[1]¿p#1 Objective: To determine whether epidural analgesia is associated with maternal and neonatal outcomes in preterm vaginal delivery. Design: Retrospective cohort study. Setting: Deliveries in Shenzhen Maternity & Child Healthcare Hospital, China. Population or Sample: Preterm parturients with singleton pregnancies and vaginal delivery in 2020-2024. Methods: The association of epidural analgesia with outcomes were examined. Propensity score matching and entropy balancing were used to eliminate potential confounders. Main Outcome Measures: Duration of first, second and third stages of labor, hemorrhage during vaginal delivery and postpartum hemorrhage (and ≥500mL), Apgar scores (and <7) at 1, 5 and 10 minutes, assisted ventilation, NICU admission, neonatal intraamniotic infection, neonatal sepsis, neonatal asphyxia and neonatal respiratory distress syndrome. Results: The study comprised 853 parturients, 564 (66.12%) received epidural analgesia. After propensity score matching, 567 parturients remained, 339 (59.79%) received epidural analgesia. Duration of first and second stages of labor were longer in epidural group than non-epidural group (difference: 6 [95% CI: 4 to 9], difference: 6 [95% CI: 4 to 9], respectively). Epidural analgesia was associated with Apgar score <7 at 1 minute (OR: 0.355 [95% CI: 0.161-0.783], P = 0.010), but not after adjusted covariates (OR: 0.453[ 95% CI: 0.166-1.233], P = 0.121). Conclusions: Use of epidural analgesia in preterm vaginal delivery may increase duration of first and second stages of labor, but associations with other outcomes were not observed.