The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

Abstract Background No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change of overall cesarean delivery(CD) and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods The neuraxial labor analgesia was initiated in May 1st 2015. A multidisciplinary NPLD team from America was invited to our hospital to give education and training for 7 days. After training, the application of neuraxial labor analgesia became a routine operation in our hospital, and every parturient can choose to use neuraxial analgesia or not according to her own requirement. The rates of neuraxial labor analgesia(NA), CD, MRCD, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from May 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 ( p< 0.001); the rate of CD decreased from 50.4% in May 2015 to 36.3% in April 2016 (, p< 0.001); the rate of MRCD decreased from 10.8%in May 2015 to 5.7% in April 2016( p< 0.001). There was a negative correlation between the rate of NA and that of overall CD, r=-0.803 (95%CI[-0.951,-0.642], p =0.002), and also a negative correlation between the utilization rate of NA and that of MRCD, r=-0.790 (95%CI[-0.971,-0.497], p =0.004). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in vaginal delivery women and the rates of intrapartum CD, neonatal asphyxia, and PPH in CD women remained unchanged from May 2015 to April 2016.Conclusions Our study shows that the rates of CD and MRCD in our department significantly decreased over a year period(2015 05~2016. 04), which may be due to the increasing use of NA during vaginal delivery.

Download Full-text

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: A 16-month retrospective study

10.21203/rs.2.13558/v4 ◽

2020 ◽

Author(s):

Yun ZHAO ◽

Ying GAO ◽

Guoqiang SUN ◽

Ling YU ◽

Ying LIN

Keyword(s):

Retrospective Study ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Negative Correlation ◽

Utilization Rate ◽

Specialized Training ◽

Neonatal Asphyxia ◽

Neuraxial Analgesia ◽

Operative Vaginal Delivery ◽

Multiparous Women

Abstract Background No Pain Labor ＆Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). Methods NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p<0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p＞0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 ( p<0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p＞0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p<0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p＞0.05). There was a negative correlation between the rate of NA and rate of overall CD, r=-0.782 (95%CI [-0.948, -0.534], p＜0.001), and between the utilization rate of NA and rate of MRCD, r=-0.914 (95%CI [-0.989, -0.766], p＜0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p＞0.05). Conclusions: Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.

Download Full-text

The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective studyThe initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

10.21203/rs.2.13558/v2 ◽

2020 ◽

Author(s):

Yun ZHAO ◽

YING GAO ◽

Guoqiang SUN ◽

Lin YU ◽

Ying LIN

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Negative Correlation ◽

Labor Analgesia ◽

Utilization Rate ◽

Maternal Request ◽

Neonatal Asphyxia ◽

Neuraxial Analgesia ◽

Operative Vaginal Delivery ◽

Multiparous Women

Abstract Background No Pain Labor ＆Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change is overall cesarean delivery (CD) and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods The neuraxial labor analgesia（NA） was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not according to her own requirement. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from May 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p<0.001); the rate of CD was decreased from 50.4% in May 2015 to 36.3% in April 2016 ( p<0.001); the rate of MRCD was decreased from 10.8% in May 2015 to 5.7% in April 2016 (p<0.001), but the rate of multiparous women had no change (p＞0.05). There was a negative correlation between the rate of NA and that of overall CD, r=-0.803 (95%CI[-0.951, -0.642], p=0.002), and also a negative correlation between the utilization rate of NA and that of MRCD, r=-0.790 (95%CI[-0.971, -0.497], p=0.004). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women underwent CD remained unchanged from May 1st 2015 to April 30th 2016. Conclusions: Our study shows that the rates of CD and MRCD in our department significantly were decreased over a year period (2015. 05.01~2016. 04.30), which may be due to the increasing use of NA during vaginal delivery by the help of NPLD. Key Words: Neuraxial Labor Analgesia; Cesarean Delivery; Maternal Request Cesarean Delivery

Download Full-text

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03294-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yun Zhao ◽

Ying Gao ◽

Guoqiang Sun ◽

Ling Yu ◽

Ying Lin

Keyword(s):

Retrospective Study ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Negative Correlation ◽

Utilization Rate ◽

Specialized Training ◽

Neonatal Asphyxia ◽

Neuraxial Analgesia ◽

Operative Vaginal Delivery ◽

Multiparous Women

Abstract Background No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). Methods NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p < 0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p>0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 (p < 0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p>0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p < 0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p>0.05). There was a negative correlation between the rate of NA and rate of overall CD, r = − 0.782 (95%CI [− 0.948, − 0.534], p<0.001), and between the utilization rate of NA and rate of MRCD, r = − 0.914 (95%CI [− 0.989, − 0.766], p<0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p>0.05). Conclusions Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.

Download Full-text

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: A 16-month retrospective study

10.21203/rs.2.13558/v3 ◽

2020 ◽

Author(s):

Yun ZHAO ◽

YING GAO ◽

Guoqiang SUN ◽

Lin YU ◽

Ying LIN

Keyword(s):

Retrospective Study ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Utilization Rate ◽

Specialized Training ◽

Neonatal Asphyxia ◽

Neuraxial Analgesia ◽

Operative Vaginal Delivery ◽

Multiparous Women ◽

High Level

Abstract Background No Pain Labor ＆Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods A neuraxial labor analgesia（NA） was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not according to her own requirement. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from January 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 ( p< 0.001); the rate of CD was decreased from 50.4% in May 2015 to 36.3% in April 2016 ( p< 0.001); the rate of MRCD was decreased from 10.8% in May 2015 to 5.7% in April 2016 ( p< 0.001); but the rates of overall CD and MRCD remained stable at a high level from January to May 2015( p ＞0.05). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation ( p ＞0.05). There was a negative correlation between the rate of NA and rate of overall CD, r=-0.803 (95%CI[-0.951, -0.642], p =0.002), and between the utilization rate of NA and rate of MRCD, r=-0.790 (95%CI[-0.971, -0.497], p =0.004).The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged from January 1st 2015 to April 30th 2016 . Conclusions: Our study shows that the rates of CD and MRCD in our department were significantly decreased from January 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery.

Download Full-text