Severe maternal complications (SMM: severe maternal morbidity), which here include heart attack, heart failure, sepsis and hysterectomy. Researchers point out that epidurals are recommended for women with known risk factors for these complications, including obesity, certain underlying conditions or multiple births. In these women, it is a “medical indication” for epidural analgesia that is required.
Finally, while previous research has suggested this benefit of epidurals, the evidence remains limited.
The epidural however reduces the risk of maternal complications by 35%
The study therefore specifies these positive effects of the labor epidural on the risk of complications in the mother, and evaluates whether this advantage is greater in women with a medical indication, in particular vs. in women at risk of premature delivery. The researchers analyzed data from 567,216 mothers aged on average 29 years, who gave birth vaginally or by unplanned cesarean section between 2007 and 2019, referenced in the Scottish National Health Service database. Medical records were used to identify one of 21 conditions defined as “SMM” by the US Centers for Disease Control and Prevention (CDC) or admission to intensive care between the date of delivery and 42 days after delivery. childbirth. The team also took into account possible confounding factors, including mother’s age, ethnicity, weight, smoking history and pre-existing conditions, as well as place of birth and gestational age. at birth.
- of the 567,216 women, 22% had an epidural during labor;
- one complication (SMM) occurred in 4.3/1,000 births;
- the epidural was found to be associated with a 35% reduction in the risk of SMM in all participants;
- an even higher reduction is observed in participants with a medical indication for epidural (50% risk reduction) vs. those without (33% risk reduction) and vs. participants giving birth before term (risk reduction 47%);
- among the 77,439 women in the study who were at higher risk of serious maternal morbidity, only 25% received an epidural.
Researchers argue for more careful monitoring of mother and baby during laborfor measures allowing the reduction of physiological stress linked to work and for the adoption of “obstetric interventions” if necessary.
The relatively low use of epiduralsparticularly in patients with clinical indications, indeed reflects the fact that women do not fully understand the potential benefits of this form of analgesia, because it is the woman’s choice that determines whether she will benefit or not an epidural.
This large, observational, but well-designed study therefore reflects room for improvement in obstetric and anesthetic practices and “supports the practice of recommending epidural analgesia during labor to women with known risk factors.” She also highlights the importance of ensuring equitable access to epidurals.
The researchers are continuing their work, with the objective of understanding the mechanisms at the origin of this protective effect, of reducing as much as possible the incidence of these complications regardless of the socio-economic and ethnic origin of the mothers.
