Patient-Controlled Epidural Analgesia: A Promising Option for Labor Pain Management in Preeclampsia

Recent study investigated the association of epidural labor analgesia (ELA) with maternal and neonatal outcomes in women with preeclampsia. The research was a retrospective cohort study conducted at Fujian Provincial Maternity and Children's Hospital between January 2015 and December 2020. A total of 686 women with preeclampsia were included in the final analysis after exclusions based on specific criteria. Patients were classified using International Classification of Diseases 10th Revision (ICD-10) codes for different types of preeclampsia. Pre-eclampsia was diagnosed based on criteria outlined by medical associations.

ELA Protocol and Data Collection

ELA was administered to one group of participants, while the other received no analgesia. The ELA protocol involved meticulous procedures to ensure safety and efficacy. Data on maternal and neonatal outcomes were collected, including the primary outcome of intrapartum cesarean section and secondary outcomes such as operative vaginal delivery, fetal distress, NICU admission, and ELA-related complications. Statistical analyses, including propensity score matching, were employed to assess the association between ELA and outcomes, considering various confounding factors.

Outcome Analysis and Results

The results indicated that ELA was not associated with an increased risk of intrapartum cesarean section in women with preeclampsia. However, there was initially a higher incidence of operative vaginal delivery in the ELA group, which was not significant after propensity score matching. No increased risk of fetal distress, NICU admission, or ELA-related complications was observed in the ELA group. Subgroup analysis revealed a reduced risk of cesarean section in women with severe preeclampsia who received ELA. The study findings support the potential efficacy and safety of ELA for labor pain relief in women with preeclampsia. The authors suggest the need for larger studies to validate these results. Previous literature on ELA and cesarean section rates in hypertensive disorders and operative vaginal delivery were discussed to provide context for the current findings. Limitations of the study, including sample size, population homogeneity, and potential unmeasured confounders, were acknowledged. Future research is recommended to investigate the dose-dependent effects of ELA on cesarean section rates.

Conclusion

In conclusion, the study suggests that patient-controlled epidural analgesia could be an effective option for managing labor pain in women with preeclampsia without increasing the risk of adverse maternal and neonatal outcomes. Further research is needed to confirm the safety and efficacy of this pain relief approach in this specific population.

Key Points

- The study focused on investigating the association between epidural labor analgesia (ELA) and maternal and neonatal outcomes in women with preeclampsia.

- A retrospective cohort study was conducted at Fujian Provincial Maternity and Children's Hospital between January 2015 and December 2020, involving 686 women with preeclampsia after exclusions based on specific criteria.

- Patients were classified using International Classification of Diseases 10th Revision (ICD-10) codes for different types of preeclampsia, and diagnosis was based on outlined medical criteria.

- ELA was administered to one group of participants, with meticulous safety and efficacy protocols followed, while the other group received no analgesia. Data on primary (intrapartum cesarean section) and secondary outcomes were collected, and statistical analyses, including propensity score matching, were utilized.

- Results showed that ELA was not associated with an increased risk of intrapartum cesarean section in women with preeclampsia, and no significant differences were found in operative vaginal delivery, fetal distress, NICU admission, or ELA-related complications between the ELA and non-ELA groups.

- Subgroup analysis indicated a reduced risk of cesarean section in women with severe preeclampsia who received ELA, supporting the potential efficacy and safety of ELA for labor pain relief in this specific population. The authors recommend larger studies to validate the results and suggest investigating dose-dependent effects of ELA on cesarean section rates in future research.

Reference –

Xi-Zhu Wu et al. (2025). Association Of Epidural Labor Analgesia With Maternal And Neonatal Outcomes In Women With Preeclampsia: A Propensity Score-Matched Single-Center Retrospective Cohort Study. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07155-5.