TY - JOUR
T1 - Frequent epidural dosing as a marker for impending uterine rupture in patients who attempt vaginal birth after cesarean delivery
AU - Cahill, Alison G.
AU - Odibo, Anthony O.
AU - Allsworth, Jenifer E.
AU - Macones, George A.
N1 - Funding Information:
Supported in part by the National Institute of Child Health and Human Development Grant no. R01 HD 35631 (G.A.M.).
PY - 2010/4
Y1 - 2010/4
N2 - Objective: The purpose of this study was to estimate the association between epidural dosing and the risk of uterine rupture in women who attempt vaginal birth after cesarean delivery (VBAC). Study Design: A nested case-control study within a multicenter retrospective cohort of >25,000 women with previous cesarean delivery compared cases of uterine rupture with women without rupture (control subjects) while attempting VBAC with epidural anesthesia. Dose timing, frequency, and quantity were compared. Time-to-event analyses were performed to estimate the association between epidural dosing and risk for uterine rupture while accounting for labor duration. Results: Of 804 women in the nested case-control study, 504 women (62.7%) had epidural anesthesia, with no statistical difference in epidural usage rates between cases and control subjects (70.4% vs 62.4%; P = .09). Cox-regression analysis revealed a dose-response relationship between the number of epidural doses and uterine rupture risk: 1 dose (hazard ratio, 2.8; 95% confidence interval [CI], 1.4-5.7), 2 doses (hazard ratio, 3.1; 95% CI, 2.2-6.2), 3 doses (hazard ratio, 6.7; 95% CI, 3.8-12.1), ≥4 doses (hazard ratio, 8.1; 95% CI, 5.4-18.2). Conclusion: Clinical suspicion for uterine rupture should be high in women who require frequent epidural dosing during a VBAC trial.
AB - Objective: The purpose of this study was to estimate the association between epidural dosing and the risk of uterine rupture in women who attempt vaginal birth after cesarean delivery (VBAC). Study Design: A nested case-control study within a multicenter retrospective cohort of >25,000 women with previous cesarean delivery compared cases of uterine rupture with women without rupture (control subjects) while attempting VBAC with epidural anesthesia. Dose timing, frequency, and quantity were compared. Time-to-event analyses were performed to estimate the association between epidural dosing and risk for uterine rupture while accounting for labor duration. Results: Of 804 women in the nested case-control study, 504 women (62.7%) had epidural anesthesia, with no statistical difference in epidural usage rates between cases and control subjects (70.4% vs 62.4%; P = .09). Cox-regression analysis revealed a dose-response relationship between the number of epidural doses and uterine rupture risk: 1 dose (hazard ratio, 2.8; 95% confidence interval [CI], 1.4-5.7), 2 doses (hazard ratio, 3.1; 95% CI, 2.2-6.2), 3 doses (hazard ratio, 6.7; 95% CI, 3.8-12.1), ≥4 doses (hazard ratio, 8.1; 95% CI, 5.4-18.2). Conclusion: Clinical suspicion for uterine rupture should be high in women who require frequent epidural dosing during a VBAC trial.
KW - cesarean delivery
KW - epidural dosing
KW - uterine rupture
KW - vaginal delivery
UR - http://www.scopus.com/inward/record.url?scp=77949879280&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2010.01.041
DO - 10.1016/j.ajog.2010.01.041
M3 - Article
C2 - 20350643
AN - SCOPUS:77949879280
VL - 202
SP - 355.e1-355.e5
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
SN - 0002-9378
IS - 4
ER -