Factors associated with severe pain during the active phase of pushing despite labor epidural analgesia: a secondary analysis on a prospective cohort study
Authors' conclusion
In this cohort, 9.5% of women experienced severe pain during the active phase of pushing despite labor epidural analgesia (PIEB and PCEA), which was associated with rapid cervical change and fetal macrosomia.
Study context
- Population
- Women who delivered vaginally with labor epidural analgesia (levobupivacaine 1.25 mg/mL with sufentanil 0.25 μg/mL; Programmed intermittent epidural bolus (PIEB) and patient-controlled epidural analgesia (PCEA)) at Toulouse University Hospital, February–April 2025
- Participants
- 210 women
- Comparison
- Factors associated with severe pain during the active phase of pushing
- Severe painn = 20
- Primary endpoint
- Severe pain during the active phase of pushing (NRS score ≥ 7)
Methodological detailspre-specified, multivariable logistic regression, single-centre
- Pre-specified
- Multivariable logistic regression
- Single-centre
Primary result
As reported in the abstract
Severe pain during the active phase of pushing and independent associated factors
Adjusted odds ratio (95% CI)P value
Rapid cervical change
4.58(1.59–13.18)
P = 0.005Fetal macrosomia > 4000 g
5.23(1.22–22.41)
P = 0.026- Women with severe pain during the active phase of pushing
- 20 (9.5%)
Further findings
Median
| Outcome | Severe pain | No severe pain | P value |
|---|---|---|---|
| Satisfaction with labor epidural analgesia | 4.0 | 5.0 | P < 0.001 |
| Satisfaction with overall pain management | 4.5 | 5.0 | P < 0.001 |
Original publication
Factors associated with severe pain during the active phase of pushing despite labor epidural analgesia: a secondary analysis on a prospective cohort study. Int J Obstet Anesth. Published 23 December 2025. doi:10.
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