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Clinical Obstetrics

Poster Session 1

(117) Pregnancy and delivery outcomes of women who underwent a VBAC with and without epidural analgesia

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary Author(s)

  • Merav jacobs, MD

    Soroka University Medical Center
    Beer-Sheva, HaDarom, Israel

    • Coauthor(s)

  • Tamar Eshkoli, MD

    Senior
    Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
    Beer Sheva, HaDarom, Israel, Israel

  • Alla Saban, MD, MPH

    Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
    Beer Sheva, HaDarom, Israel, Israel

  • YB

    Yael Baumfeld, MD

    Soroka Medical Center
    Beer-Sheva, HaDarom, Israel

    • Presenting Author(s)

  • RB

    Renana Ben shushan Amor, MD

    Soroka University Medical Center
    Beer-Sheva, HaDarom, Israel

    • Coauthor(s)

  • zY

    zehava Yohay, MHA, RN

    Pain Unit, Soroka University Medical Center, Beer Sheva, Israel
    Soroka medical center, HaDarom, Israel

  • AW

    Adi Y. Weintraub, MD

    Soroka Medical Center
    Beer-Sheva, HaDarom, Israel

Objective:

To evaluate whether there is an association between Epidural Analgesia (EA) during VBAC (vaginal birth after cesarean) and pregnancy and delivery outcomes.

Study Design:

In this retrospective population-based cohort study, all women who underwent a VBAC with and without EA, between the years 1996-2016 at the Soroka University Medical Center (SUMC) were included. Women who delivered by cesarean section (elective and non-elective) and those who gave birth to a newborn with chromosomal abnormalities or major malformations, and multifetal gestations were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. Univariate analysis was followed by a multivariate analysis to control for confounders. A p-value of < 0.05 was considered statistically significant.

Results:

During the study period 17,516 women who have had a previous CS met the inclusion criteria, of which 15% (n= 2652) used EA during labor, while the rest of the cohort 85% (n= 14,864) were non-EA users. Women in the EA group had higher rates of instrumental delivery and postpartum hemorrhage (PPH) as well as higher rates of oxytocin augmentation and a longer second stage of labor . The use of EA was found to be an independent risk factor for instrumental delivery after controlling for maternal age, ethnicity, parity, DM (diabetes mellitus), hypertensive disorders of pregnancy, oxytocin augmentation and prolonged second stage of labor . However, no significant differences were observed regarding neonatal outcomes including perinatal mortality, birth weight, Apgar scores and shoulder dystocia rates.

Conclusion:

EA for women undergoing a VBAC was associated with higher rates of instrumental delivery and PPH, oxytocin augmentation and a longer second stage of labor compared with women without EA. However, neonatal outcomes did not differ between the groups.