Impact of labor epidural analgesia on maternal and neonatal outcomes with trial of labor in previous caesarean delivery: A prospective, controlled, longitudinal study

Abstract

Background: Labor outcome with regional anesthesia following previous cesarean section has been fraught with concerns regarding uterine rupture. There is sparse literature regarding the association between the impact of epidural analgesia and labor outcome in vaginal birth after cesarean section (VBAC). This study aims to evaluate the effect of labor epidural analgesia on labor outcome following TOL (Trial of labor) in previous cesarean or normal delivery with maternal and neonatal outcomes. Material and Methods: This is a prospective controlled longitudinal study in second-gravida patients in labor. A total of 132 patients were enrolled for the study out of which 101 were divided into three groups. Group A included 38 second-gravid women with a history of previous caesarean delivery and Group B included 32 second-gravid having previous normal vaginal delivery, both the groups received epidural analgesia during labor. Group C included 31 second-gravid with a history of previous cesarean section who did not receive epidural analgesia during labor. The aim of the study was to evaluate labor outcome in terms of successful vaginal delivery with or without epidural analgesia, along with visual analogue scale (VAS) pain scores during the conduction of delivery, hemodynamic parameters, and progress of trial of labor (TOL). Other obstetric and neonatal parameters were also evaluated. Results: Vaginal delivery was conducted in all patients in Group B (32/32; 100%) and Group C (31/31; 100%), whereas in Group A, two patients underwent emergency cesarean section as a result of impending uterine rupture in one case and acute fetal hypoxia in another. According to the intensity of pain on VAS, women having previous cesarean delivery experienced more severe pain before starting epidural analgesia (VAS in Groups A and C; 7.9 ± 0.2) as compared to previous vaginal delivery (VAS; Group B 6.4 ± 0.2) (P 0.05) Cervical dilatation on admission to the maternity ward was 4.1 ± 1.0 (Group A and C) and 4.0 ± 1.0 (Group B). The total consumption of ropivacaine in epidural analgesia was significantly high in Group A (previous CD) (29.6 ± 1.2 mg) as compared to Group B (previous vaginal delivery) (28.1 ± 1.6 mg) (P < 0.0001). Conclusions: Epidural analgesia is an effective and safe method of analgesia for vaginal delivery after previous cesarean section, and does not involve the risk of untimely diagnosis of impending uterine rupture.

Keywords

• epidural analgesia
• labor pain
• uterine rupture
• uterine scar
• vaginal delivery