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