Epidural Anaesthesia in Labour: Influence on Surgical Delivery Rates, Intrapartum Fever and Blood Loss

Abstract

We retrospectively analyzed 7,317 fully documented deliveries to assess the effect of epidural anaesthesia (EA) on surgical delivery rates, on the incidence of intrapartum fever and on peripartal blood loss. 1,056 (14.4%) had EA and 6,261 (85.6%) had no or other analgesia. The use of EA was associated with a decreased spontaneous delivery rate (50.0 vs. 79.2%), increased forceps delivery rate (30.7 vs. 4.0%) and increased vacuum extraction rate (3.5 vs. 0.7%). The caesarean section rate was not significantly changed in patients with EA (14.4 vs. 13.0%). Fever greater than 38°C during labour and intrapartum haemorrhage exceeding 500 ml were associated with the use of EA.

The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study

“…Although some studies have observed no effect of epidural analgesia on maternal temperature during labor, 24,25 other studies have indicated such an association. [26][27][28][29] The temperature elevation observed with labor epidural analgesia likely represents a non-infectious systemic inflammatory process; 30 however, thermoregulatory mechanisms present within the neuraxial column may have a role. 26 The thermoregulatory modulation of epidural solutions at varying temperatures should be further explored in a study adequately powered to evaluate this effect.…”

Labor Epidural Fever and Chorioamnionitis

“…Similarly, Greenwell et al 26 concluded that "Among low-risk women receiving epidural analgesia, intrapartum maternal temperature >99.51F was associated with adverse neonatal outcomes," without highlighting that prolonged labor was a highly significant (P < 0.0001) predictor that offered a much more plausible explanation of the observed association. As Segal 27 noted in a recent review article, studies that make mention of maternal temperature while investigating effects of labor analgesia can be categorized as observational [28][29][30][31][32] and randomized controlled trials. [33][34][35][36][37] The common thread among those studies is that although there is a higher proportion of mothers who have Z1 temperature reading >100.41F in the epidural group, patients receiving epidural analgesia also tend to have longer labor, one of the known risk factors for chorioamnionitis.…”

The effect of epidural analgesia on labour progress and mode of delivery

“…A recent study from the Department of Anesthesiology at Baylor College of Medicine concluded that there is strong evidence that the use of epidural analgesia during labour is associated with an increase in instrumental deliveries. In this comparison there were 609 consecutive patients having an instrumental 29 Nulliparous Parous Combined parity Diro, 1985 6 Combined parity Poore, 1985 5 Combined parity Kaminski, 1987 30 Nulliparous Parous Combined parity Cox, 1988 31 Combined parity Lurie, 1987 31 Combined parity Neuhoff, 1989 32 Nulliparous Thorp, 1989 7 Nulliparous Eakes, 1990 33 Nulliparous Thorp, 1991 9 Nulliparous Paterson, 1992 16 Nulliparous Parous Combined parity Peaceman, 1993 34 ' 1 Nulliparous Bright, 1993 35 Combined parity Cammu, 1994 11 Nulliparous Newton, 1995 17 Combined parity Hawkins-1,1995 36 Nulliparous Hawkins-ll, 1995 36 Nulliparous Parous Combined parity Hueston, 1995 37 Combined parity Ploeckinger, 1995 38 Combined parity Ueberman, 1996 3at Nulliparous delivery and 246 controls having a spontaneous vaginal delivery. The second part was a case control study designed to determine factors, in addition to epidural analgesia, associated with an increase in instrumental delivery.…”

“…The investigators controlled for possible confounding variables such as birth weight, cervical dilation on admission, duration of labour and oxytocin use. 9 Table 5 reviews 15 retrospective studies reporting caesarean section rates in epidural and non-epidural groups in over 55,000 parturie n t s 6,7,9,11,16,20,28,[32][33][34][35][37][38][39]46 spective studies were specifically designed to address the relationship of intrapartum epidurai analgesia and caesarean section and all four suggest a significant association. This large variance in caesarean birth could not be explained by potentially confounding variables.…”