Epidural analgesia during labour and severe maternal morbidity: population based study
Main finding · SMMResult — go to the resultAdjusted relative risk 0.65 95% CI 0.50–0.85Authors' conclusion
Epidural analgesia during labour was associated with a 35% reduction in SMM, and showed a more pronounced effect in women with medical indications for epidural analgesia and with preterm births.
Study context
- Population
- Women in labour at 24+0 to 42+6 weeks' gestation, delivering vaginally or by unplanned caesarean section, all NHS hospitals in Scotland, 2007–2019
- Participants
- 567,216 women
- Exposure
- Epidural analgesia during labour vs no epidural
- Epiduraln = 125,024
- Outcome
- Severe maternal morbidity (SMM): ≥1 of 21 US CDC conditions or critical care admission
- Follow-up
- Delivery to 42 days post partum
Methodological detailsnational (all NHS hospitals in Scotland)
- National (all NHS hospitals in Scotland)
Main finding
SMM
Adjusted relative risk
0.65
95% CI 0.50–0.85
Epidural vs No epidural
adjusted relative risk 0.65 (95% CI 0.50–0.85)
As reported in the abstract
- Severe maternal morbidity (SMM), whole cohort
- events; rate per 1000 births 2412; 4.3 per 1000 births (95% CI 4.1 to 4.4)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Adjusted relative risk (95% CI) | |
|---|---|---|
| SMM plus critical care admission | 0.46 (0.29–0.73) | |
| Respiratory morbidityUnderpowered, wide CIs | 0.42 (0.16–1.15) | |
| SMM by medical indication for epidural (subgroup)Epidural vs No epidural · medical indication | 0.50 (0.34–0.72) | |
| SMM by medical indication for epidural (subgroup)Epidural vs No epidural · no medical indication | 0.67 (0.43–1.03) | |
| SMM by gestation at delivery (subgroup)Epidural vs No epidural · preterm | 0.53 (0.37–0.76) | |
| SMM by gestation at delivery (subgroup)Epidural vs No epidural · term or post term | 1.09 (0.98–1.21) | |
| 0.10.31310Adjusted relative risk (log scale) |
- SMM by medical indication for epidural (subgroup): P<0.001 for difference
- SMM by gestation at delivery (subgroup): P<0.001 for difference
SMM by gestation at delivery (subgroup)
- Reduced SMM risk with epidural increasingly noticeable as gestational age at birth decreased (whole cohort and women with medical indication)
Original publication
Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ. Published 22 May 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →