• Phui Sze Au-Yong, Chin Wen Tan, Wee How Tan, Kah Heng Tan, Zhaohan Goh, Rehena Sultana, and Ban Leong Sng.
• From the Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital (PSA), Department of Women's Anaesthesia, KK Women's and Children's Hospital (CWT, BLS), Department of Anaesthesia, Tan Tock Seng Hospital (WHT), Department of Anaesthesia, Ng Teng Fong General Hospital (KHT), Duke-NUS Medical School (ZG), Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore (RS).
• Eur J Anaesthesiol. 2021 Oct 1; 38 (10): 105910661059-1066.

BackgroundEpidural analgesia is the most effective form of labour analgesia, but is associated with an increased risk of instrumental delivery.ObjectiveTo evaluate factors that are associated with an increased risk of instrumental delivery.DesignRetrospective cohort data study.SettingSingapore's major public maternity institution.PatientsAll obstetric patients who received labour epidural analgesia for vaginal delivery between January 2012 to December 2015.InterventionNone.Main Outcome MeasuresOur primary outcome was the incidence of instrumental delivery.ResultsOut of 17 227 pregnant women who received labour epidural analgesia, 12% (n = 2069) had instrumental delivery. Independent factors associated with an increased risk of instrumental delivery included maternal factors [nulliparity (adjusted odds ratio (aOR) 2.97, 95% CI 2.61 to 3.39, P < 0.0001] and advanced maternal age (aOR 1.04, 95% CI 1.03 to 1.05, P < 0.0001)). Greater maternal height (aOR 0.18, 95% CI 0.08 to 0.40), P < 0.0001) was associated with a reduced risk of instrumental delivery. Significant labour-related factors increasing the risk of an instrumental delivery were the use of prostin (aOR 1.19, 95% CI 1.07 to 1.32, P = 0.0014), pre-epidural analgesia (aOR 1.16, 95% CI 1.05 to 1.28, P = 0.0040), a longer second stage of labour (aOR 1.23, 95% CI 1.20 to 1.26, P < 0.0001), higher infant birth weight (aOR 1.27, 95% CI 1.12 to 1.43, P = 0.0002) and an epidural performed by a senior anaesthetist (aOR 1.94, 95% CI 1.72 to 2.18, P < 0.0001). Labour epidural-related factors for an increased risk of instrumental delivery were the occurrence of breakthrough pain (aOR 1.55, 95% CI 1.37 to 1.76, P < 0.0001), a more dense motor block (aOR 1.14, 95% CI 1.03 to 1.25, P = 0.0097) and having an epidural infusion stopped at full cervical dilatation (aOR 1.18, 95% CI 1.05 to 1.32, P = 0.0048) [receiver operating characteristic (ROC) = 0.75].ConclusionsThe multivariate model generated would help identify women at higher risk of instrumental delivery, which can help clinicians to address potentially modifiable factors and improve clinical care.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

12 keywords...

hide…