• Fen Wang, Yun-Xia Cao, Shan-Gao Ke, Tao-Hua Zhu, and Miao Zhang.
• Obstetrics and Gynecology Department, The First Affiliated Hospital, Anhui Medical University, Hefei, China; Obstetrics and Gynecology Department, Tongling Maternity and Child Health Care Hospital, Tongling, China.
• Int J Gynaecol Obstet. 2016 Dec 1; 135 (3): 259-263.

ObjectiveTo determine whether combined spinal-epidural analgesia (CSEA) during labor increases the frequency of emergency cesarean delivery among Chinese nulliparous women.MethodsIn a retrospective study, the medical records of nulliparous women with a singleton fetus in cephalic presentation who delivered at term at Tongling Maternity Hospital, China, between January 2012 and December 2014 were reviewed. Information about CSEA, mode of delivery, labor duration, oxytocin augmentation, and neonatal outcome was obtained. Logistic regression was used to examine independent associations between CSEA and emergency cesarean after controlling for confounding variables.ResultsAmong 3456 women included, 1786 (51.7%) received CSEA and 1670 (48.3%) received no labor analgesia. Emergency cesarean was more frequent among CSEA users (219/1786 [12.3%]) than non-users (119/1670 [7.1%]; P<0.001). Among the maternal-fetal variables included in multivariate regression, maternal age, maternal height, cervical dilatation at admission, birth weight, and CSEA use were significantly associated with emergency cesarean. After adjustment, women with CSEA maintained a slightly increased risk for cesarean (adjusted odds ratio 1.54, 95% confidence interval 1.20-2.00).ConclusionAmong Chinese nulliparous women, use of CSEA for labor pain was associated with an increased risk of emergency cesarean delivery; moreover, this effect was maintained after adjustment for other potential obstetric risk factors.Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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