Labor epidural analgesia in pre-eclampsia: a prospective study.
OBJECTIVE
To assess the safety of labor epidural analgesia in subjects with pre-eclampsia.


METHODS
Nulliparous laboring women were included in the prospective study. One hundred pre-eclamptic nullipara who were given epidural analgesia (group I) were compared with 100 nullipara with pre-eclampsia who were not given epidural analgesia (group II). The outcome was further compared with 200 women who were not pre-eclamptic, but who were given epidural analgesia (group III), and also with 200 women who were normotensive and who were not given epidural analgesia (group IV).


RESULTS
In group I, 58% of subjects delivered normally compared with 60% in group II. The operative vaginal delivery rate was 28% in group I compared with 24% in group II (P = 0.62), and the cesarean section rate was 14% and 16% in groups I and II, respectively, (P = 0.8). The difference was not statistically significant. The incidence of a prolonged second stage of labor was also not increased in pre-eclamptic women who received epidural analgesia. Five of the neonates in group I had a 5-min APGAR score <6 compared with seven neonates in group II. The necessity of neonatal resuscitation was also not significantly increased in group I (P = 1.0). The incidences of fetal distress (P = 0.71), non-progressive second stage of labor (P = 0.66) and cephalopelvic disproportion (P = 0.90) were not statistically different in the pre-eclampsia group compared with the non-pre-eclampsia group. Similar results were noted when these outcome measures were compared with the other two groups. With regard to hypotension and tachycardia in the pre-eclamptic subjects who were given epidural analgesia, no statistical difference (P = 0.72) was seen when compared with the normotensive subjects.


CONCLUSIONS
In the absence of coagulopathy, epidural analgesia is a safe and effective method for labor pain relief, even for subjects with pre-eclampsia.
Patel
Purvi
P
Department of Obstetrics and Gynecology, Medical College and Shree Sayaji General Hospital, Baroda, India. patel_purvi_k@hotmail.com
Desai
Pankaj
P
Gajjar
Fulva
F
D000328:Adult; D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology*; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D014147:Tramadol / Q000008:administration & dosage; D016896:Treatment Outcome
D000700:Analgesics; D014147:Tramadol; D002045:Bupivacaine