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Labor

Poster Session 4

(1074) The impact of post-epidural hypotension requiring vasopressor treatment on mode of delivery

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To investigate the impact of post-epidural hypotension on the risk of cesarean delivery and, secondarily, to assess the impact of post-epidural hypotension on perinatal outcomes.

Study Design: Retrospective cohort study of intrapartum individuals with post-epidural hypotension requiring treatment with either ephedrine or phenylephrine between 2015-2021 at a single institution. A control group who received an epidural without need for vasopressors was randomly selected in a 4:1 ratio compared to the exposure group. Individual characteristics and perinatal outcomes were collected from the electronic medical record. A chi-square test was used to analyze categorical outcomes including the primary outcome of mode of delivery, and a logistic regression was performed to assess confounding by covariates including age, BMI, nulliparity, induction and premature rupture of membranes.

Results: A total of 3474 subjects were included in the cohort with 694 having post-epidural hypotension and 2780 without hypotension. Post-epidural hypotension requiring treatment with vasopressors was associated with a nearly 3 times increased risk of cesarean delivery compared to no hypotension requiring vasopressors after epidural (24.6% vs. 8.2%; RR 2.99, 95% CI 2.5- 3.6). This finding persisted in the logistic regression model (aOR 3.29, 95% CI 2.6-4.1). Additionally, post-epidural hypotension increased the risk for adverse neonatal outcomes including NICU admission (RR 3.39, 95% CI 2.4-4.9) and neonatal oxygen requirement (RR 2.45, 95% CI 1.6-3.7) compared to no hypotension after epidural placement.

Conclusion: Individuals with post-epidural hypotension requiring vasopressor treatment have an increased risk of cesarean delivery compared to those who do not have epidural hypotension requiring treatment. These findings are relevant for patient counseling, and future studies are needed to develop strategies to prevent post-epidural hypotension.