How does regional anesthesia (epidural or combined spinal-epidural) affect childbirth outcomes?

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Epidural and combined spinal-epidural (CSE) analgesia increase the risk for instrumental vaginal delivery, maternal hypotension, prolonged second stage of labor, and need for oxytocin augmentation, without increasing the overall risk of cesarean section (SOR: A, systemic review of RCTs). They have no immediate adverse effects on neonatal outcomes as determined by low Apgar scores or neonatal intensive care unit (NICU) admission (SOR: A, systematic review of RCTs). There is less risk of instrumental delivery with CSE than traditional epidural (SOR: A, systemic review of RCTs).

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