Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Anesthesia
Published in: Journal of Anesthesia 1/2023

17-10-2022 | Sectio Ceasarea | Original Article

Obstetrical outcomes of labor with and without analgesia in Robson classification groups 1 and 2a: a single-center retrospective study

Authors: Taro Yagi, Yasuto Kinose, Michiko Bun, Megumi Horai, Chie Matsuda, Tatsuya Miyake, Kazuya Mimura, Chiyo Otaki, Masayuki Endo, Tadashi Kimura

Published in: Journal of Anesthesia | Issue 1/2023

Login to get access

Abstract

Purpose

This study aimed to elucidate the effects of neuraxial analgesia on labor in women classified based on the Robson classification system.

Methods

We retrospectively reviewed the clinical data of singleton cephalic nulliparous deliveries in labor at term between January 2018 and December 2021 and compared obstetrical outcomes between deliveries with and without neuraxial analgesia in women of Robson group 1 (spontaneous labor) and group 2a (induced labor). Statistical analyses were performed using the Wilcoxon ranked-sum test, Fisher’s exact test, and logistic regression model. Statistical significance was set at p < 0.05.

Results

We identified 2726 deliveries during the period, of which 387 deliveries (215 with analgesia and 172 without analgesia) were in Robson group 1 and 502 deliveries (258 with analgesia and 244 without analgesia) in Robson 2a. In Robson group 1 pregnancies, the cesarean section (CS) rate was higher in those who received analgesia (15%) than in those who did not (3%) (p = 0.0001). Multivariate analysis revealed that labor with analgesia was a significant risk factor for CS (p < 0.0001). Similarly, in Robson group 2a pregnancies, we observed a higher CS rate in those with analgesia than in those without analgesia (18 vs. 11%, p = 0.042).

Conclusion

A higher CS rate was observed in deliveries with analgesia than in those without analgesia both in the Robson group 1 and group 2a pregnancies.
Appendix
Available only for authorised users
Literature
1.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 209: obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133:e208–25.CrossRef
2.
Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5:CD00031.
3.
Kurakazu M, Umehara N, Nagata C, Yamashita Y, Sato M, Sago H. Delivery mode and maternal and neonatal outcomes of combined spinal–epidural analgesia compared with no analgesia in spontaneous labor: a single-center observational study in Japan. J Obstet Gynaecol Res. 2020;46:425–33.CrossRef
4.
Naito Y, Ida M, Yamamoto R, Tachibana K, Kinouchi K. The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute. JA Clin Rep. 2019;5:40.CrossRef
5.
6.
7.
Brennan DJ, Robson MS, Murphy M, O’Herlihy C. Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009;201:308.e1-308.e8.CrossRef
8.
Betrán AP, Vindevoghel N, Souza JP, Gülmezoglu AM, Torloni MR. A systematic review of the Robson classification for caesarean section: what works, doesn’t work and how to improve it. PLoS ONE. 2014;9: e97769.CrossRef
9.
Butwick AJ, Bentley J, Wong CA, Snowden JM, Sun E, Guo N. United States state-level variation in the use of neuraxial analgesia during labor for pregnant women. JAMA Netw Open. 2018;1: e186567.CrossRef
10.
Blondel B, Coulm B, Bonnet C, Goffinet F, Le Ray C, National Coordination Group of the National Perinatal Surveys. Trends in perinatal health in metropolitan France from 1995 to 2016: results from the French national perinatal surveys. J Gynecol Obstet Hum Reprod. 2017;46:701–13.CrossRef
11.
Public Health Agency of Canada. Care during labour and birth. In: Family centred maturnity and newborn care: national guidelines. Ottawa (ON): PHAC; 2018.
12.
Lavand’homme P, Roelants F. Patient-controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short-acting opioid remifentanil. Survey in the French part of Belgium (Wallonia and Brussels). Acta Anaesthesiol Belg. 2009;60:75–82.
13.
Japan Association of Obstetricians and Gynecologists. Surveillance on delivery (in Japanese). Tokyo: Japan Association of Obstetricians and Gynecologists; 2017.
14.
Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol. 2011;117:805–11.CrossRef
15.
Japan Society of Obstetrics and Gynecology (JSOG), Japan Association of Obstetricians and Gynecologists (JAOG). Guidelines for obstetrical practice in Japan. 2017 ed. Tokyo: Kyorin-Sha; 2017.
16.
Japan Society of Obstetrics and Gynecology (JSOG), Japan Association of Obstetricians and Gynecologists (JAOG). Guidelines for obstetrical practice in Japan. 2020 ed. Tokyo: Kyorin-Sha; 2020.
17.
Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798–804.CrossRef
18.
Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand Suppl. 1965;16:55–69.CrossRef
19.
American College of Obstetricians and Gynecologists (College), Society for Maternal-Fetal Medicine, Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210:179–93.CrossRef
20.
Hasegawa J, Farina A, Turchi G, Hasegawa Y, Zanello M, Baroncini S. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome. J Anesth. 2013;27:43–7.CrossRef
21.
Nguyen U-SDT, Rothman KJ, Demissie S, Jackson DJ, Lang JM, Ecker JL. Epidural analgesia and risks of Cesarean and operative vaginal deliveries in nulliparous and multiparous women. Matern Child Health J. 2010;14:705–12.CrossRef
22.
Eriksen LM, Nohr EA, Kjaergaard H. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas. Birth. 2011;38:317–26.CrossRef
23.
Hung TH, Hsieh TT, Liu HP. Differential effects of epidural analgesia on modes of delivery and perinatal outcomes between nulliparous and multiparous women: a retrospective cohort study. PLoS ONE. 2015;10:1–11.CrossRef
24.
Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS ONE. 2016;11: e0148343.CrossRef
25.
Ishikawa K, Ikeda T, Miyazaki R. Cesarean delivery and perinatal mortality rates in Japan, 2007–2011. J Matern Fetal Neonatal Med. 2014;27:994–9.CrossRef
26.
Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing Cesarean delivery rate. Obstet Gynecol. 2011;118:29–38.CrossRef
27.
Song BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ESY, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. 2014;17:CD0007238.
28.
Fischer C, Blanié P, Jaouën E, Vayssière C, Kaloul I, Coltat JC. Ropivacaine, 0.1%, plus sufentanil, 0.5 microg/ml, versus bupivacaine, 0.1%, plus sufentanil, 0.5 microg/ml, using patient-controlled epidural analgesia for labor: a double-blind comparison. Anesthesiology. 2000;92:1588–93.CrossRef
29.
Lee BB, Ngan Kee WD, Ng FF, Lau TK, Wong ELY. Epidural infusions of ropivacaine and bupivacaine for labor analgesia: a randomized, double-blind study of obstetric outcome. Anesth Analg. 2004;98:1145–52.CrossRef
30.
Capogna G, Camorcia M, Stirparo S, Farcomeni A. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesth Analg. 2011;113:826–31.CrossRef
31.
Song Y, Du W, Zhou S, Zhou Y, Yu Y, Xu Z, Liu Z. Effect of dural puncture epidural technique combined with programmed intermittent epidural bolus on labor analgesia onset and maintenance: a randomized controlled trial. Anesth Analg. 2021;132:971–8.CrossRef
32.
Caughey AB, Sharshiner R, Cheng YW. Fetal malposition: impact and management. Clin Obstet Gynecol. 2015;58:241–5.CrossRef
33.
Lieberman E, Davidson K, Lee-Parritz A, Shearer E. Changes in fetal position during labor and their association with epidural analgesia. Obstet Gynecol. 2005;105:974–82.CrossRef
34.
Chestnut DH, Wong CA, Tsen LC, Kee WDN, Beilin Y, Mhyre JM, Bateman BT, Nathan N. Epidural and spinal analgesia: anaesthesia for labour and vaginal delivery. In: Wong CA, editor. Chestnut’s obstet anesth. 6th ed. Philadelphia: Mosby/Elsevier; 2019. p. 475–524.
35.
Rahm VANR, Hallgren AH, Högberg HH, Hurtig IH, Odlind VO. Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study. Acta Obstet Gynecol Scand. 2002;81:1033–9.CrossRef
36.
Behrens O, Goeschen K, Luck HJ, Fuchs AR. Effects of lumbar epidural analgesia on prostaglandin F2α release and oxytocin secretion during labor. Prostaglandins. 1993;45:285–96.CrossRef
37.
Kotaska AJ, Klein MC, Liston RM. Epidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials. Am J Obstet Gynecol. 2006;194:809–14.CrossRef
38.
American College of Obstetricians and Gynecologists. ACOG practice bulletin no 107: induction of labor. Obstet Gynecol. 2009;114:386–97.CrossRef
39.
National Institute for Health and Care Excellence (NICE). Surveillance report Induction of labour; 2017. London: National Institute for Health and Care Excellence. UK; 2008 NICE Guideline cg70. p. 2017.
40.
Leduc D, Biringer A, Lee L, Dy J, Clinical practice obstetrics committee, special contributors. Induction of labour. J Obstet Gynaecol Can. 2013;35:840–57.CrossRef
41.
Zhao B, Qian X, Wang Q, Ou X, Lin B, Song X. The effects of ropivacaine 0.0625% and levobupivacaine 0.0625% on uterine and abdominal muscle electromyographic activity during the second stage of labor. Minerva Anestesiol. 2019;85:854–61.CrossRef
42.
Reitman E, Conell-Price J, Evansmith J, Olson L, Drosinos S, Jasper N, Randolph P, Smiley RM, Shafer S, Flood P. β2-adrenergic receptor genotype and other variables that contribute to labor pain and progress. Anesthesiology. 2011;114:927–39.CrossRef
43.
Terkawi AS, Jackson WM, Thiet MP, Hansoti S, Tabassum R, Flood P. Oxytocin and catechol-O-methyltransferase receptor genotype predict the length of the first stage of labor. Am J Obstet Gynecol. 2012;207:184.e1-184.e8.CrossRef
44.
Greenberg MB, Cheng YW, Hopkins LM, Stotland NE, Bryant AS, Caughey AB. Are there ethnic differences in the length of labor? Am J Obstet Gynecol. 2006;195:743–8.CrossRef
45.
Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett G, Hill K, Thom EA, El-Sayed YY, Perez-Delboy A, Rouse DJ, Saade GR, Boggess KA, Chauhan SP, Iams JD, Chien EK, Casey BM, Gibbs RS, Srinivas SK, Swamy GK, Simhan HN, Macones GA, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379:513–23.CrossRef
46.
Wuitchik M, Bakal D, Lipshitz J. The clinical significance of pain and cognitive activity in latent labor. Obstet Gynecol. 1989;73:35–42.
Metadata
Title
Obstetrical outcomes of labor with and without analgesia in Robson classification groups 1 and 2a: a single-center retrospective study
Authors
Taro Yagi
Yasuto Kinose
Michiko Bun
Megumi Horai
Chie Matsuda
Tatsuya Miyake
Kazuya Mimura
Chiyo Otaki
Masayuki Endo
Tadashi Kimura
Publication date
17-10-2022
Publisher
Springer Nature Singapore
Published in
Journal of Anesthesia / Issue 1/2023
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-022-03125-9

Other articles of this Issue 1/2023

Journal of Anesthesia 1/2023 Go to the issue

Letter to the Editor

Re-sedation after a large dose of flumazenil

Original Article

Change in cerebral circulation during the induction of anesthesia with remimazolam

Letter to the Editor

Tolerance to remimazolam at a high effect-site concentration

Review Article

Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone

Clinical Report

The intraoperative motor-evoked potential when propofol was changed to remimazolam during general anesthesia: a case series

Original Article

Deep breathing alleviates propofol-induced pain: a prospective, randomized, single-blind study