Delivery mode and neonatal morbidity after remifentanil-PCA or epidural analgesia using the Ten Groups Classification System: A 5-year single-centre analysis of more than 10 000 deliveries.

ABSTRACT

OBJECTIVE: This study aimed to explore the potential association between remifentanil patient-controlled analgesia (RPCA) or epidural analgesia (EA), and caesarean section (CS) rate, operative vaginal delivery rate (OVD), operative delivery (OD) rate (CS or OVD) with pathological cardiotocography (CTG) tracing, Apgar score < 7 at 5 min after birth, incidence of perinatal asphyxia and neonatal intensive care unit (NICU) admission within four groups of the Ten Groups Classification System (TGCS) labour types; group 1 nulliparous, singleton cephalic, ≥37 weeks, spontaneous onset of labour; group 2a nulliparous, singleton cephalic, ≥37 weeks, induction of labour; group 3 multiparous, singleton cephalic, ≥37 weeks, spontaneous onset of labour; group 4a multipara, singleton cephalic, ≥37 weeks, induction of labour). We hypothesized that labour and delivery outcomes between RPCA and EA would differ within the different TGCS labour types. STUDY DESIGN: 10,561 deliveries (4876 with RPCA, 5685 with EA) at the University Clinical Centre Ljubljana, Slovenia, from 2015 through 2019 were analysed using the Slovenian National Perinatal Information System data. RESULTS: Compared to EA, RPCA was associated with lower CS and OVD rates in nulliparous women with spontaneous onset of labour (group 1) (CS 9.9 % vs14.3 %; P < 0.001) (OVD 5.1 % vs 8.4 %; P < 0.001), in nulliparous women with induced labour (group 2a) (CS 14.8 % vs 24.2 %; P < 0.001) (OVD 6.5 % vs 8.9 %; P = 0.036) and in multiparous women with spontaneous onset of labour (group 3) (CS 1.1 % vs 2.4 %; P = 0.021) (OVD 0.1 % vs 0.8 %; P = 0.007), respectively. RPCA was associated with a lower incidence of OD with pathologic CTG in all four studied groups (groups 1, 2a, 3, 4a). No differences in APGAR < 7 at 5 min, neonatal asphyxia, and NICU admission were recorded between the two analgesic techniques within any of the TGCS groups. CONCLUSION: Compared to EA, RPCA was not associated with worse delivery and neonatal outcomes within any of the four studied TGCS groups. RPCA could be used for labour analgesia routinely if strict adherence to protocols is ensured and regular staff training is provided.