Epidural Anesthesia during labor on Infants Apgar: Systematic Review Article

Background: Epidural analgesia provides the most effective pain control during labor. However, the preoccupation regarding the possible negative effects on the neonates one of the greatest hindrances in the way of its wider use. Infant Apgar is a fast and reliable way of assessing infant health in the early stages of birth. The aim of the study is to assess the effect of epidural analgesia on the Infants Apgar. Methods: In this systematic review of 43 clinical trial of Epidural analgesia and Apgar in databases Scopus, PubMed, ScienceDirect GoogleScholar, Iranmedex, ISI, of 17 studies that had been done during labor, in years 1987-2017 were examined. Results: Epidural analgesia is a central nerve block technique that is used as a form of pain relief in labour. Apgar coefficient contains the sum of the scores for the five clinical findings, derivedfrom the first letter of the words Appearance, Pulse ,Grimace, Activity, Respiration. Some studies indicate that opioids of Epidural analgesia can induce side effects in neonates, such as respiratory depression and neurobehavioural changes. Perhaps the reason is that Epidural analgesia is associated with slowly progressing labor, thus resulting in an increased rate of instrumental delivery and affect the neonatal outcomes. The increased incidence of hypotension by the rapid onset of sympathetic blockade under spinal anaesthesia has been associated with a decline in uteroplacental blood flow and significant fetal acidosis, which may compromise neonatal well-being. Nevertheless, a decrease in fetal pH has not been shown to reduce neonatal Apgar or neurobehavioural assessment scores. Maternal blood pressure can be preserved with little side effects with low dose(50 micrograms of sufentanil) of vasopressors. The infants whose mothers received 80 micrograms sufentanil showed a mild neurobehavioraldepression. In most studies long-term neonatal outcomes were not reported. All neonates were vigorous at 5 minutes and had good Apgar Scores, umbilical cord acid base status, and Neurological Adaptive Capacity Scores. Conclusion: Epidural analgesia is a safe and effective method of pain relief during labor, No adverse effects on infants as determined by Apgar scores or in admissions to neonatal intensive care.