{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T12:39:09Z","timestamp":1793623149627,"version":"4.5.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T00:00:00Z","timestamp":1619568000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T00:00:00Z","timestamp":1619568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Projects of medical and health technology development program in Shandong province","award":["202004110774"],"award-info":[{"award-number":["202004110774"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Labor epidural analgesia (LEA) effectively relieves the labor pain, but it is still not available consistently for multiparous women in many institutions because of their obviously shortened labor length.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 811 multiprous women were retrospective enrolled and firstly divided into two groups: LEA group or non-LEA group. And then they were divided into seven subgroups and analyzed according to the use of LEA and cervical dilation. The primary outcomes (time intervals, blood loss and Apgar scores) and secondary outcomes (maternal demographic characteristics and birth weight) were collected by checking electronic medical records.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The prevalence of using LEA in multiprous women was 54.5\u2009%. Using LEA significantly lengthened the duration of labor stage by 56\u00a0min (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), increased the blood loss (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and lowered Apgar scores (<jats:italic>P<\/jats:italic>\u2009=\u20090.001). In the comparison of sub-group analysis, using LEA can obviously prolong the duration of first-second stage in women with 2\u00a0cm cervical dilation (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and 3\u00a0cm cervical dilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.014), while there was no significant difference with 4\u00a0cm or more cervical dilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.69). Using LEA can significantly increased the blood loss when the initiation of LEA in the women with 2\u00a0cm cervical dilation (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and 3\u00a0cm cervical dilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.035), meanwhile there were no significantly differences in the women with 4\u00a0cm or more cervical dilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.524). Using LEA can significantly lower the Apgar scores when the initiation of LEA in the women with 2\u00a0cm cervical dilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.001) and 4\u00a0cm or more cervical dilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.025), while there were no significantly differences in the women with 3\u00a0cm cervical dilation (<jats:italic>P<\/jats:italic>\u2009=\u20090.839).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Labor epidural analgesia for the multiparous woman may alter progress of labor, increase postpartum blood loss and lower Apgar scores. Early or late initiation of LEA should be defined as with cervical dilatation of less or more than 3\u00a0cm and the different effect should be understand.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ChiCTR2100042746. Registered 27 January 2021-Prospectively registered, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.chictr.org.cn\">http:\/\/www.chictr.org.cn<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12871-021-01355-0","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T07:06:30Z","timestamp":1619593590000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Labor epidural analgesia versus without labor epidural analgesia for multiparous women: a retrospective case control study"],"prefix":"10.1186","volume":"21","author":[{"given":"Shuzhi","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaowen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xujian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changyu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shili","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,28]]},"reference":[{"key":"1355_CR1","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s00404-018-4777-6","volume":"298","author":"Q Wang","year":"2018","unstructured":"Wang Q, Zheng SX, Ni YF, et al. The effect of labor epidural analgesia on maternal-fetal outcomes: a retrospective cohort study. Arch Gynecol Obstet. 2018;298:89\u201396.","journal-title":"Arch Gynecol Obstet"},{"key":"1355_CR2","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1002\/ijgo.13424","volume":"152","author":"MA Souza","year":"2021","unstructured":"Souza MA, Cecatti JG, Guida JP, et al. Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health. Int J Gynaecol Obstet. 2021;152:401\u201308.","journal-title":"Int J Gynaecol Obstet"},{"issue":"20","key":"1355_CR3","first-page":"30265","volume":"S1871-5192","author":"D H\u00f8toft","year":"2020","unstructured":"H\u00f8toft D, Maimburg RD. Epidural analgesia during birth and adverse neonatal outcomes: A population-based cohort study [published online ahead of print, 2020 Jun 18]. Women Birth. 2020;S1871-5192(20):30265\u20131.","journal-title":"Women Birth"},{"key":"1355_CR4","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.aan.2018.07.006","volume":"36","author":"A Chau","year":"2018","unstructured":"Chau A, Tsen LC. Update on Modalities and Techniques for Labor Epidural Analgesia and Anesthesia. Adv Anesth. 2018;36:139\u201362.","journal-title":"Adv Anesth"},{"key":"1355_CR5","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1177\/1054773817722689","volume":"27","author":"A Herrera-G\u00f3mez","year":"2018","unstructured":"Herrera-G\u00f3mez A, De Luna-Bertos E, Ramos-Torrecillas J, Oca\u00f1a-Peinado FM, Ruiz C. Garc\u00eda-Mart\u00ednez O. Risk Assessments of Epidural Analgesia During Labor and Delivery. Clin Nurs Res. 2018;27:841\u201352.","journal-title":"Clin Nurs Res"},{"key":"1355_CR6","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1111\/j.1552-6909.2010.01195.x","volume":"39","author":"E Gillesby","year":"2010","unstructured":"Gillesby E, Burns S, Dempsey A, et al. Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia. J Obstet Gynecol Neonatal Nurs. 2010;39:635\u201344.","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"1355_CR7","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1097\/NMC.0b013e3181cae7ad","volume":"35","author":"M Kelly","year":"2010","unstructured":"Kelly M, Johnson E, Lee V, et al. Delayed versus immediate pushing in second stage of labor. MCN Am J Matern Child Nurs. 2010;35:81\u20138.","journal-title":"MCN Am J Matern Child Nurs"},{"key":"1355_CR8","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1097\/AOG.0b013e3182639fae","volume":"120","author":"MG Tuuli","year":"2012","unstructured":"Tuuli MG, Frey HA, Odibo AO, Macones GA, Cahill AG. Immediate compared with delayed pushing in the second stage of labor: a systematic review and meta-analysis. Obstet Gynecol. 2012;120:660\u201368.","journal-title":"Obstet Gynecol"},{"key":"1355_CR9","doi-asserted-by":"publisher","first-page":"354","DOI":"10.3390\/medicina55070354","volume":"55","author":"A Malevic","year":"2019","unstructured":"Malevic A, Jatuzis D, Paliulyte V. Epidural Analgesia and Back Pain after Labor. Medicina. 2019;55:354.","journal-title":"Medicina"},{"key":"1355_CR10","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1097\/AOG.0b013e318202c845","volume":"117","author":"M Driessen","year":"2011","unstructured":"Driessen M, Bouvier-Colle MH, Dupont C. et al. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol. 2011;117:21\u201331.","journal-title":"Obstet Gynecol"},{"key":"1355_CR11","doi-asserted-by":"crossref","unstructured":"Cheng YW, Shaffer BL, Nicholson JM, Caughey AB. Second stage of labor and epidural use: a larger effect than previously suggested. Obstet Gynecol. 2014;123:527\u201335.","DOI":"10.1097\/AOG.0000000000000134"},{"key":"1355_CR12","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1111\/aas.12477","volume":"59","author":"S T\u00f6rnell","year":"2015","unstructured":"T\u00f6rnell S, Ek\u00e9us C, Hultin M, H\u00e5kansson S, Thunberg J, H\u00f6gberg U. Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study. Acta Anaesthesiol Scand. 2015;59:486\u201395.","journal-title":"Acta Anaesthesiol Scand"},{"key":"1355_CR13","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/j.1542-2011.2011.00074.x","volume":"57","author":"K Osborne","year":"2012","unstructured":"Osborne K, Hanson L. Directive versus supportive approaches used by midwives when providing care during the second stage of labor. J Midwifery Womens Health. 2012;57:3\u201311.","journal-title":"J Midwifery Womens Health"},{"key":"1355_CR14","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/j.1552-6909.2007.00205.x","volume":"37","author":"RM Brancato","year":"2008","unstructured":"Brancato RM, Church S, Stone PW. A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor. J Obstet Gynecol Neonatal Nurs. 2008;37:4\u201312.","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"1355_CR15","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/00006250-200407000-00061","volume":"104","author":"ACOG Committee Opinion","year":"2004","unstructured":"ACOG Committee Opinion. #295: pain relief during labor. Obstet Gynecol. 2004;104:213.","journal-title":"Obstet Gynecol"},{"key":"1355_CR16","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1186\/s12884-020-03161-x","volume":"20","author":"H Ando","year":"2020","unstructured":"Ando H, Makino S, Takeda J, et al. Comparison of the labor curves with and without combined spinal-epidural analgesia in nulliparous women- a retrospective study. BMC Pregnancy Childbirth. 2020;20:467.","journal-title":"BMC Pregnancy Childbirth"},{"key":"1355_CR17","first-page":"CD000331","volume":"5","author":"M Anim-Somuah","year":"2018","unstructured":"Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5:CD000331.","journal-title":"Cochrane Database Syst Rev"},{"key":"1355_CR18","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1097\/AOG.0000000000002306","volume":"130","author":"X Shen","year":"2017","unstructured":"Shen X, Li Y, Xu S, et al. Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial. Obstet Gynecol. 2017;130:1097\u2013103.","journal-title":"Obstet Gynecol"},{"key":"1355_CR19","doi-asserted-by":"crossref","unstructured":"Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ES, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. 2014;9(10):CD007238.","DOI":"10.1002\/14651858.CD007238.pub2"},{"key":"1355_CR20","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1056\/NEJMoa042573","volume":"352","author":"CA Wong","year":"2005","unstructured":"Wong CA, Scavone BM, Peaceman AM, et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med. 2005;352:655\u201365.","journal-title":"N Engl J Med"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01355-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-021-01355-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01355-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T07:06:52Z","timestamp":1619593612000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-021-01355-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,28]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1355"],"URL":"https:\/\/doi.org\/10.1186\/s12871-021-01355-0","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,28]]},"assertion":[{"value":"18 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee of Shandong Province Maternal and Child Health Care Hospital (reference number: 2020SYY006). The data are anonymous, and the requirement for informed consent was therefore waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This is a retrospective case control study and the data are anonymous, and the requirement for informed consent was therefore waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"133"}}