Epidural analgesia at trial of labour after caesarean section. A retrospective cohort study over 12 years

Abstract

Epidural analgesia at trial of labour after caesarean section. A retrospective cohort study over 12 years Valeria Filippi1 , Luigi Raio2 , Sophia Amylidi-Mohr2 , Rudolf Tschudi3 , Daniele Bolla1, * 1Department of Obstetrics and Gynaecology, Hospital of Langenthal, 4900 Langenthal, Switzerland 2Department of Obstetrics and Gynaecology, University Hospital of Bern, 3010 Bern, Switzerland 3 Sevisa AG, 8280 Ermatingen, Switzerland *Correspondence: d.bolla@sro.ch (Daniele Bolla) DOI:10.31083/j.ceog4804144 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 5 April 2021 Revised: 2 May 2021 Accepted: 27 May 2021 Published: 15 August 2021 Background: Epidural analgesia (EA) in patients at trial of labour after caesarean section (TOLAC) remains a matter of controversy due to fear of masking symptoms suggestive of uterine rupture. The aim of this study was to evaluate if EA during TOLAC increases the risk of maternal and foetal complications. Methods: This study utilized a database containing details of deliveries collected prospectively by a Swiss obstetric study group over a 12-year period. The cohort was dichotomised between women with and without EA during delivery. Contingency tests and Spearman rank correlation were used for statistical analyses. A p < 0.05 was considered significant. Results: Of 4401 women, 1736 (39.4%) were delivered with EA (Group 1) and 2665 (60.6%) without (Group 2). Overall, 56.1% of the women delivered vaginally. Group 1 had a higher vaginal operative delivery birth rate (24.9% vs 9.5%, p < 0.0001) while Group 2 showed a greater rate of emergency caesarean section (49.1% vs 31.50%; p < 0.0001). The overall incidence of uterine rupture was 20/4401 (0.45%) with no difference between groups. Conclusions: EA during TOLAC appears to improve vaginal delivery without increasing maternal and foetal morbidity or uterine ruptur. Keywords Caesarean section; Uterine rupture; Vaginal delivery; Epidural analgesia