Lumbar epidural analgesia during labour was associated with a five-fold higher rate of instrumental delivery and a more than three-fold higher rate of fetal malposition (20%) versus no regional analgesia.
Observational
Does lumbar epidural analgesia increase the risk of instrumental delivery and fetal malposition in women in labour?
Lumbar epidural analgesia during labour is associated with significantly higher rates of instrumental delivery and fetal malposition.
The incidence of instrumental delivery and malposition immediately before delivery was compared in patients who were given lumbar epidural analgesia and those who were not. Instrumental delivery was five times more common and a malposition of the fetal head was more than three times as common in the epidural group as in women who did not receive regional analgesia. Similar incidences were found even when the epidural was electively chosen before labour in the absence of medical indications. The instrumental delivery rate was affected by parity, the length of the second stage of labour, and the return of sensation by the second stage but not by other factors studied. The high incidence (20%) of malposition associated with epidural analgesia was not affected by any of the factors studied. The psychological and physical disadvantages of malposition and instrumental delivery have yet to be assessed. In the meantime, when there are no medical indications for epidural analgesia, the advantages of pain relief should be weighed against those of a normal spontaneous delivery.
Hoult et al. (Sat,) conducted a observational in Labour. Lumbar epidural analgesia vs. No regional analgesia was evaluated on Incidence of instrumental delivery and fetal malposition. Lumbar epidural analgesia during labour was associated with a five-fold higher rate of instrumental delivery and a more than three-fold higher rate of fetal malposition (20%) versus no regional analgesia.