(651) Do significant adverse reactions to labor epidural anesthesia affect interval to delivery?

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Epidural anesthesia during labor may lead to maternal hypotension and changes in fetal heart rate (FHR). We have evaluated whether occurrence of such adverse reactions affect the interval to delivery after anesthesia.

Study Design: Cohort study of all laboring women who underwent epidural anesthesia during labor for the period October 1, 2020-December 31, 2020. Excluded were cases of elective CD, non-cephalic presentation, twins or multiples, fetal death, and gestational age < 37.0 weeks. Significant adverse reactions included severe maternal hypotension (defined as systolic blood pressure < 100 mm Hg in the 60 minutes after epidural or decreasing by >20% compared with before epidural) or presence of severe (prolonged or recurrent late) decelerations in the 60 minutes after epidural. Occurrence of any significant adverse reaction was related to the interval-to-delivery after completion of epidural anesthesia using linear regression analysis (SPSS 28).

Results: Among the 438 women in the cohort, significant adverse reactions to epidural occurred in 172 (39.2%), including severe maternal hypotension in 149 (34%) and severe FHR decelerations in 50 (11.4%). Interval-to-delivery after labor epidural anesthesia was associated with maternal age (P=0.007), body mass index (P < 0.001), cervical dilation at epidural (P < 0.001) as well as occurrence of severe adverse reactions to epidural (P=0.019), cesarean delivery (CD) (P < 0.001) and CD for non-reassuring FHR (P=0.009). Linear regression demonstrated that only cervical dilation at epidural (P < 0.001) and CD (P < 0.001) were related to interval-to-delivery after epidural, whereas adverse reactions to epidural were not (P=0.22).

Conclusion: Although significant adverse reactions to labor anesthesia were not uncommon in our cohort, they did not independently affect interval-to-delivery after completion of anesthesia.

Primary & Presenting Author(s)

Alessandro Ghidini, MD
Medical Director
Inova Alexandria Hospital
Alexandria, Virginia, United States

Coauthor(s)

KV
Kelly Vanasche, RN
Inova Alexandria Hospital
Alexandria, Virginia, United States
AC
Alyssa Cacace, N/A
Inova Alexandria Hospital
Alexandria, Virginia, United States
MC
Marietta Cacace, RN
Inova Alexandria Hospital
Alexandria, Virginia, United States
SF
Simona Fumagalli, CNM
University of Milano-Bicocca
Monza, Lombardia, Italy
Anna Locatelli, MD (she/her/hers)
Department of Medicine and Surgery, University of Milano Bicocca
Milano, Lombardia, Italy