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Type of axial analgesia does not influence time to vaginal delivery in a Proportional Hazards Model

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To create a Proportional Hazards Model of prospective factors associated with time-to-vaginal-delivery (TTVD).

Methods

We analyzed a group of 144 women undergoing childbirth who received one out of two possible axial analgesia techniques, to find-out factors associated with TTVD. The patients were randomly assigned to receive either a levobupivacaine labor epidural (bolus concentration 0.25 % or less; infusion concentration 0.125 % or less) or a combined spinal–epidural procedure (morphine 0.20 mg, fentanyl 25 µg and hyperbaric bupivacaine 2.5 mg as spinal components) for labor analgesia. The factors initially chosen were: mother age, height and weight, parity, gestational age, newborn weight, type of labor, analgesic procedure, levobupivacaine and fentanyl doses, Bromage scale, pain Numeric Rating Scale, and a satisfaction interview. Cesarean section was the censored variable in our model. A systematic multivariate Cox regression was performed.

Results

Our Final Model stated that nulliparous women had 2.5 times more chances of having longer TTVD than primiparous (p < 0.001, CI 1.76–3.8), and 3.4 times more (p = 0.015, CI 1.27–9.25) than multiparous. Women with oxytocin-augmented labor had 2.05 times more chances (p = 0.001, CI 1.31–3.22) of having longer TTVD than patients without oxytocin. An induced partum had 3.8 times more chances (p < 0.001, CI 2.09–6.8) of having longer TTVD compared to a spontaneous partum.

Conclusion

Parity, labor augmentation, induction of labor and fetal weight determine TTVD; axial analgesia-related factors do not contribute to the model.

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Anesthesiology Department, Hospital General de Ciudad Real, SESCAM, C/Besana, 2b, 13170, Miguelturra, Spain

    Javier Pascual-Ramírez & Silvia Gil Trujillo

  2. Obstetrics and Gynecology Department, Hospital General de Ciudad Real, SESCAM, Ciudad Real, Spain

    Javier Haya

  3. Obstetrics and Gynecology Department, Hospital Clínico de la Universidad de Zaragoza, Zaragoza, Spain

    Faustino Pérez-López

Authors
  1. Javier Pascual-Ramírez
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  2. Javier Haya
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  3. Faustino Pérez-López
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  4. Silvia Gil Trujillo
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Corresponding author

Correspondence to Javier Pascual-Ramírez.

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Pascual-Ramírez, J., Haya, J., Pérez-López, F. et al. Type of axial analgesia does not influence time to vaginal delivery in a Proportional Hazards Model. Arch Gynecol Obstet 286, 873–880 (2012). https://doi.org/10.1007/s00404-012-2360-0

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  • DOI: https://doi.org/10.1007/s00404-012-2360-0

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