Safety of labor epidural anesthesia for women with severe hypertensive disease. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
OBJECTIVE
The aim of this study was to determine whether epidural anesthesia during labor increased the frequencies of cesarean delivery, pulmonary edema, and renal failure among women with severe hypertensive disease.


METHODS
We performed a secondary retrospective analysis of a subgroup population within a multicenter double-blind trial of low-dose aspirin therapy for women at high risk for development of preeclampsia. Subjects in whom severe hypertensive disease developed were selected. The primary outcomes were the overall frequencies of cesarean delivery among women with severe hypertensive disease who had labor with and without epidural anesthesia. Other maternal and neonatal outcomes were also compared between women who did and did not receive epidural anesthesia.


RESULTS
Among the women with severe hypertensive disease (n = 444) 327 had labor. Among the women with severe disease who had labor there was no difference in either the overall cesarean delivery rate (32.1% vs 28.0%; P =.44) or the rate of cesarean delivery for fetal distress or failure to progress (27.8% vs 22.0%; P =.26) between women who did and did not receive epidural analgesia. Women with chronic hypertension were more likely to have a cesarean delivery overall if they received epidural anesthesia, but there was otherwise no difference in the frequencies of cesarean delivery for these indications between women with and without epidural anesthesia within each of the high-risk groups. Pulmonary edema was rare and acute renal failure did not develop in any women.


CONCLUSIONS
Epidural anesthesia use did not increase the frequencies of cesarean delivery, pulmonary edema, and renal failure among women with severe hypertensive disease.
Hogg
B
B
University of Alabama at Birmingham, Department of Obstetrics and Gynecology 35233-7333, USA.
Hauth
J C
JC
Caritis
S N
SN
Sibai
B M
BM
Lindheimer
M
M
Van Dorsten
J P
JP
Klebanoff
M
M
MacPherson
C
C
Landon
M
M
Paul
R
R
Miodovnik
M
M
Meis
P J
PJ
Thurnau
G R
GR
Dombrowski
M P
MP
McNellis
D
D
Roberts
J M
JM
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D005316:Fetal Distress; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015994:Incidence; D007231:Infant, Newborn; D007743:Labor, Obstetric; D015337:Multicenter Studies as Topic; D011225:Pre-Eclampsia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011249:Pregnancy Complications, Cardiovascular; D018566:Pregnancy, High-Risk; D011654:Pulmonary Edema / Q000453:epidemiology* / Q000209:etiology; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety
D001241:Aspirin