SEDATIVE AND ANALGESIC COCKTAIL DURING PARTURITION: ADVERSE EFFECTS ON NEONATES?

Objective: To compare the neonatal outcome in women who received a sedative and analgesic medication during labor vs. women who did not.

Methods: A consecutive sample of 5,196 nulliparous women not receiving medication and 411 nulliparous women receiving treatment with a combination of triazolam, codeine or morphine, terbutaline, and paracetamol (the medical cocktail) during prolonged latent phase of labor. Data on delivery, neonatal status, and transmission to neonatal intensive care unit (NICU) were extracted from patient files. Main outcome measures were Apgar scores, umbilical artery pH, mode of delivery, and transmissions to NICU.

Results: Women who received the medical cocktail had a lower frequency of vaginal delivery (P = 0.01) and a higher risk of cesarean section due to birth complications (P < .001). Vaginally delivered neonates after cocktail had a lower five-minute Apgar score (P = .002). There were no significant differences in umbilical artery pH or transmissions to NICU between cases and controls. The risk of adverse neonatal outcome was unrelated to the time between medication and delivery.

Conclusions: Women treated with a sedative and analgesic cocktail had an increased risk of instrumental delivery, cesarean section, and low Apgar scores, which may be explained by maternal characteristics and prolonged labor in women requesting the cocktail.