Complications & Outcome with Epidurals for Labour: Analysis of Seven Years Experience

Abstract

Objectives: To audit the incidence of obstetric epidural complications and its outcome at Fatima Memorial Hospital. Lahore Methods: All parturients who received epidurals for painless deliveries in the labour room of Fatima Memorial Hospital from 1999 to 2005 were included in this audit. All parturients received bolus of 500-l000ml of Ringers lactate or 0.9%) Normal saline prior to insertion of epidural catheter. Information regarding parturient’s name, age, gravida (primi or multi), effectiveness of epidural or any complication was noted by anaesthetist on register kept in the anaesthesia office. Results: Out of 25916 deliveries during seven years, 2610 (10.07%) parturients received epidural for painless delivery. Those who received epidurals, 437 developed one or more complications. The overall incidence of complications was 19.57% Consultants gave epidural to 2004 parturients (76.90%) and residents gave to 602 parturients (23.10%). The most common complication or complaint was shivering, 166 parturient (6.36%). Next common was hypotension, 162 parturients (6.20%). Inadequate analgesia and missed segment noted in 99 (3.79%) parturients. Post-delivery urinary retention was problem in 25 (0.95%). Dural puncture occurred in 15 (0.57%) and three (0.11%) received blood patch for control of persistent post dural puncture headache. In three parturients procedure was abandoned. Other complication like Intravascular injection noted in two (0.07%), Catheter blockade in three (0.11%), Reinsertion of catheter required in five (0.190/) and High spinal noted in three (0.11%) parturients. One parturient had total spinal and intubated. Eight (0.30%) parturients complained backaches. Out of 2610, parturients who received epidurals 237 (9.09 underwent Caesarian sections, 185 (7.09%) deliveries were assisted by Vacuum and 150 (5.57%) by outlet forceps. Conclusion: Every sixth parturient (16.747%) is susceptible to get some form of complications when epidural analgesia is offered for pain relief but these complications can be detected early and managed if monitoring facilities available.