Epidural Analgesia During Labour in Twin Pregnancy

Abstract

Summary We report on the use of epidural analgesia during labour in 58 out of a total of 234 twin deliveries performed over a five‐year period. A comparable control group consisted of 44 twin pregnancies delivered consecutively during the year preceding the introduction of epidural analgesia into our department. Epidural analgesia shortened the mean time of labour and made possible the performance of all necessary instrumental and obstetrical manoeuvres, without additional anaesthesia or adverse effects on the second twin. The epidural group required oxytocin more often due to an increased incidence of hypotonic uterine dysfunction. There was also a considerable increase of instrumental deliveries in the epidural group. The condition of the newborn infants of both groups, evaluated by Apgar score at one minute, was similar, but there was a higher perinatal mortality among pre‐term infants delivered under epidural analgesia. Epidural analgesia was found to be an acceptable method of relieving pain in twin labour, but because of the increased necessity to use oxytocin and the relatively high perinatal mortality observed among pre‐term infants, further experience is necessary before it can be claimed that this is the method of choice for relief of pain in twin labour.

Trends in the use for labor analgesia in twin pregnancies: A nationwide register-based analysis in Finland

“…The use for epidural analgesia was notably higher among twin pregnancies, where at least the first neonate was born vaginally when compared to singleton pregnancies. This is also supported by the findings in previous literature [3] , [4] , [5] . These studies concluded that epidural analgesia was the best choice for the mode of delivery and the health of twins, as it reduced the average duration of labor and allowed for all required instrumental and obstetric procedures to be performed, without the need for supplementary anesthesia or any negative effects on the second twin [3] , [4] , [5] .…”

“…These studies concluded that epidural analgesia was the best choice for the mode of delivery and the health of twins, as it reduced the average duration of labor and allowed for all required instrumental and obstetric procedures to be performed, without the need for supplementary anesthesia or any negative effects on the second twin [3] , [4] , [5] . However, compared to our study, the study sample was relatively small, and these studies were published in 1977, meaning that the use of labor analgesia may have undergone additional changes and advancements since then, including the development of new techniques and drugs, increased focus on personalized pain management, and improved safety measures [3] , [4] , [5] . There are also few recently published studies on this topic.…”

“…Previous literature has only focused on the effects of epidural analgesia on maternal and fetal outcomes in twin pregnancies. In these studies, epidural analgesia was found to be the optimal option in terms of delivery mode and health of the twins, as it shortened the mean time of labor and made possible the performance of all necessary instrumental and obstetrical maneuvers, without additional anesthesia or adverse effects on the second twin [3] , [4] , [5] . However, a study published in 2019 found that epidural analgesia in twin pregnancies prolongs the second stage of labor in both twins [6] .…”

Relationship between labour analgesia modalities and types of anaesthetic techniques in categories 2 and 3 intrapartum caesarean deliveries

“…A recent study by Parissenti et al [35] demonstrated that EA constitutes a significant risk factor for the failure of vaginal breech delivery, leading to an increased likelihood of intrapartum CD. Jaschevatzky et al [33] reported higher rates of operative vaginal deliveries and higher pre-term perinatal mortality in twin deliveries with EA, despite similar neonatal status (as assessed by the Apgar score at one minute) in both the EA and control groups. Similarly, in a case series of parturients with multiple gestations who delivered vaginally, a higher incidence of low Apgar-minus-color scores at 1 min among the second twins of at least 36 weeks gestation was reported in the EA group [32].…”

“…Firstly, women opting for remifentanil-PCA often present with contraindications for epidural analgesia. Additionally, certain obstetric conditions, such as a history of previous CD, twin gestation, or a breech presentation, may pose heightened risks with epidural analgesia, prompting a preference for alternative analgesic approaches [31][32][33][34]. A recent study by Parissenti et al [35] demonstrated that EA constitutes a significant risk factor for the failure of vaginal breech delivery, leading to an increased likelihood of intrapartum CD.…”