Kariman Ghazal, Shahrazad Moallem, Marita Yaghi and Jihad el Hassan

Introduction: Childbirth can be extremely painful. Labor pain is multifactorial and very complex, as it is a combination of visceral pain and somatic pain, in addition to psychological factors. Thus, the provision of effective pain relief during labor is an important element for a positive maternal experience. Epidural anesthesia is the most frequently used method of pain control In normal vaginal delivery (NVD), labor epidurals provide effective analgesia for laboring parturient.

Objective: of the present study was to review the maternal and fetal risks associated with epidural analgesia for pain relief during labor, and to investigate whether the use of epidural analgesia during labor was a risk factor for AVD and CS delivery.

Methods: We performed a 1-year (2020) prospective cohort analysis of the patients presenting at four obstetricled maternity units part of major academic medical centers in Beirut, Lebanon from January 2020 until December 2020. All eligible patients were approached for the consenting process, and those who agreed to participate in the study were included in the analysis. Patients were stratified in two groups based on the type of pain control they opted for/received at the time of admission: epidural delivered anesthesia or intravenous infusion of pain medications.

Results: A 100 eligible women consented to take part in the study, between January 1st, 2020 and December 31st, 2020. Maternal and fetal survival at the 30-days mark was 100.0% for both groups. Duration of labor was significantly 0.1h shorter in the epidural group with a mean of 6.7 ± 1.8 h as opposed to 6.8 ± 2.6 h in the nonepidural group. Use of forceps and/or vacuum was significantly higher in the epidural group 9 (17.3%) and 2 (3.8%) as opposed to 1 (2.1%) and 0 (0.0%) in the epidural group. A higher rate of severe perineal tears (grade 3 or more) was observed in women who received epidural anesthesia.

Conclusion: Epidural anesthesia is a safe option for pain control during vaginal delivery, both for the mother and the infant no effect on the duration of labor, and thus does not increase the risk of maternal or fetal infection or conversion to CS is also safe for neonates and is not associated with increased short term neonatal morbidity such as admission to the NICU. Epidural anesthesia however remains a risk factor for AVD and thus the use of instruments Its role as for severe perineal lacerations remains unclear according to our data, as we did not account for confounding factors. This last point remains to be investigated in large population-based studies.

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