Influences of epidural labor analgesia on maternal postpartum cognitive function after vaginal delivery: a prospective cohort study
Bibliographic record
Abstract
Objective To investigate the incidence of cognitive dysfunction in postpartum women who underwent epidural or non-drug labor analgesia and the influence factors. Methods A prospective cohort study was performed in 1 618 uneventful singleton pregnancies in International Peace Maternity and Child Health Hospital from January 2017 to January 2018. Women who received epidural labor analgesia were assigned to the epidural group (n=803), and those who received Doula technique non-drug labor analgesia rather than labor analgesia to the control group (n=815). Cognitive function was assessed using symbol digit modalities test (SDMT90) and Montreal cognitive assessment (MoCA) 1 d and 42 d after delivery. Incidence of maternal cognitive dysfunction, SDMT90 scores and pain intensity measured by visual analogue score (VAS) at the cervical dilatation of 3, 6 and 10 cm between the two groups were compared using independent sample t-test, Chi-square test or logistic regression analysis. Results MoCA and SDMT90 scores of the epidural group were significantly higher than those of the control group 1 d after delivery (27.1±1.5 vs 26.2±1.8, 49.1±2.4 vs 42.5±3.6; t=3.775 and 16.956, both P<0.05), but the incidence of postoperative cognitive dysfunction (POCD) in the epidural group was remarkably lower comparing to the control group [13.9% (112/803) vs 21.2% (173/815), χ2=14.769, P=0.002]. The VAS scores of the epidural group at the cervical dilatation of 3, 6 and 10 cm were all lower than those of the control group (2.3±0.6 vs 6.9±1.3, 3.3±0.9 vs 8.7±0.9, 5.7±0.9 vs 9.7±0.4; t=0.013, 0.011 and 0.015; all P<0.001). Logistic regression analysis indicated that VAS scores ≤ 3 at the cervical dilatation of 3, 6 and 10 cm were protective factors against the incidence of POCD 1 d after delivery [OR(95%CI): 0.238 (0.198-0.287), 0.180 (0.145-0.222) and 0.112 (0.088-0.142), all P<0.001], while the absence of epidural labor analgesia was a risk factor (OR=4.698, 95%CI:1.812-11.321, P<0.001). Conclusions Epidural labor analgesia can reduce the incidence of postpartum cognitive dysfunction in women 1 d after delivery. The incidence of POCD has close relationship with the VAS scores at the cervical dilatation of 3, 6 and 10 cm and epidural labor analgesia. Key words: Labor, obstetric; Analgesia, epidural; Cognitive Dysfunction; Neuropsychological tests; Prospective studies
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".