本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-077190

摘要内容如下：

目标

确定硬膜外分娩对严重孕产妇发病率（SMM）的影响，并探讨这种影响是否在分娩期间有硬膜外镇痛医学指征的妇女或早产妇女中更大。

设计

基于人群的研究。

设置

苏格兰所有的NHS医院。

参与者

在2007年1月1日至2019年12月31日期间，567216名妇女在妊娠24+0至42+6周分娩，通过阴道分娩或意外剖腹产。

主要结果指标

主要结果是SMM，定义为美国疾病控制和预防中心（CDC）用作SMM标准的21种情况中存在≥1种，或重症监护入院，发生在分娩之日至产后42天的任何时间点（称为SMM）。次要结果包括21种CDC疾病中≥1种的复合结果和重症监护入院（SMM+重症监护入院）以及呼吸系统发病率。

结果

在567216名妇女中，125024名（22.0%）在分娩过程中接受了硬膜外镇痛。有2412名妇女发生了SMM（每1000名新生儿4.3例，95%置信区间（CI）4.1至4.4）。硬膜外镇痛与SMM（校正相对风险0.65，95%CI 0.50至0.85）、SMM+重症监护入院（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，尽管最后一种方法效果不佳且置信区间较宽。在有硬膜外镇痛医学指征的妇女中（0.50，0.34至0.72），与无此指征的妇女相比（0.67，0.43至1.03；差异P<0.001）。与足月或足月后分娩者（1.09，0.98至1.21）相比，早产妇女（0.53，0.37至0.76）的SMM降低更为显著。差异P<0.001）。在整个队列中，以及在有硬膜外镇痛医学指征的妇女中，随着出生胎龄的降低，观察到的硬膜外镇痛降低SMM的风险越来越明显。

结论

分娩时硬膜外镇痛与SMM降低35%相关，并且在有硬膜外镇痛医学指征和早产的妇女中显示出更显著的效果。扩大所有妇女在分娩期间获得硬膜外镇痛的机会，特别是那些风险最大的妇女，可以改善孕产妇健康。

英文原文如下：

Abstracts

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.

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