To observe the influence of epidural labor analgesia on the maternal and neonatal outcomes of trial of labor after cesarean section (TOLAC).

In this retrospective study, one hundred and three parturients who chose TOLAC at the Peking University First Hospital from August 2010 to May 2017 were enrolled. The perinatal information including age, BMI, prenatal diagnosis, past history, prenatal hemoglobin, mode of delivery, duration of delivery, ammiotomy, fever, use of oxytocin during labor, neonatal Apgar score, and the incidence of fetal distress was collected. The independent sample t-test was used to compare the differences in age, BMI, time after last birth, gestational age, prediction of fetal weight in 36 weeks prior to birth, neonatal length, neonatal weight, and prenatal hemoglobin between the two groups of subjects who underwent repeated cesarean section (RCS) or not. The t-test was used to compare the differences in duration of first and second stage of delivery between the two groups of subjects who accepted epidural labor analgesia or not. The rank sum test was used to compare the difference in gravidity between the two groups of subjects who undertaken RCS or not, and the Apgar score between the two groups of subjects who accepted epidural labor analgesia or not. The chi-square test was used to compare the difference in combined internal, gynecological, obstetrical diseases, oxytocin, fever, ammiotomy, and epidural labor analgesia between the two groups of subjects who undertaken RCS or not, and the incidence of forceps assisted delivery, neonatal distress, and admission to NICU between the subjects who accepted epidural labor analgesia or not. Multivariate logistic regression analysis was applied to investigate the relationship between perinatal factors including epidural labor analgesia and delivery mode of TOLAC.

Among the 103 parturients who chose TOLAC, 23 (22.3%) underwent RCS. Between the two groups of subjects who undertaken RCS or not, BMI [(29±5) kg/m² vs (27±3) kg/m², t=2.55, P=0.01], past gynecological diseases (13.0% vs 11.3%, χ²=4.82, P=0.03), and the rate of acceptance of epidural labor analgesia (13.0% vs45.0%, χ²=7.75, P<0.01) differed significantly. Among the parturients who underwent vaginal birth after cesarean section (VBAC), the use of epidural labor analgesia prolonged the first stage of labor [(543±231) vs (316±211), t=4.59, P<0.001]. The incidence of fetal distress and Apgar scores at 1 minute and 5 minutes did not differ significantly between the two groups of subjects who used epidural labor analgesia or not (P>0.05). BMI was identified to be an independent risk factor of RCS (β=0.164, P=0.03) while acceptance of epidural labor analgesia was an independent protective factor for RCS (β=-1.600, P=0.02).

Epidural labor analgesia can decrease the rate of RCS in women who have an earlier cesarean section but is accompanied by the prolonged first stage of labor. Using epidural labor analgesia has no obvious influence on the incidence of neonatal distress.