Comparison of the effect of spinal, epidural, and combined of neuroaxial anesthesia on maternal and fetal outcomes of normal vaginal delivery: A clinical trial study

Abstract

Background: Natural delivery process is accompanied by severe pain during labor, and various ways of reducing it have been presented so far, of them, spinal anesthesia is one of the most commonly used methods. The aim of this study was to compare the effect of spinal, epidural, and combined neuroaxial anesthesia on the maternal and fetal outcomes of normal vaginal delivery. Methods: In a clinical trial study, 105 pregnant women candidates for normal delivery were randomly assigned to three groups of 35. To reduce labor pain, the first group was under spinal anesthesia, the second under epidural anesthesia, and the third under combined anesthesia. The incidences of maternal and neonatal complications were determined and compared between the three groups. Findings: The mean Apgar scores of 1 st and 5 th seconds were not significantly different between the three groups, but the mean duration of stage two was significantly less in the group under epidural anesthesia (32.66 ± 7.57 minutes) compared to those in spinal (36.28 ± 6.38 minutes) and combined anesthesia (35.78 ± 7.39 minutes) (P = 0.027). Other complications, including bleeding and mortality, were not significantly different between the study groups. Conclusion: The incidence of maternal and fetal complications in the three groups under the spinal, epidural, and combined anesthesia did not show a significant difference, but the duration of the second stage of delivery was significantly lower in the group of epidural anesthesia. Therefore, it seems that the use of epidural anesthesia is preferable to the spinel and combined anesthesia to reduce delivery pain. © 2019, Isfahan University of Medical Sciences(IUMS). All rights reserved.