Usage of ‘Big-Data’ Analysis for Choosing the Optimal Timing of Epidural Analgesia in Primi- and Multi-paras
2Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem
3Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan
Background: Obstetric Epidural Analgesia (EA) has been in use since 19231 and is the most efficient intrapartum analgesia 2.Meta-analyses3,4 have dogmatized that EA does not prolong the 1st stage of labour and prolongs the 2nd by 15 minutes. These summaries focused attention on increased instrumental labour with EA, without an increase in caesarean sections or neonatal morbidity5. The question of EA timing remains open. Various studies examined ‘early’ vs. ‘late’ administration6, focusing chiefly on primiparas.
Objective: Utilizing ’Big Data’ analysis to determine whether EA prolongs the labour stages differentially in primi- and multi-paras and whether EA timing (regarding cervical dilation (CD) at administration) correlates with stages lengths and obstetric outcomes.
Methods: We retrospectively analyzed an EMR-based database of births at our medical centers, in 2003-20147. Included were singleton vaginal deliveries, where EA timing (in terms of CD ± 0.5 h) and 1st stage timing were available (3/4 cm CD; N = 34,704). Data was analyzed using SPSS8 and R6, for findings reproducibility.
Results: EA prolonged median 1st (+33-40 min.; p<0.001) and 2nd (+54 min.; p<0.001) stage lengths in primiparas. Similar results were seen in multiparas, with median increase in 1st (+28-34 min.; p<0.001) and 2nd (+5-8 min.; p<0.001) stage lengths. Timing of EA did not affect the prolongation degree or clinical outcomes. Labour was prolonged regardless of timing, whilst more pronounced in primiparas.
Conclusion: Contrary to common belief and previous professional guidlines9 delaying EA until a set CD, we have shown to be irrelevant (and possibly deleterious), particularly in multiparas.
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