{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T08:25:32Z","timestamp":1785831932299,"version":"3.56.0"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the rate of emergency delivery for presumed fetal compromise after epidural analgesia (EDA) compared with that after alternative analgesia or no analgesia, and to assess whether this rate is increased in pregnancies with reduced placental reserve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a nationwide registry\u2010based cohort study of 629\u2009951 singleton pregnancies delivered at 36\u2009+\u20090 to 42\u2009+\u20090\u2009weeks of gestation that were recorded in the Dutch national birth registry between 2014 and 2018, including 120\u2009426 cases that received EDA, 86\u2009957 that received alternative analgesia and 422\u2009568 that received no analgesia during labor. Pregnancies with congenital anomaly, chromosomal abnormality, fetal demise, planned Cesarean delivery, non\u2010cephalic presentation at delivery and use of multiple forms of analgesia were excluded. The primary outcome was emergency delivery for presumed fetal compromise. Secondary outcomes included delivery characteristics and neonatal outcome. Negative binomial regression analysis was stratified by parity and results are presented according to birth\u2010weight centile, after adjusting for confounding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among women who received EDA, 13.2% underwent emergency delivery for presumed fetal compromise, compared with 4.1% of women who had no analgesia (relative risk (RR), 3.23 (95%\u2009CI, 3.16\u20133.31)) and 7.0% of women who received alternative analgesia (RR, 1.72 (95%\u2009CI, 1.67\u20131.77)). Independent of birth weight, the RR of presumed fetal compromise after EDA <jats:italic>vs<\/jats:italic> no analgesia was higher in parous women (adjusted RR (aRR), 2.15 (95%\u2009CI, 2.04\u20132.27)) compared with nulliparous women (RR, 1.88 (95%\u2009CI, 1.84\u20131.94)). Stratified for parity, the effect of EDA was modified significantly by birth\u2010weight centile (interaction <jats:italic>P<\/jats:italic>\u2010value, &lt;\u20090.001 for nulliparous and 0.004 for parous women). The emergency delivery rate following EDA was highest in those with a birth weight &lt;\u20095<jats:sup>th<\/jats:sup> centile (25.2% of nulliparous and 16.6% of parous women), falling with each increasing birth\u2010weight centile category up to the 91<jats:sup>st<\/jats:sup>\u201395<jats:sup>th<\/jats:sup> centile (11.8% of nulliparous and 7.2% of parous women).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Intrapartum EDA is associated with a higher risk of emergency delivery for presumed fetal compromise compared with no analgesia and alternative analgesia, after adjusting for relevant confounding. The highest rate of emergency delivery for presumed fetal compromise was observed at the lowest birth\u2010weight centiles. RRs of emergency delivery for presumed fetal compromise after EDA were modestly but consistently modified by birth\u2010weight centile, supporting the hypothesis that the adverse effects of EDA are exacerbated by reduced placental function. While EDA provides effective pain relief during labor, alternative strategies for pain management may be preferable in pregnancies with a high background risk of fetal compromise. \u00a9 2023 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26309","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T06:28:50Z","timestamp":1689316130000},"page":"668-674","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Effect of intrapartum epidural analgesia on rate of emergency delivery for presumed fetal compromise: nationwide registry\u2010based cohort study"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8411-2816","authenticated-orcid":false,"given":"S. E.","family":"Damhuis","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University Medical Center Groningen, University of Groningen  Groningen The Netherlands"},{"name":"Department of Obstetrics and Gynecology Amsterdam University Medical Centers, University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Groen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University Medical Center Groningen, University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Thilaganathan","sequence":"additional","affiliation":[{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"},{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Ganzevoort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam University Medical Centers, University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3915-8609","authenticated-orcid":false,"given":"S. J.","family":"Gordijn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Medical Center Groningen, University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11]]},"reference":[{"key":"e_1_2_7_2_1","article-title":"Epidural versus non\u2010epidural or no analgesia for pain management in labour","volume":"5","author":"Anim\u2010Somuah M","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12966"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2014.10.023"},{"key":"e_1_2_7_5_1","article-title":"Pain management for women in labour: an overview of systematic reviews","volume":"3","author":"Jones L","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_6_1","article-title":"Perinatale zorg in Nederland anno 2018: landelijke perinatale cijfers en duiding","author":"Perined","year":"2019","journal-title":"Utrecht"},{"key":"e_1_2_7_7_1","article-title":"Perinatale zorg in Nederland anno 2003: landelijke perinatale cijfers en duiding","author":"Perined","year":"2006","journal-title":"Bilthoven"},{"key":"e_1_2_7_8_1","article-title":"Perinatale zorg in Nederland anno 2008: landelijke perinatale cijfers en duiding","author":"Perined","year":"2011","journal-title":"Utrecht"},{"key":"e_1_2_7_9_1","first-page":"139","article-title":"Advances in labor analgesia","volume":"1","author":"Wong CA","year":"2010","journal-title":"Int J Womens Health"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(83)90076-5"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199410000-00041"},{"key":"e_1_2_7_12_1","first-page":"1785","article-title":"Epidural analgesia during labor","volume":"58","author":"Vincent RD","year":"1998","journal-title":"Am Fam Physician"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2009.07.021"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.07.032"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.577"},{"key":"e_1_2_7_16_1","first-page":"2014","article-title":"Perinatal Care in the Netherlands","author":"Perined","journal-title":"Utrecht"},{"key":"e_1_2_7_17_1","article-title":"Perinatale zorg in Nederland anno 2019: landelijke perinatale cijfers en duiding","author":"Perined","year":"2020","journal-title":"Utrecht"},{"issue":"383","key":"e_1_2_7_18_1","first-page":"e1","article-title":"From population reference to national standard: new and improved birthweight charts","volume":"220","author":"Hoftiezer L","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14644"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000512658"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12355"},{"key":"e_1_2_7_22_1","unstructured":"NHS Maternity Statistics.England 2020\u201321.https:\/\/digital.nhs.uk\/data\u2010and\u2010information\/publications\/statistical\/nhs\u2010maternity\u2010statistics\/2020\u201021."},{"key":"e_1_2_7_23_1","first-page":"1","article-title":"Births: Final Data for 2019","volume":"70","author":"Martin JA","year":"2021","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/204946370800200205"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(02)70179-8"}],"container-title":["Ultrasound in Obstetrics &amp; 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