Effects of combined spinal-epidural anesthesia and epidural analgesia on pain and blood pressure in preeclamptic women undergoing painless delivery.

Abstract

Objective: To analyze the impact of combined spinal-epidural anesthesia and epidural analgesia on pain and blood pressure in preeclamptic women undergoing painless delivery.

Methods: A retrospective analysis was conducted on the clinical data of 137 preeclamptic women who underwent painless delivery at The Second People's Hospital of Linhai City between July 2022 and July 2024. Based on the type of analgesia intervention received, the women were divided into a control group (n=68, receiving Doula delivery analgesia) and an observation group (n=69, receiving combined spinal-epidural anesthesia and epidural analgesia). Labor duration, pain (assessed using the Visual Analogue Scale (VAS)), blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)], serum markers [prolactin (PRL), tissue-type plasminogen activator (t-PA)] levels, and maternal and neonatal outcomes were compared between the two groups.

Results: ① Labor duration: Significant differences were observed between groups (F=10.279), over time (F=35.794), and in their interaction (F=16.589) (P < 0.05). Within groups: both groups had shorter second and third stages of labor compared to the first stage (P < 0.05). Between groups: no significant difference was observed in the second stage (P > 0.05), but the observation group had shorter first and third stages than the control group (P < 0.05). ② Pain: Significant differences were found between the groups (F=19.785), over time (F=8.637), and in their interaction (F=14.492) (P < 0.05). Within groups: both groups had lower VAS scores in the 1-3 stages of labor compared to before analgesia (P < 0.05). Between groups: no significant difference in VAS scores before analgesia (P > 0.05), but the observation group had lower VAS scores in all stages than the control group (P < 0.05). ③ Blood pressure: Significant differences in SBP were found between the groups (F=5.572), over time (F=10.295), and in their interaction (F=8.149) (P < 0.05); similarly, significant differences in DBP were found between the groups (F=4.915), over time (F=9.761), and in their interaction (F=7.784) (P < 0.05). Within groups: both groups had lower SBP and DBP levels at 10 minutes post-analgesia, during the active phase, and in the second stage of labor compared to before analgesia (P < 0.05). Between groups: no significant difference in SBP and DBP levels before analgesia (P > 0.05), but the observation group had lower SBP and DBP levels at 10 minutes post-analgesia, during the active phase, and in the second stage of labor compared to the control group (P < 0.05). ④ Serum indicators: Both groups showed increased PRL and t-PA levels post-delivery compared to pre-delivery (P < 0.05); the observation group had higher post-delivery PRL and lower t-PA levels compared to the control group (P < 0.05). ⑤ Maternal and neonatal outcomes: The observation group had lower rates of cesarean section, postpartum hemorrhage, postpartum blood loss, and neonatal asphyxia compared to the control group (P < 0.05); no significant difference was found in neonatal Apgar scores between the two groups (P > 0.05).

Conclusion: The combined use of spinal-epidural anesthesia and epidural analgesia in preeclamptic women undergoing painless delivery shows significant effectiveness. Compared to Doula delivery analgesia, this method accelerates labor, relieves pain, lowers blood pressure, improves serum indicators, and decreases adverse maternal and neonatal outcomes.