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Background <p>Labor pain is a major physiological and psychological stressor for women during childbirth. Epidural analgesia is widely recognized as the most effective form of pain relief in labor, yet its utilization varies greatly, and uncertainty remains regarding its determinants and potential impact on maternal and neonatal outcomes. This study aimed to identify factors influencing the use of epidural analgesia and to evaluate its associations with labor progression and postpartum hemorrhage.</p> Methods <p>This retrospective cohort included 1035 women who delivered at our hospital between 2020 and 2023. Univariable and multivariable logistic regression analyses were performed to identify independent determinants of epidural analgesia use. A clinical prediction model was developed and compared with eleven machine learning classifiers using receiver operating characteristic analysis. Associations between epidural analgesia and maternal-neonatal outcomes, particularly postpartum hemorrhage, were evaluated.</p> Results <p>Younger maternal age, primiparity, and lower pre-delivery fibrinogen levels were independently associated with the use of epidural analgesia. The logistic regression model demonstrated good discrimination (AUC = 0.70, 95% CI: 0.66–0.75), comparable to that of the machine learning models. Among vaginal deliveries, epidural analgesia was associated with longer total, first-stage, and second-stage labor durations (<i>P</i> &lt; 0.001) but did not increase the incidence of postpartum hemorrhage or adverse maternal-neonatal outcomes. Across the entire cohort, higher pre-delivery D-dimer (OR = 1.54, 95% CI: 1.08–2.20, <i>P</i> = 0.017) and fibrinogen (OR = 1.34, 95% CI: 1.07–1.67, <i>P</i> = 0.010) levels were independent risk factors for postpartum hemorrhage, whereas epidural analgesia itself was not.</p> Conclusions <p>Maternal age, parity, and coagulation status are key factors influencing the choice of epidural analgesia. Although epidural analgesia prolongs labor, it does not increase postpartum hemorrhage or other adverse outcomes. These findings support the safety of epidural analgesia and highlight the importance of assessing coagulation function to improve individualized labor management and prevent postpartum complications.</p>

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Determinants of labor epidural analgesia uptake and associations with maternal-neonatal outcomes: a stratified cohort study with risk prediction modeling

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月4日

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  • Ling Guo,
  • Yan Song,
  • Yumei Zhang,
  • Qian Sun,
  • Wei Liu,
  • Yanan Liang,
  • Fengchun Gao,
  • Yaqiu Guo

摘要

Background

Labor pain is a major physiological and psychological stressor for women during childbirth. Epidural analgesia is widely recognized as the most effective form of pain relief in labor, yet its utilization varies greatly, and uncertainty remains regarding its determinants and potential impact on maternal and neonatal outcomes. This study aimed to identify factors influencing the use of epidural analgesia and to evaluate its associations with labor progression and postpartum hemorrhage.

Methods

This retrospective cohort included 1035 women who delivered at our hospital between 2020 and 2023. Univariable and multivariable logistic regression analyses were performed to identify independent determinants of epidural analgesia use. A clinical prediction model was developed and compared with eleven machine learning classifiers using receiver operating characteristic analysis. Associations between epidural analgesia and maternal-neonatal outcomes, particularly postpartum hemorrhage, were evaluated.

Results

Younger maternal age, primiparity, and lower pre-delivery fibrinogen levels were independently associated with the use of epidural analgesia. The logistic regression model demonstrated good discrimination (AUC = 0.70, 95% CI: 0.66–0.75), comparable to that of the machine learning models. Among vaginal deliveries, epidural analgesia was associated with longer total, first-stage, and second-stage labor durations (P < 0.001) but did not increase the incidence of postpartum hemorrhage or adverse maternal-neonatal outcomes. Across the entire cohort, higher pre-delivery D-dimer (OR = 1.54, 95% CI: 1.08–2.20, P = 0.017) and fibrinogen (OR = 1.34, 95% CI: 1.07–1.67, P = 0.010) levels were independent risk factors for postpartum hemorrhage, whereas epidural analgesia itself was not.

Conclusions

Maternal age, parity, and coagulation status are key factors influencing the choice of epidural analgesia. Although epidural analgesia prolongs labor, it does not increase postpartum hemorrhage or other adverse outcomes. These findings support the safety of epidural analgesia and highlight the importance of assessing coagulation function to improve individualized labor management and prevent postpartum complications.