title: Risk factors and peripartum outcomes of failed epidural: a prospective cohort study.
abstract: OBJECTIVE
  Awareness to rate, risk factors, and the associated peripartum outcomes of failed epidural analgesia (FEA) may improve expectations and labor management. We aimed to identify risk factors for FEA and to examine peripartum outcomes associated with failure.
  
  
  METHODS
  A prospective cohort study conducted between March 2015 and August 2015, at a single university medical center. Laboring women at ≥34 weeks, receiving epidural analgesia, were eligible. Pain was evaluated using a 0-10 cm visual analogue scale (VAS). FEA was defined as VAS score ≥5, 30 min after the loading dose. The primary outcome was to identify risk factors for FEA. In addition, second-stage duration and operative vaginal delivery rate were also examined. Univariate logistic regression and stepwise multivariate logistic regression were performed to estimate the predictors for FEA.
  
  
  RESULTS
  Of all 414 women included, 35 (8.5%) had FEA. Multivariate stepwise logistic regression revealed that fetal head station 1 cm above the ischial spines (p = 0.002, adjusted OR 5.4, 95% CI 1.9-16.0), oxytocin use (p = 0.026, adjusted OR 2.8, 95% CI 1.1-6.8), and seniority of the anesthesiologist (p = 0.046, adjusted OR 0.97, 95% CI 0.93-0.99) at epidural insertion were found as significant variables associated with FEA. Second-stage duration and operative vaginal delivery rate did not differ significantly between women with failed and successful epidural.
  
  
  CONCLUSIONS
  Higher fetal head station and oxytocin use may be associated with higher failure rate. Labor outcomes related to epidural use, occurred at comparable rates, among women with failed and successful epidural.
authors.affiliation: Department of Anesthesiology, Emek Medical Center, Afula, Israel.
authors.forename: Carmen
authors.initials: C
authors.lastname: Bucstain
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel.|Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Gali
authors.initials: G
authors.lastname: Garmi
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel.|Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Noah
authors.initials: N
authors.lastname: Zafran
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel.
authors.forename: Sivan
authors.initials: S
authors.lastname: Zuarez-Easton
authors.affiliation: Department of Anesthesiology, Emek Medical Center, Afula, Israel.
authors.forename: Julia
authors.initials: J
authors.lastname: Carmeli
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel. salim_ra@clalit.org.il.|Rappaport Faculty of Medicine, Technion, Haifa, Israel. salim_ra@clalit.org.il.
authors.forename: Raed
authors.identifier: http://orcid.org/0000-0002-3603-8452
authors.initials: R
authors.lastname: Salim
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007746:Labor Presentation; D007743:Labor, Obstetric; D016015:Logistic Models; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects; D010147:Pain Measurement; D058725:Peripartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D010121:Oxytocin
keywords: Epidural analgesia; Failed epidural analgesia; Labor pain; Risk factors