Labor Analgesia
Influences of epidural labor analgesia on maternal postpartum cognitive function after vaginal delivery: a prospective cohort study
Jianwei Wang, Rui Ma, Zhou Feng, Xiaoyu Zhang, Zifeng Xu, Weiwei Cheng
Published 2019-02-16
Cite as Chin J Perinat Med, 2019, 22(2): 118-122. DOI: 10.3760/cma.j.issn.1007-9408.2019.02.009
Abstract
ObjectiveTo investigate the incidence of cognitive dysfunction in postpartum women who underwent epidural or non-drug labor analgesia and the influence factors.
MethodsA prospective cohort study was performed in 1 618 uneventful singleton pregnancies in International Peace Maternity and Child Health Hospital from January 2017 to January 2018. Women who received epidural labor analgesia were assigned to the epidural group (n=803), and those who received Doula technique non-drug labor analgesia rather than labor analgesia to the control group (n=815). Cognitive function was assessed using symbol digit modalities test (SDMT90) and Montreal cognitive assessment (MoCA) 1 d and 42 d after delivery. Incidence of maternal cognitive dysfunction, SDMT90 scores and pain intensity measured by visual analogue score (VAS) at the cervical dilatation of 3, 6 and 10 cm between the two groups were compared using independent sample t-test, Chi-square test or logistic regression analysis.
ResultsMoCA and SDMT90 scores of the epidural group were significantly higher than those of the control group 1 d after delivery (27.1±1.5 vs 26.2±1.8, 49.1±2.4 vs 42.5±3.6; t=3.775 and 16.956, both P<0.05), but the incidence of postoperative cognitive dysfunction (POCD) in the epidural group was remarkably lower comparing to the control group [13.9% (112/803) vs 21.2% (173/815), χ2=14.769, P=0.002]. The VAS scores of the epidural group at the cervical dilatation of 3, 6 and 10 cm were all lower than those of the control group (2.3±0.6 vs 6.9±1.3, 3.3±0.9 vs 8.7±0.9, 5.7±0.9 vs 9.7±0.4; t=0.013, 0.011 and 0.015; all P<0.001). Logistic regression analysis indicated that VAS scores ≤ 3 at the cervical dilatation of 3, 6 and 10 cm were protective factors against the incidence of POCD 1 d after delivery [OR(95%CI): 0.238 (0.198-0.287), 0.180 (0.145-0.222) and 0.112 (0.088-0.142), all P<0.001], while the absence of epidural labor analgesia was a risk factor (OR=4.698, 95%CI:1.812-11.321, P<0.001).
ConclusionsEpidural labor analgesia can reduce the incidence of postpartum cognitive dysfunction in women 1 d after delivery. The incidence of POCD has close relationship with the VAS scores at the cervical dilatation of 3, 6 and 10 cm and epidural labor analgesia.
Key words:
Labor, obstetric; Analgesia, epidural; Cognitive Dysfunction; Neuropsychological tests; Prospective studies
Contributor Information
Jianwei Wang
Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
Rui Ma
Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
Zhou Feng
Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
Xiaoyu Zhang
Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
Zifeng Xu
Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
Weiwei Cheng
Department of Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
