Neuraxial analgesia in labour and the fetus

Kearns, R.J. and Lucas, D.N. (2023) Neuraxial analgesia in labour and the fetus. Best Practice and Research: Clinical Anaesthesiology, 37(1), pp. 73-86. (doi: 10.1016/j.bpa.2023.02.005) (PMID:37295856)

Abstract

Providing pain relief during labour is a fundamental human right and can benefit both mother and fetus. Epidural analgesia remains the “gold standard’’, providing excellent pain relief, as well as the facility to convert to anaesthesia should operative intervention be required. While maternal well-being remains the primary focus, epidural analgesia may also have implications for the fetus. Data from meta-analyses finds that epidural compared with systemic opioids in labour is associated with reduced neonatal respiratory depression. Clinically relevant neonatal outcomes such as Apgar score < 7 at 5 minutes, neonatal resuscitation and need for admission to a neonatal unit are reassuring, with the benefits of epidural analgesia for both mother and neonate outweighing any potential risks. Recent concerns regarding an association of epidural with the development of autism spectrum disorder in childhood appear to be unfounded, with several large observational studies refuting this association. This review discusses the evidence relating to maternal neuraxial analgesia in labour, implications for the fetus in utero, and childhood outcomes both in the immediate peripartum period and longer term.

• Item Type: Articles
• Additional Information: This work was supported by Wellbeing of Women / Chief Scientist Office, Scotland (RGS2301 - grant to RK), and an NHS Research Scotland Career Researcher Fellowship (RK).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kearns, Dr Rachel
• Authors: Kearns, R.J., and Lucas, D.N.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Best Practice and Research: Clinical Anaesthesiology
• Publisher: Elsevier
• ISSN: 1521-6896
• ISSN (Online): 1532-169X
• Published Online: 05 March 2023
• Copyright Holders: Copyright © 2023 Crown Copyright
• First Published: First published in Best Practice and Research: Clinical Anaesthesiology 37(1):73-86
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
310398		Effects of public health policy on maternal lifestyle choices and offspring health outcomes - A population-based linkage study	Rachel Kearns	Wellbeing of Women (WELLWOM)	RGS2301	School Of Medicine