Hypothesis: To assess the association between the use of labor neuraxial analgesia for vaginal delivery and severe maternal morbidity.
Methods
Data came from the New York State Inpatient Database from Jan 2010 – Dec 2017
Inverse propensity score-weighting method and mediation analysis
Population
Women 15yo to 49yo undergoing first vaginal delivery
575,524 subjects
Results
Prior to adjustment, women receiving an epidural were more likely to:
Be non-Hispanic White
Have private health insurance
Have PROM
Be induced
Have fetal heart abnormalities
Give birth at a high-volume teaching hospital
Before weighting, the incidence of SMM was 1.3% with neuraxial analgesia versus 1.4% without neuraxial analgesia
After weighting, neuraxial analgesia was associated with a 14% (0.86; 95% CI, 0.82-0.90) decrease in the risk of severe maternal morbidity and a decreased risk of PPH
21% (95% CI, 14-28) of the decrease in severe maternal morbidity was mediated through a reduction in postpartum hemorrhage
Strengths
Large study population
IPTW
Biological explanation to support hypothesis
Generalizable
Relevant topic that is applicable to most anesthesia providers, especially those in community hospitals
Weaknesses
Retrospective study
External validity - only includes vaginal deliveries
Mode of data collection – billing codes, estimated number of providers per hospital, etc.
Did not specify type of neuraxial analgesia
Only identified SMM during the hospitalization period and did not account for SMM occurring after discharge
Key Point: The use of neuraxial analgesia during vaginal delivery is associated with a reduction in the rate of severe maternal morbidity