The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor

Objective: We aimed to evaluate the impact of epidural analgesia on the mode of delivery of nulliparous women with a term single fetus in vertex presentation (NTSV) that attained the second stage of labor. Study design: A single-center retrospective study provided a strict and constant department protocol for epidural analgesia practice and obstetric interventions, between 2005 and 2014. Epidural users were compared to nonusers. The primary outcome was the mode of delivery. Secondary outcomes were diagnosis of prolonged second stage of labor and maternal and neonatal morbidities. The outcomes were evaluated by adjusted multivariate analyses (Adjusted Odds Ratios (aOR), 95% CI). Results: During the study period, 25,643 NTSV attained the second stage of labor; 18 676 (73%) epidural users and 6967 (27%) nonusers. Epidural users had an increased risk of instrumental delivery 2.48, [2.22–2.76], along with a lower risk of cesarean delivery 0.38, [0.29–0.50]. Notably, the diagnosis of prolonged second stage of labor was comparable among the study groups 0.99, [0.89–1.12]. The epidural users had a significantly higher risk of early postpartum hemorrhage 1.15, [1.04–1.27]. The risk for neonatal morbidity was comparable among the study groups 1.21 [0.90–1.63]. Conclusion: Epidural analgesia in a population of NTSV that attains the second stage of labor is associated with a higher risk of instrumental delivery, nonetheless with a reduced risk of cesarean delivery; independent of the length of the second stage of labor is and safe for the neonate.