Regional epidural analgesia for labour following previous caesarean section. A 15 year review, 1972–1987

Summary

Epidural analgesia was employed in 345 (25.5 per cent) of 1350 patients labouring after a previous caesarean section between 1972–1987. On retrospective analysis of results for 1972–1982, a vaginal delivery success of 88 per cent was associated with an unacceptable ‘procedure related' perinatal mortality and incidence of true rupture of the uterus. Stricter management policies were implemented for 1982–1987 with particular attention to the use of a strict regimen for oxytocin administration, continuous cardiotocography and termination of the labour by repeat caesarean section after 6 hours of active labour if vaginal delivery was not imminent. This resulted in an 82 per cent vaginal delivery rate, no perinatal death associated with delivery and elimination of true rupture of the uterus. Oxytocin for induction or acceleration of labour was given to 50 per cent of patients overall and there was a 50 per cent assisted vaginal delivery rate. Comparisons with patients not having epidural analgesia, delivered concurrently, showed it to be safe for mother and fetus in properly conducted labour. No maternal death occurred in these patients but there were two deaths in patients with elective repeat caesarean sections.