Accidental Dural Puncture During Labor Analgesia and Obstetric Outcomes in Nulliparous Women

Abstract

(Int J Obst Anesth. 2019;38:46–51) An accidental dural puncture (ADP) is a common adverse event during epidural procedures, occurring in up to 1.5% of patients receiving neuraxial analgesia for labor. Yet, little is known about the effect of ADP on obstetric outcomes. Possible interventions following ADP in obstetric patients include intrathecal catheter placement or a repeat epidural catheter placement—both of which can provide effective analgesia with no evidence of significant differences in obstetric outcomes. However, comparisons of obstetric outcomes between women with an ADP and those with uncomplicated epidural analgesia have not been reported. This study aimed to investigate whether ADP was associated with a prolonged second stage of labor or a higher incidence of instrumented vaginal delivery or cesarean delivery due to the failure of labor to progress compared with uneventful epidural placement.