European Journal of Cardiovascular Medicine

Pain during delivery is regarded as one of the most severe types of acute pain encountered by women, and its proficient management is an essential aspect of contemporary obstetric care. Epidural analgesia is considered the gold standard for relieving pain during childbirth since it works better than other methods and can give continuous, adjustable pain relief throughout delivery [1-3]. Even though many people agree with it, the use of epidural analgesia has sparked ongoing discussion about how it can affect the course of labor and delivery results. Numerous studies indicate that epidural analgesia may extend the duration of the first and second stages of labor, although others report no meaningful effect [4-6]. There are also worries that women who get epidural analgesia would have more instrumental births and cesarean sections. However, more recent evidence shows that improvements in low-dose local anesthetic and opioid combinations have lessened many of these negative effects, making epidural analgesia safer and more tolerable [7, 8]. For women, who frequently endure prolonged labors and heightened pain relative to multiparous women, the selection of analgesia is very critical. It is important to understand how epidural analgesia, the length of labor, and the way of delivery are related so that both doctors and pregnant women can make smart choices. Consequently, this study was undertaken to examine the impact of epidural analgesia on labor time and delivery method in women, emphasizing mother and newborn outcomes [9, 10].

This prospective comparison study was performed on 70 women in active labor. Participants were randomly assigned to two groups; Group I (n = 35) comprised women who received epidural analgesia. Group II (n = 35) consists of women who did not receive epidural analgesia (control group).

Inclusion criteria

·         Women with a singleton pregnancy.

·         Age between 18-35 years.

·         Term gestation (≥ 37 weeks).

·         Cephalic presentation.

·         Spontaneous onset of labor or labor induced by standard obstetric protocols.

·         Willingness to provide informed consent.

Exclusion criteria

·         Multiparous women.

·         Multiple gestations.

·         Malpresentations (e.g., breech, transverse lie).

·         Preterm (<37 weeks) or post-term (42 weeks) pregnancies.

·         Contraindications to epidural analgesia

·         Patients with significant medical disorders

Procedure

The study documented basic demographic information, including the mother's age, weight, height, and gestational age. Epidural analgesia was started and continued in Group I once patients entered active labor (cervical dilatation ≥ 4 cm). All the usual suspects in intrapartum monitoring were checked in both groups: the mother's vitals, the uterus contracting, the baby's heart rate, and the labor progress.

Statistical Analysis

We used Chi-square for categorical variables and Student's t-test for continuous ones when we examined the data. It was deemed statistically significant if the p-value was less than 0.05.

The study involved 70 women who were unable to conceive; 35 women were assigned to the group that had an epidural (Group I), and 35 women were assigned to the group that did not ($$). Baby outcomes, delivery method, demographics, and length of labor were among the variables studied.

Table 1: Maternal demographic characteristics

When comparing the two groups, we could not find any statistically significant differences (p>0.05) in the following areas: mother age, weight, and gestational age. The study population appears to be well-matched.

Table 2: Duration of labor

                          *p< 0.05 significant

Epidural analgesia was linked to a statistically significant lengthening of both the first stage and the total duration of labor. The second stage of labor was a little longer for the epidural group, but this was not statistically significant.

Table 3: Mode of delivery

Table 4: Neonatal outcomes

The neonatal results were similar in both groups, with Apgar scores that were the same at 1 and 5 minutes and low rates of NICU admission. This shows that epidural analgesia did not have a negative effect on the health of the newborn.

Modern obstetric care is built on good pain management during labor, and epidural analgesia is usually seen as the best way to relieve labor discomfort. Nonetheless, apprehensions have remained over its possible impact on labor duration and delivery method, especially in women who frequently undergo prolonged labors [11, 12]. In this study, epidural analgesia was linked to a statistically significant extension of the first stage and the overall duration of labor, whereas the second stage exhibited only a marginal increase that lacked statistical significance. These results are consistent with prior studies suggesting that epidural analgesia may slightly prolong the first stage due to reduced maternal bearing-down efforts or subtle motor blockade, but generally does not substantially extend the second stage when low-dose local anesthetics and opioids are administered [13-15]. Our investigation revealed no significant difference in cesarean section rates or spontaneous vaginal deliveries between the epidural and non-epidural groups concerning the mode of delivery. Instrumental deliveries occurred with somewhat greater frequency in the epidural group, aligning with prior research that indicate a higher, albeit not statistically significant, incidence of assisted vaginal deliveries associated with epidural use. In general, epidural analgesia did not raise the chance of cesarean delivery, which shows that it is safe for women who had never given birth before . The outcomes for newborns were reassuring, with comparable 1- and 5-minute Apgar scores and low rates of NICU hospitalization in both groups. This shows that, when given correctly, epidural analgesia does not affect the health of newborns . The results align with previous research indicating that low-dose epidural procedures decrease fetal exposure to anesthetic drugs and mitigate negative neonatal outcomes.

Epidural analgesia effectively alleviates pain during labor in women, resulting in a slight extension of the first stage of labor. It does not have a substantial impact on the second stage, cesarean delivery rates, or spontaneous vaginal deliveries. Instrumental births may occur with slightly greater frequency, albeit this difference is not statistically significant. Neonatal outcomes, such as Apgar scores and NICU admissions, continue to be unchanged. Epidural analgesia is a safe and dependable technique for labor analgesia that does not jeopardize maternal or newborn safety.

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