IMPACT OF EPIDURAL ANALGESIA ON LABOR OUTCOMES: A PROSPECTIVE COHORT STUDY
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Keywords
Epidural analgesia, Labor outcomes, Cesarean section, Second stage of labor, Neonatal outcomes, Maternal health
Abstract
Background: Labor is often associated with significant pain, which can contribute to maternal exhaustion, stress, and negative childbirth experiences. Effective pain relief is therefore a critical component of obstetric care. Epidural analgesia is widely regarded as the gold standard for labor analgesia due to its superior efficacy compared to systemic opioids or non-pharmacological methods. However, its influence on labor progression, mode of delivery, and neonatal outcomes remains controversial, with prior studies reporting mixed results. While some research suggests an association with prolonged labor and increased operative delivery rates, others have found no adverse impact.
Objective: To assess the impact of epidural analgesia on labor outcomes, specifically the duration of labor stages, mode of delivery, and maternal and neonatal outcomes in a cohort of nulliparous women.
Methods: A prospective cohort study was conducted at a tertiary care Lahore General Hospital Lahore between January to December 2024. A total of 400 nulliparous women with singleton term pregnancies were enrolled and divided into two groups: those who opted for epidural analgesia (n=200) and those who did not (n=200). Data were collected on labor duration, delivery mode, and immediate maternal and neonatal outcomes.
Results: A total of 400 nulliparous women meeting the inclusion criteria were enrolled in the study, with 200 women opting for epidural analgesia (epidural group) and 200 women managing labor without epidural analgesia (non-epidural group). Epidural analgesia was associated with a significantly longer second stage of labor (86.3 ± 22.5 minutes vs. 65.7 ± 18.9 minutes; p<0.001). Although the cesarean delivery rate was higher in the epidural group (19% vs. 13%), the difference was not statistically significant (p=0.09). Neonatal outcomes, including Apgar scores and NICU admission rates, were comparable between groups.
Conclusion: Epidural analgesia during labor prolongs the second stage of labor but does not significantly increase the risk of cesarean delivery or adverse neonatal outcomes. It remains a safe and effective option for labor analgesia when administered appropriately.
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Amna Javed
Assistant Professor, Department of Gynaecology & Obstetrics, Al-Aleem Medical College, Gulab Devi Teaching Hospital Lahore, Pakistan
Shazia Noor
Assistant Professor, Department of Gynaecology & Obstetrics, University College of Medicine & Dentistry, University of Lahore Teaching Hospital, The University of Lahore, Pakistan
Abdul Bary
Assistant Professor, Department of Anesthesia, Rahbar Medical & Dental College, Punjab Rangers Teaching Hospital Lahore, Pakistan
Faiza Aslam
Post Graduate Resident, Department of Anesthesia, Jinnah Post Graduate Medical Centre Karachi, Pakistan
Nusrat Lakho
Associate Professor, Department of Gynaecology & Obstetrics, Al-Tibri Medical College, Isra University, Karachi, Pakistan
Syma Arshad
Associate Professor, Department of Community Medicine & Public Health, Rashid Latif Medical College Lahore, Pakistan