Epidural Anesthesia during Labor and Delivery and its Influence on postpartum Blood Loss

Introduction and Aim:

Epidural anesthesia (EDA) is widely used for pain management during labor and delivery. The influence of EDA on postpartum bleeding was assessed by few studies with contradicting results and without validated methods of accurate blood loss measurement. Aim of this study is to investigate blood loss after vaginal delivery in women with EDA in consideration of established risk factors for postpartum bleeding and by using a prior validated blood measurement technique.

Methods:

699 patients were prospectively included into this cohort study. Blood loss was assessed by a validated measurement technique. Included were all vaginal deliveries at the University Hospital of Zurich from October 2015 until November 2016. Exclusion criteria comprised breech presentation, multiple fetus pregnancies, retained placental tissue, morbidly adherent placenta, early preterm birth. Risk factors for increased blood loss (such as uterine atony, vacuum delivery, placental abruption, parity, gestational age and duration of second stage labor amongst others) were assessed and stratified by EDA use. Significant variables were entered into a stepwise multivariate regression analysis.

Results:

Women with EDA showed a significantly higher blood loss when compared to women without EDA (median 400 [IQR 300 – 500] mL versus 300 [IQR 250 – 400] mL, p< 0.001) in the univariate analysis. Furthermore, women with EDA were more likely primiparous, experienced more often uterine atony and postpartum hemorrhage, major perineal laceration, vacuum delivery, longer second stage of labor and bigger neonatal head circumference. After multivariate regression analyses the association between increased blood loss and epidural anesthesia did not remain significant.

Conclusion:

The association of EDA with increased blood loss after delivery is found in the univariate analysis only. EDA is associated with bigger neonatal head circumference, prolonged second stage of labor, uterine atony, vacuum delivery and major perineal laceration, which all had an effect on blood loss remaining statistically significant in the multivariate analysis as well. Increased blood loss in women with EDA might be observed due to obstetric complications and not to EDA itself.