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

Francisco Pascual-Ramirez, Javier Haya, Faustino Pérez-López, Silvia Gil Trujillo

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)873-880
Number of pages8
JournalArchives of Gynecology and Obstetrics
Volume286
Issue number4
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Proportional Hazards Models
Analgesia
Induced Labor
Fentanyl
Oxytocin
Parity
Weights and Measures
Fetal Weight
Bupivacaine
Cesarean Section
Morphine
Gestational Age
Analgesics
Mothers
Parturition
Newborn Infant
Interviews
Pain

Keywords

  • Axial analgesia for labor
  • Combined spinal-epidural for labor
  • Cox regression
  • Duration of labor and delivery
  • Labor epidural

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Type of axial analgesia does not influence time to vaginal delivery in a Proportional Hazards Model. / Pascual-Ramirez, Francisco; Haya, Javier; Pérez-López, Faustino; Trujillo, Silvia Gil.

In: Archives of Gynecology and Obstetrics, Vol. 286, No. 4, 01.10.2012, p. 873-880.

Research output: Contribution to journalArticle

Pascual-Ramirez, Francisco ; Haya, Javier ; Pérez-López, Faustino ; Trujillo, Silvia Gil. / Type of axial analgesia does not influence time to vaginal delivery in a Proportional Hazards Model. In: Archives of Gynecology and Obstetrics. 2012 ; Vol. 286, No. 4. pp. 873-880.
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N2 - 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.

AB - 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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KW - Cox regression

KW - Duration of labor and delivery

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