In VBAC, Epidural Doses Linked to Uterine Rupture Risk

Higher number of doses associated with increased risk of rupture
By Monica Smith
HealthDay Reporter

THURSDAY, April 29 (HealthDay News) -- Frequent epidural anesthesia doses needed by women who attempt vaginal delivery after cesarean delivery (VBAC) may indicate an increased risk for uterine rupture, according to research published in the April issue of the American Journal of Obstetrics & Gynecology.

Alison G. Cahill, M.D., of the Washington University School of Medicine in St. Louis, and colleagues conducted a nested, case-control study of 804 women with a history of cesarean delivery, 134 of whom experienced a uterine rupture during a VBAC trial. The other 670 women were controls. They compared the dose timing, frequency, and quantity of epidural anesthesia between the two groups to estimate the association between epidural dosing and the risk of uterine rupture.

Of the 804 women, the researchers found that 504 (62 percent) received epidural anesthesia, and there was no statistical difference between cases and control subjects in use of epidural. Rates of uterine rupture were higher in those who received more epidural doses, with hazard ratios of 2.8, 3.1, 6.7 and 8.1 for one, two, three and four or more doses, respectively. There was also evidence of increased epidural dosing in the final 90 minutes of labor in women who had a rupture.

"Our findings support the notion that epidural anesthesia does not mask uterine rupture and that the dosing requirements can be viewed as a clinical objective sign, particularly those that increase in number over a 90-minute period," the authors write.

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