Influences of epidural labor analgesia on maternal postpartum cognitive function after vaginal delivery: a prospective cohort study

• DOI: 10.3760/cma.j.issn.1007-9408.2019.02.009
• Publication Date: 2019-02-16
• Authors: Jianwei Wang; Rui Ma; Feng Zhou; Xiaoyu Zhang; Zifeng Xu; Weiwei Cheng
• Keywords: Montreal Cognitive Assessment; Postoperative cognitive dysfunction

Objective To investigate the incidence of cognitive dysfunction in postpartum women who underwent epidural or non-drug labor analgesia and influence factors.

Methods A prospective cohort study was performed 1 618 uneventful singleton pregnancies International Peace Maternity Child Health Hospital from January 2017 to 2018. Women received were assigned group (n=803), those Doula technique rather than control (n=815). Cognitive function assessed using symbol digit modalities test (SDMT90) Montreal assessment (MoCA) d 42 after delivery. Incidence maternal dysfunction, SDMT90 scores pain intensity measured by visual analogue score (VAS) at cervical dilatation 3, 6 10 cm between two groups compared independent sample t-test, Chi-square logistic regression analysis.

Results MoCA significantly higher delivery (27.1±1.5 vs 26.2±1.8, 49.1±2.4 42.5±3.6; t=3.775 16.956, both P<0.05), but postoperative (POCD) remarkably lower comparing [13.9% (112/803) 21.2% (173/815), χ2=14.769, P=0.002]. The VAS all (2.3±0.6 6.9±1.3, 3.3±0.9 8.7±0.9, 5.7±0.9 9.7±0.4; t=0.013, 0.011 0.015; P<0.001). Logistic analysis indicated that ≤ 3 protective factors against POCD [OR(95%CI): 0.238 (0.198-0.287), 0.180 (0.145-0.222) 0.112 (0.088-0.142), P<0.001], while absence a risk factor (OR=4.698, 95%CI:1.812-11.321, P<0.001).

Conclusions Epidural can reduce has close relationship with analgesia.

Key words: Labor, obstetric; Analgesia, epidural; Cognitive Dysfunction; Neuropsychological tests; Prospective studies