Labor and delivery outcomes with remifentanil patient-controlled analgesia versus labor epidural analgesia among women with and without obesity: a retrospective population-based cohort study (2015–2024)
Authors' conclusion
In this large population-based cohort study, remifentanil PCA was associated with lower risks of intrapartum cesarean delivery and operative vaginal delivery than labor epidural irrespective of maternal body mass index, without evidence of increased neonatal morbidity.
Study context
- Population
- Women with singleton, term, cephalic pregnancies in spontaneous or induced labor, Slovenia, 2015–2024; analysed separately by BMI < 30 and ≥ 30 kg/m²46,448 BMI < 30
- Participants
- 52,118 women
- Exposure
- Remifentanil patient-controlled analgesia (PCA) vs labor epidural analgesia
- Outcome
- Intrapartum cesarean delivery and operative vaginal delivery
Methodological detailspopulation-based, multivariable logistic regression, stratified by BMI
- Population-based
- Multivariable logistic regression
- Stratified by BMI
Main finding
As reported in the abstract
- Remifentanil PCA associated with lower risks of intrapartum cesarean and operative vaginal delivery vs labor epidural analgesia in both BMI strata
- all P ≤ 0.001
Observational data: associations, not effects.
Further findings
Apgar score < 7 at 1 min (BMI < 30 subgroup)
- Lower odds with remifentanil PCA
Apgar score < 7 at 5 min, NICU admission, perinatal asphyxia (BMI < 30 subgroup)
- No differences observed
Neonatal outcomes
- Otherwise comparable between groups
Safety
Postpartum hemorrhage
- Higher risks with remifentanil PCA across both BMI groups
Blood transfusion and third- or fourth-degree perineal tears (BMI < 30 subgroup)
- Higher risks with remifentanil PCA
Original publication
Labor and delivery outcomes with remifentanil patient-controlled analgesia versus labor epidural analgesia among women with and without obesity: a retrospective population-based cohort study (2015–2024). Int J Obstet Anesth. Published 30 August 2026. doi:10.
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