Assessment of the Impact of Epidural Anesthesia on Postpartum Hemorrhage Risk in Vaginal Delivery: A Retrospective Study
Abstract
Thomas Botti*, Tamara Zec, Nadine Lenoir, Aude Vermoezen, Celine Van Lerberghe and Seyed Javad Bidgoli
Background: Post-partum hemorrhage is a major complication of childbirth. Obstetric epidurals are often implicated in the occurrence of post-partum hemorrhage. Given the paradoxical data in the literature, we aim to retrospectively evaluate the impact of epidural on the risk of post-partum hemorrhage, instrumental delivery and the occurrence of risk factors for post- partum hemorrhage.
Material and Methods: We retrospectively analyzed 5753 records of patients with vaginal deliveries at the Brugmann University Hospital between January 1, 2020, and December 31, 2021. Our primary objective was to evaluate whether the epidural constitutes a risk of post-partum hemorrhage. Secondly, we assessed whether epidurals increase the risk of childbirth instrumentation and the emergence of risk factors for post-partum hemorrhage.
Results: A total of 4143 patients were included in our study. No significant difference was observed between the "epidural" and "no epidural" groups regarding postpartum blood loss (340.72mL ± 410.05 vs 354.14mL ± 371.08; p=0.2996). The "epidural" group had a higher rate of instrumental delivery (11.23% vs 6.99%; p<0.001) and obstetric trauma (33.93% vs 29.41%; p=0.0029). The rate of coagulopathy was higher in the " no epidural" group (1.51% vs 5.79%; p<0.001). No significant difference was observed for uterine atony (5.89% vs 5.79%; p=0.8939) and tissue abnormalities (7.15% vs 8.59%; p=0.1099).
Conclusion: Epidural anesthesia is not associated with an increased risk of post-partum hemorrhage in patients who have undergone vaginal delivery. However, it is associated with a higher rate of instrumental delivery and obstetric trauma.