Obstetric analgesia in labor and its association with neonatal outcomes

Silva, Yasmin Aparecida Pires; Araújo, Fernanda Gontijo; Amorim, Torcata; FranciscaMartins, Eunice; Felisbino-Mendes, Mariana Santos

doi:10.1590/0034-7167-2018-0757

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (2) • 2020 • https://doi.org/10.1590/0034-7167-2018-0757 linkcopy

Obstetric analgesia in labor and its association with neonatal outcomes

Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes.

Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors.

Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments.

Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

Descriptors: Analgesia, Obstetrical; Infant, Neonatal; Labor, Obstetric; Apgar Score; Intensive Care Units, Neonatal

Characteristics	Use of analgesia
	Yes		No		p value^* * Pearson's Chi-squared Test;
	n (%)	mean±(SD)	n (%)	mean±(SD)	p value^* * Pearson's Chi-squared Test;
Companion/doula					0.124
Yes	286 (99.0)		516 (97.4)
No	3 (1.0)		14 (2.6)
Level of education					0.07
0 to 8 years of education	16 (8.1)		16 (4.3)
9 to 11 years	117 (59.1)		208 (55.8)
12 years or more	65 (32.8)		149 (39.9)
Age					0.791
13 to 19 years	86 (29.1)		155 (28.0)
20 to 29 years	147 (49.7)		269 (48.7)
31 years or more	63 (21.3)		129 (23.3)
Previous deliveries					<0.0001
None	182 (61.7)		246 (44.8)
More than one	113 (38.3)		303 (55.2)
Duration of labor		7.1(±3.1)		4.3(±2.7)	<0.0001^ Student's T-test; SD= standard-deviation
Gestational age		39.3 (±1.1)		39.0 (±1.2)	0.946
37 to 40 weeks	260 (87.5)		485 (87.7)
41 weeks or more	37 (12.5)		68 (12.3)

Neonatal outcome	Women with vaginal delivery (n=850)
Neonatal outcome	n (%)	p value	OR^* * Unadjusted values, (95%CI)	OR^ Adjusted for: maternal age, gestational age, number of previous deliveries. OR= Odds Ratio; 95%CI: 95% Confidence Interval; CPR: Cardiopulmonary Resuscitation; NB: Newborn; ICU: Intensive Care Unit (95%CI)
1 min Apgar <7		<0.0001
With analgesia	28 (9.4)		2.92 (1.60-5.32)	2.80 (1.52-5.17)
Without analgesia	19 (3.4)		Ref.	Ref.
5 min Apgar <7		0.101
With analgesia	5 (1.7)		3.13 (0.74-13.20)	.
Without analgesia	3 (0.5)		Ref.
CPR		<0.0001
With analgesia	31 (10.5)		3.48 (1.91-6.33)	3.21 (1.74-5.90)
Without analgesia	18 (3.2)		Ref.	Ref.
NB referred to the ICU		0.004
With analgesia	12 (4.1)		3.89 (1.44-10.48)	3.85 (1.40-10.65)
Without analgesia	6 (1.1)		Ref.	Ref.

Neonatal outcome	Low risk pregnant (n=614)				High risk pregnant (n=225)
Neonatal outcome	n (%)	p value	OR^ ***** Adjusted for: maternal age, gestational age, number of previous deliveries. OR= Odds Ratio; 95%CI: 95% Confidence Interval; CPR: Cardiopulmonary Resuscitation; NB: Newborn; ICU: Intensive Care Unit (95%CI)	OR^*** Nota: (95%CI)	n (%)	p value	OR^ ***** Adjusted for: maternal age, gestational age, number of previous deliveries. OR= Odds Ratio; 95%CI: 95% Confidence Interval; CPR: Cardiopulmonary Resuscitation; NB: Newborn; ICU: Intensive Care Unit (95%CI)	OR^*** Nota: (95%CI)
1 min Apgar <7		0.003^* ** Unadjusted values;				0.052^* ** Unadjusted values;
With analgesia	21 (9.8)		2.80 (1.41-5.56)	2.73 (1.35-5.53)	07 (8.9)		3.52 (0.99-12.43)	-
Without analgesia	15 (3.8)		Ref.		04 (2.7)		Ref.
5 min Apgar <7		0.190^* ** Unadjusted values;				1.000^* ** Unadjusted values;
With analgesia	4 (1.88)		3.80 (0.69-20.96)	-	1 (1.28)		1.89 (0.11-30.73)	-
Without analgesia	2 (0.50)		Ref.		1 (0.8)		Ref.
CPR		<0.0001				0.015
With analgesia	22 (10.3)		3.43 (1.69-6.97)	3.12 (1.50-6.46)	9 (11.6)		3.68 (1.16-11.71)	3.69 (1.15-11.71)
Without analgesia	13 (3.2)		Ref.		5 (3.4)		Ref.	Ref.
NB referred to the ICU		0.014^* ** Unadjusted values;				0.342^* ** Unadjusted values;
With analgesia	9 (4.2)		4.44 (1.35-14.60)	4.32 (1.27-14.66)	3 (3.9)		2.93 (0.48-17.97)	-
Without analgesia	4 (1.0)		Ref.		2 (1.3)		Ref.

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[TFN1] Note:

[TFN2] ^*
Pearson's Chi-squared Test;

[TFN3] ^**
Student's T-test; SD= standard-deviation