Analgesia protocol
In CMRC, obstetric analgesia is not considered a pain management
standard during labour and is not used in any patient. In contrast, CUB
incorporates obstetric analgesia as the standard of care for all
patients; therefore, all participants with NLA were limited to CUB.
Maternal vital signs and foetal tracing were monitored during analgesia
(Philips IntelliVue MP20). All patients were evaluated by a consultant
obstetrician every 3 h. At the patient’s request, a cervical examination
was performed at the time of analgesia. We defined the active phase of
the first stage of labour as cervical dilation ≥ 4 cm and cervical
effacement ≥ 80%. The neuraxial blockade technique (epidural, spinal,
or combined spinal-epidural) was selected according to the stage of
labour. In patients with cervical dilation below 5 cm, the epidural
technique was the preferred technique, while in those > 5
cm accompanied by moderate to severe pain, combined spinal-epidural
analgesia was selected. The visual analogue scale for pain (VAS-P) was
used for pain assessment. The entire protocol is described in