Objectives To determine the effect of labour epidural on severe maternal morbidity (SMM) and to explore whether this effect might be greater in women with a medical indication for epidural analgesia during labour, or with preterm labour. Design Population based study. Setting All NHS hospitals in Scotland. Participants 567 216 women in labour at 24+0 to 42+6 weeks’ gestation between 1 January 2007 and 31 December 2019, delivering vaginally or through unplanned caesarean section. Main outcome measures The primary outcome was SMM, defined as the presence of ≥1 of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or a critical care admission, with either occurring at any point from date of delivery to 42 days post partum (described as SMM). Secondary outcomes included a composite of ≥1 of the 21 CDC conditions and critical care admission (SMM plus critical care admission), and respiratory morbidity. Results Of the 567 216 women, 125 024 (22.0%) had epidural analgesia during labour. SMM occurred in 2412 women (4.3 per 1000 births, 95% confidence interval (CI) 4.1 to 4.4). Epidural analgesia was associated with a reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), SMM plus critical care admission (0.46, 0.29 to 0.73), and respiratory morbidity (0.42, 0.16 to 1.15), although the last of these was underpowered and had wide confidence intervals. Greater risk reductions in SMM were detected among women with a medical indication for epidural analgesia (0.50, 0.34 to 0.72) compared with those with no such indication (0.67, 0.43 to 1.03; P<0.001 for difference). More marked reductions in SMM were seen in women delivering preterm (0.53, 0.37 to 0.76) compared with those delivering at term or post term (1.09, 0.98 to 1.21; P<0.001 for difference). The observed reduced risk of SMM with epidural analgesia was increasingly noticeable as gestational age at birth decreased in the whole cohort, and in women with a medical indication for epidural analgesia. 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. Expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health. Depersonalised study data may be made available on request to accredited researchers who submit a proposal that is approved by NHS Scotland’s electronic Data Research and Innovation Service.

中文翻译：

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分娩期间的硬膜外镇痛和严重孕产妇发病率：基于人群的研究


目的 确定硬膜外分娩镇痛对严重孕产妇发病率 (SMM) 的影响，并探讨在分娩期间或早产时有硬膜外镇痛医学指征的女性中这种影响是否更大。设计基于人群的研究。设置 苏格兰所有 NHS 医院。参与者 567 216 名在 2007 年 1 月 1 日至 2019 年 12 月 31 日期间妊娠 24+0 至 42+6 周的临产妇女，通过阴道分娩或通过计划外剖腹产分娩。主要结局指标 主要结局指标是 SMM，定义为美国疾病控制与预防中心 (CDC) 使用的 21 种情况中存在 ≥ 1 种情况作为 SMM 的标准，或进入重症监护室，其中任一情况发生在从分娩日期至产后 42 天（称为 SMM）。次要结局包括 21 种 CDC 病症中≥1 种的综合结果和重症监护入院（SMM 加重症监护入院）以及呼吸道疾病发病率。结果 567 216 名妇女中，125 024 名（22.0%）在分娩期间接受了硬膜外镇痛。 SMM 发生在 2412 名女性中（每 1000 名新生儿中有 4.3 名，95% 置信区间 (CI) 4.1 至 4.4）。硬膜外镇痛与 SMM（调整后相对风险 0.65，95% CI 0.50 至 0.85）、SMM 加重症监护入院率（0.46，0.29 至 0.73）和呼吸系统发病率（0.42，0.16 至 1.15）的降低相关，尽管最后一项其中的动力不足且置信区间较宽。与没有硬膜外镇痛医学指征的女性（0.67、0.43 至 1.03；差异 P<0.001）相比，有硬膜外镇痛医学指征的女性（0.50、0.34 至 0.72）SMM 风险降低幅度更大。与足月或足月分娩的女性（1.09、0.98 至 1.09、0.98 至 1.21；差异 P<0.001）。随着整个队列中出生胎龄的降低，以及在有硬膜外镇痛医学指征的女性中，观察到的硬膜外镇痛 SMM 风险的降低越来越明显。结论 分娩期间硬膜外镇痛与 SMM 降低 35% 相关，并且对于有硬膜外镇痛医学指征和早产的妇女显示出更显着的效果。扩大所有妇女在分娩期间接受硬膜外镇痛的机会，特别是那些风险最大的妇女，可以改善孕产妇健康。去个性化的研究数据可以根据要求提供给提交提案并得到 NHS 苏格兰电子数据研究和创新服务批准的认可研究人员。