A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

Aim To explore the impact of epidural analgesia on maternal and neonatal outcomes, especially the relation between epidural analgesia and intrapartum fever. Methods A retrospective cohort study was conducted in a tertiary hospital for all deliveries from November 2017 to December 2017. A total of 506 women were divided into epidural and non-epidural group by whether to receive analgesia or not. Univariate and multivariate analyses were performed with P < 0.05 as significant. Results Epidural analgesia was associated with higher risk of maternal intrapartum fever (relative risk [RR] = 3.28, 95% confidence interval, 1.55-6.95), more intravenous use of antibiotics (36.66% vs 17.04%, P<0.001), longer time of second stage (58.55 +/- 33.75 vs 47.39 +/- 28.36 min?P = 0.001) and longer total duration of labor (790.32 +/- 433.71 vs 461.33 +/- 270.39 min?P<0.001), but had no influence on mode of delivery, the amount of post-partum hemorrhage or hospital stay after delivery and all the neonatal outcomes we studied. Further time effect analysis found that epidural analgesia less than 6 h did not increase the risk of intrapartum fever (RR = 1.73, P = 0.15), however, when epidural analgesia lasted over 6 h, it significantly increased the risk of fever (RR = 5.23, P<0.001) but did not increase more adverse outcomes. Conclusion Having epidural anesthesia 6 h or more increases the risk of developing fever, but the prognosis of mothers and children is less affected.