Efficacy of epidural analgesia with ropivacaine on labor, maternal, and neonatal: a meta-analysis of prospective and retrospective studies

Background: Epidural analgesia is generally accepted as the most effective method for pain relief during labor. However, results of published studies regarding the efficacy of epidural analgesia with ropivacaine on the modes of delivery, labor progression, need for oxytocin, maternal and neonatal outcomes are inconsistent. Objective: We conducted a comprehensive meta-analysis to appraise the efficacy and security of ropivacaine epidural analgesia on labor, maternal and neonatal. Methods: Databases of the PubMed, Embase, and Cochrane Library were searched independently by 2 reviewers to retrieve eligible studies that compare the influence of ropivacaine epidural analgesia (REA) on labor, maternal and neonatal with non-epidural analgesia (NEA) in parturients. Primary outcomes were the modes of labor, duration of labor and the need for oxytocin, and secondary outcomes were maternal outcomes (pain scores, nausea, vomiting and pruritus), and neonatal outcomes (Apgar scores, umbilical artery pH). Standardised mean difference (SMD) or odds ratio (OR) with their 95% confidence intervals (CIs) were calculated by fixed-or random-effects models, depending upon the heterogeneity of the included trials. Sensitivity analyses and subgroup analyses were also performed. Newcastle-Ottawa Scale (NOS) was applied to assess the qualities of all included studies. Results: A total of eight studies (four prospective and four retrospective studies) with ten trials involving 18832 parturients were included in this analysis. Comparing with the NEA, the rate of spontaneous vaginal delivery was decreased, the risk of instrumental delivery was increased, and the second stage of labor was prolonged in the REA group (OR 0.61, 95% CI 0.43-0.87, P=0.006, I-2=84%; OR 2.2, 95% CI 1.93-2.54, P=0.000, I-2=13%; SMD 0.58, 95% CI 0.41-0.75, P=0.000, I-2=89%, respectively). There were no statistical differences of the rate of cesarean delivery (OR 1.26, 95% CI 0.82-1.96, P=0.296, I-2=83%), the need for oxytocin (OR 1.43, 95% CI 0.95-2.13, P=0.09, I-2=95%), and the first stage of labor (SMD 0.27, 95% CI-0.40-0.93, P=0.427, I-2=99%) between two groups. Pain scores were significantly lower in parturients receiving epidural ropivacaine when comparing to those with non-epidural method of relieving pain or those with no any way for pain relief in labour. No differences concerning maternal outcomes (nausea, vomiting and pruritus) and neonatal adverse events (Apgar scores, umbilical artery pH) were observed. Conclusions: This meta-analysis shows that REA increases the rate of instrumental delivery and the duration of the second stage of labor, and decreases rate of spontaneous vaginal delivery. However, REA does not affect the rate of cesarean delivery, the need for oxytocin and the first stage of labor. However, all the results should be interpreted cautiously, as heterogeneous data are used for analyzing.