Epidural Anesthesia during Routine Childbirth: A 10 Years Retrospective Analysis from the National Birth Registry Austria

Goal of the study:

The objective of this study was to retrospectively analyze a large data set from the National Birth Registry to assess quality of care and potential adverse effects of epidural analgesia (EA) for normal labor delivery at term in Austria.

Methods:

Data were gathered from the National Birth Registry of Austria between 2008 and 2017. Of 530.014 screened women, 282.929 were excluded. Only primiparas with spontaneous vaginal delivery at term were included. Multiple pregnancies were excluded. Neonatal outcome was assessed by arterial pH and base excess (BE) in cord blood depending on receiving EA or not. Secondary, differences in APGAR scores, admission to NICU, and perinatal mortality were tested. A propensity score was calculated for receiving EA and used as covariate together with the group (EA/noEA) in linear regression models of pH and BE to determine the effect of EA. Bonferroni correction was applied with a p of 0.05/2 = 0.025. Logistic regression models for admission to NICU and perinatal mortality were calculated with EA/noEA and propensity score as covariates. Differences in APGAR scores were analyzed by linear regression. Further, childbirth injury, necessity of instrumental vaginal delivery, and duration of labor was analyzed.

Results and discussion:

Preliminary results showed that 21% (51.989) of women (247.085) received EA. There was no difference in pH in the two groups. Data show that EA in spontaneous vaginal birth was associated with a lower BE without being clinically relevant. The admission rate of neonates to a NICU or pediatric department was higher in the EA group. There was no difference in perinatal mortality. Final statistics will be available in the end of August.

Conclusion:

EA remains the gold-standard of pain therapy during delivery. Our data may raise a discussion on the indication, benefit and potential harm of EA administered for pain therapy during labor and delivery. We hope that such a discussion on EA will raise visibility and thereby improve the quality of care in obstetric anesthesia in Austria.

Acknowledgement:

We thank H. Leitner from the Institute of Clinical Epidemiology tirol kliniken for providing the data of the National Birth Registry.