Analgesia neuroaxial durante o trabalho de parto: seus efeitos sobre os desfechos maternos e neonatais

Abstract

The objective was to compare obstetric and neonatal outcomes among women who used and who did not use neuraxial analgesia during labor. This is a cross-sectional, comparative and retrospective study, carried out in July 2019 to February 2020, at Maternidade Escola Assis Chateaubriand. The inclusion criteria were: women who went into labor, with a live, single and full-term fetus between 37 and 41 weeks and 6 days, in cephalic presentation. The group with neuraxial analgesia met the following criteria: patient's request, active labor, good vitality assured by the obstetrician and absence of contraindications. Both groups were excluded: elective cesarean sections, fetal malformation and medical records with incomplete information. The sample size was calculated by estimating the difference of two proportions, group 1 referring to vaginal deliveries with analgesia (73%) and group 2 to vaginal deliveries without analgesia (83%), with 130 women for each group. Data collection took place through a structured instrument developed by the researcher and consisting of socioeconomic, obstetric and neonatal data. In the statistical analysis, Student's t test, Mann-Whitney U test, Pearson's chi-square test and Fisher's exact test were used. Statistical analyzes were performed using the IBM SPSS program. Most parturients in both groups were primiparous (103; 79.23% vs 94; 72.3%; p = 0.19). The group with analgesia had a high rate of oxytocin use (57; 43.8%; p <0.001), the most used technique was the epidural (76.9%), followed by the combined spinal-epidural (11.5%) and spinal anesthesia (10.8%). The duration of active labor in the group with analgesia was 392.12 minutes and in the group without analgesia, 260.68 minutes (p <0.001). In the group with analgesia, there was a higher rate of vaginal delivery (88; 67.7%), followed by cesarean delivery (41; 31.5%) and 1 forceps delivery (0.8%). There was a higher frequency of cesarean sections in women who gave birth under analgesia (41; 31.5% vs 5; 3.8%; p <0.001). Episiotomy was more prevalent in the group with analgesia (p = 0.03), with a rate of 7.9%. There was no statistical difference between the groups regarding APGAR in the 1st and 5th minutes. The parturients under analgesia gave birth to heavier babies (p = 0.007). Most of the NBs of women from both groups were referred to the rooming-in. It was concluded that in the group with analgesia there were more interventions during labor, with a higher rate of cesarean delivery, use of oxytocin, episiotomy and longer duration of active labor and expulsion period compared to the group without neuraxial analgesia.