The use of epidural analgesia during trial of labor after cesarean section (TOLAC)

Introduction Epidural analgesia (EA) is an effective treatment for pain relief but for patients who wish a TOLAC, the use of EA still remains a matter of debate. The aim of this study was first to evaluate the use of EA in patients with a TOLAC increases the risk of uterine rupture (UR) and to investigate differences in maternal and fetal outcome.

Material and methods We analyzed anonymized database of women in Switzerland from 2005-2017.

Inclusion criteria were singleton uncomplicated pregnancies with a history of one previous CS scheduled for vaginal birth. The cohort was dichotomized between those with and without EA during delivery.

Results Out of 429.863 deliveries, 4401 cases fullfied our entry criteria. Of those 1736 (39.4%) patients delivered with EA (group 1) and 2665 (60,6%) patients without (group 2). Overall, 56.1% of the women included in this study delivered vaginally. A higher vaginal operative delivery birth rate was found in group 1 compared to group 2 (63.16%vs36.84%, p< 0.0001). Noteworthy, in group 2 the rate of emergency CS was higher than in group 1 (68.5%vs31.50%; p< 0.0001). Similarly, parameters of fetal outcome such as birth weight, Apgar and umbilical cord pH were also significantly different between the groups. The overall prevalence of UR was 20/4401 (0.45%) cases with TOLAC. There was no difference between the groups comparing cases with UR.

Conclusion EA during TOLAC is not associated with a significant increased risk of UR and seems to improve vaginal delivery without influencing maternal and fetal morbidity.

Publication History

Article published online:
07 October 2020