Incidence and associated factors of cesarean delivery following epidural analgesia for labor: A prospective cohort study at a Thai university hospital

Abstract

Background: Epidural analgesia with local anesthetics and opioids is highly effective for labor pain control. However, it may influence cesarean delivery rates. This study examined the incidence of cesarean delivery and its associated factors following epidural labor analgesia. Methods: We conducted a prospective cohort study at the largest university hospital in Thailand. We enrolled women older than 18 years who received epidural labor analgesia, excluding those who could not communicate in Thai. Data were collected from intrapartum epidural recipients. Logistic regression analysis identified factors associated with cesarean delivery, presented as adjusted odds ratios (AORs) with 95 % confidence intervals (CIs). Results: A total of 182 patients were included, and 54 (29.7 %; 95 % CI 23.5‒36.7) underwent cesarean delivery. Instrumental deliveries included 23 vacuum extractions (12.6 %) and 1 forceps extraction (0.5 %). Multivariate analysis identified three factors significantly associated with cesarean delivery. These included patient age > 27 years (AOR 2.708; 95 % CI 1.291‒5.679; P = 0.008) and no history of vaginal delivery (AOR 3.865; 95 % CI 1.668‒8.958; P = 0.002). Neonatal weight > 3270 g (AOR 4.870; 95 % CI 2.356‒10.036; P < 0.001) was also significant. Mean pain scores (numeric rating scale) decreased from 8.5 ± 1.7 to 2.2 ± 2.2 after epidural insertion (P < 0.001). Conclusion: Approximately one-third of patients who received epidural analgesia underwent cesarean delivery. Maternal age, lack of prior vaginal delivery, and higher neonatal birth weight were significantly associated with cesarean delivery. Patients should be counseled about these factors before receiving epidural analgesia.