Epidural analgesia in labor in University Hospital of Split over a ten-year period

Cilj istraživanja: Cilj ovog istraživanja utvrdit je učestalost uporabe epiduralne analgezije u porodu na Klinici za ženske bolesti i porode KBC-a Split u razdoblju od 1.1.2011. godine do 1.1.2021. godine. Osim toga, ciljevi su bili ispitati učestalost primjene epiduralne analgezije u porodu ovisno o paritetu rodilje te utvrditi učinak epiduralne analgezije na ishod poroda. Također smo ispitali povezanost između porođajne mase novorođenčadi i ishoda poroda uz epiduralnu analgeziju te indikacije za hitni carski rez nakon primjene epiduralne analgezije. Materijal i metode: Retrospektivno su pregledani rađaonski protokoli Klinike za ženske bolesti i porode u razdoblju od 1.1.2011. do 1.1.2021. godine te je od ukupno 43 745 poroda izdvojeno 1360 rodilja koje su primile epiduralnu analgeziju u porodu. Rezultati: Medijan dobi rodilja koje su primile epiduralnu analgeziju je 29 godina, minimalna dob je 15 godina, a maksimalna 43 godine. Medijan gestacijske dobi je 40 tjedana, minimalna vrijednost je 30 tjedana, a maksimalna 42 tjedna. Medijan porođajne mase novorođenčadi je 4560 grama, minimalna porođajna masa je 1900 grama, maksimalna 4970 grama. Medijan vrijednosti Apgar score-a u 1. minuti je 10, minimalna vrijednost je 4, a maksimalna 10. Učestalost epiduralne analgezije u porodu u desetogodišnjem razdoblju iznosila je 3,1%. U tom razdoblju učestalost je bila najmanja 2014. godine kada je iznosila 2,2%, a najveći 2020. godine kada je iznosila 4,5%. Za epiduralnu analgeziju odlučilo se više prvorotki (81,3%) nego višerotki (18,7%). 13% je mladih prvorotki, a 87% starih prvorotki. Od ukupno 1360 rodilja koje su primile epiduralnu analgeziju u porodu, 946 (70%) ih je rodilo vaginalnim putem, 109 (8%) uz pomoć vakuum ekstrakcije fetusa, a 305 (22%) carskim rezom. Najčešća indikacija za hitni carski rez bila je zastoj porođaja (inercija) koja se javila u 80% poroda. Distres fetusa bio je indikacija u 15% poroda, a inercija i distres u 5% poroda dovršenih carskim rezom. Pronađena je statistički značajna razlika između porođajne mase novorođenčadi i ishoda poroda (P=0,001). Broj poroda dovršen carskim rezom povećavao se s porastom porođajne mase. S druge strane, broj poroda dovršen vaginalnim putem veći je u skupinama novorođenčadi s manjom porođajnom masom. Zaključak: Stopa primjene epiduralne analgezije nije se puno mijenjala kroz deset godina. Prvorotke se češće odluče za epiduralnu analgeziju nego višerotke. Najveći broj poroda u kojima je primijenjena epiduralna analgezija dovršen je vaginalnim putem. Najčešća indikacija za dovršenje poroda hitnim carskim rezom je inercija. Postoji statistički značajna razlika između porođajne mase novorođenčadi i ishoda poroda.Objectives: The aim of this study was to determine the frequency of use of epidural analgesia in labor at the Department of Gynecology and Obstetrics of University Hospital of Split in the period from 1.1.2011. to 1.1.2021. In addition, the objectives were to examine the frequency of epidural analgesia during labor depending on the parity of the woman in labor and to determine the effect of epidural analgesia on the outcome of childbirth. We also examined association between the birth weight of newborns and the outcome of childbirth with epidural analgesia and the indications for emergency cesarean section after the application of epidural analgesia. Materials and methods: The birth protocols of the Department of Gynecology and Obstetrics in the period from 1.1.2011. to 1.1.2021. were retrospectively reviewed and out of a total of 43,745 births, 1,360 women who received epidural analgesia in labor were included. Results: The median age of women in labor who received epidural analgesia is 29 years, the minimum age is 15 years, and the maximum age is 43 years. The median gestational age is 40 weeks, the minimum value is 30 weeks, and the maximum is 42 weeks. The median birth weight of newborns is 4560 grams, the minimum birth weight is 1900 grams, the maximum is 4970 grams. The median value of the Apgar score in the 1st minute is 10, the minimum value is 4, and the maximum is 10. The incidence of epidural analgesia in labor over a ten-year period was 3.1%. in that period, the frequency was the lowest in 2014. when it was 2.2%, and the highest in 2020. when it was 4.5%. More primiparous women (81.3%) than multiparous women (18.7%) opted for epidural analgesia. 13% are young primiparous women, and 87% are old primiparous women. Out of total 1360 mothers who received epidural analgesia in labor, 946 (70%) gave birth vaginally, 109 (8%) with vacuum extraction of the fetus and 305 (22%) by caesarean section. The most common indication for emergency caesarean section was labor failure (inertia), which occurred in 80% of births. Fetal distress was an indication in 15% of deliveries, and inertia and distress in 5% of deliveries completed by caesarean section. A statistically significant difference was found between the birth weight and the outcome of mode of delivery (P=0.001). The number of births completed with caesarean section increases with the increase in birth weight. On the other hand, the number of births completed vaginally is higher in the group of newborns with lower birth weight. Conclusion: The rate of epidural analgesia has not changed much over the past ten years. Primiparas are more likely to opt for epidural analgesia than multiparas. Most births in which epidural analgesia was administered were completed vaginally. The most common indications for emergency caesarean section was inertia. There is statistically significant difference between the birth weight and the outcome of childbirth