ArticleBMJ (Clinical research ed.)2024
Epidural analgesia during labour and severe maternal morbidity: population based study.
Article in BMJ (Clinical research ed.), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed.
- Epidural Analgesia in Labor: A Nationwide Evaluation of Utilization in Germany.Deutsches Arzteblatt international · 2026Observational
- Methodological considerations when studying ethnic disparities in epidural access.Anaesthesia · 2026Article
- Labour epidural analgesia and early childhood behavioural outcomes: the moderating role of maternal mental health and pro-inflammatory cytokines.Anaesthesia · 2026Article
- Article
- Determinants of labor epidural analgesia uptake and associations with maternal-neonatal outcomes: a stratified cohort study with risk prediction modeling.BMC pregnancy and childbirth · 2026Article
- Comfort or necessity: obstetricians' perspectives on the drivers, consequences, and recommendations for reducing caesarean section rates in Turkey.BMC pregnancy and childbirth · 2026Article
- A scoping review of barriers experienced by underserved and rural maternal populations in accessing epidural analgesia in the United States.Journal of anesthesia · 2026Article
- Comparison of epidural anesthesia and intravenous self-control analgesia on postoperative recovery quality in duodenectomy.World journal of gastrointestinal surgery · 2026Article
- "Scientific trends of pharmacological methods in labor pain management: bibliometric analysis of epidural, spinal, and other approaches, 2000-2025".Revista da Associacao Medica Brasileira (1992) · 2026Review
- Epidural Analgesia Duration and Postpartum Blood Pressure Trajectory in Hypertensive Pregnancies: A Time-to-Event Analysis.International journal of women's health · 2026Article
- Effect of health education based on the Transtheoretical Model on pregnant women's knowledge, attitudes, and practices toward painless delivery: a quasi-experimental study.Frontiers in public health · 2026Article
- A History of Pregnancy Loss is a Risk Factor for Severe Maternal Morbidity in a First Live Birth: A Retrospective Cohort Study.International journal of women's health · 2026Article
- Article
- Article
- Review
- The experience of manual removal of placenta in women with retained placenta: a qualitative study.BMC pregnancy and childbirth · 2025Article
- Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration.BMJ (Clinical research ed.) · 2025Article
- Maternal fever, epidural analgesia, and genetics: implications for the neonate.British journal of anaesthesia · 2025Article
- Severe maternal morbidity in the high income setting: a systematic review of composite definitions.EClinicalMedicine · 2025Article
- Comparison of Surgical Anesthesia Onset Between Dural-Puncture Epidural and Standard Epidural Techniques for Emergency Cesarean Section: Protocol for a Randomized Controlled Trial.Journal of pain research · 2025Article
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6 authors.
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Abstract
objectivesTo determine the effect of labour epidural on severe maternal morbidity (SMM) and to explore whether this effect might be greater in women with a medical indication for epidural analgesia during labour, or with preterm labour.
designPopulation based study.
settingAll NHS hospitals in Scotland.
participants567 216 women in labour at 24+0 to 42+6 weeks' gestation between 1 January 2007 and 31 December 2019, delivering vaginally or through unplanned caesarean section.
main outcome measuresThe primary outcome was SMM, defined as the presence of ≥1 of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or a critical care admission, with either occurring at any point from date of delivery to 42 days post partum (described as SMM). Secondary outcomes included a composite of ≥1 of the 21 CDC conditions and critical care admission (SMM plus critical care admission), and respiratory morbidity.
resultsOf the 567 216 women, 125 024 (22.0%) had epidural analgesia during labour. SMM occurred in 2412 women (4.3 per 1000 births, 95% confidence interval (CI) 4.1 to 4.4). Epidural analgesia was associated with a reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), SMM plus critical care admission (0.46, 0.29 to 0.73), and respiratory morbidity (0.42, 0.16 to 1.15), although the last of these was underpowered and had wide confidence intervals. Greater risk reductions in SMM were detected among women with a medical indication for epidural analgesia (0.50, 0.34 to 0.72) compared with those with no such indication (0.67, 0.43 to 1.03; P<0.001 for difference). More marked reductions in SMM were seen in women delivering preterm (0.53, 0.37 to 0.76) compared with those delivering at term or post term (1.09, 0.98 to 1.21; P<0.001 for difference). The observed reduced risk of SMM with epidural analgesia was increasingly noticeable as gestational age at birth decreased in the whole cohort, and in women with a medical indication for epidural analgesia.
conclusionEpidural analgesia during labour was associated with a 35% reduction in SMM, and showed a more pronounced effect in women with medical indications for epidural analgesia and with preterm births. Expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health.
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