Abstract
AimThis study aimed to examine the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia.MethodsThis retrospective, single-center cohort study, conducted in a university hospital, enrolled term parturients undergoing emergency cesarean section after induction of epidural labor analgesia between September 2015 and May 2019. For the purpose of this study, all cases were re-examined to ensure that they fulfilled the criteria of chorioamnionitis, regardless of the actual indication for cesarean section proposed by obstetricians at the time of application. The primary outcome was failure of conversion of epidural labor analgesia to cesarean delivery anesthesia. Multivariable logistic regression analysis was performed to investigate the association between chorioamnionitis and failure of anesthesia for cesarean section.ResultsAmong the 180 parturients reviewed, 58 (43.9%) fulfilled the criteria for chorioamnionitis. Failure of epidural conversion in the chorioamnionitis (+) group was significantly higher than in the chorioamnionitis (-) group (46.6% [27/58] vs. 18.9% [14/74], crude odds ratio = 3.7, 95% confidence interval: 1.7–8.3). After adjustment for potential confounders (age, body mass index, multiparity, and duration for epidural labor analgesia), chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections (adjusted odds ratio = 3.6, 95% confidence interval: 1.6–8.4).ConclusionsChorioamnionitis is associated with the failed conversion of epidural labor analgesia to cesarean delivery anesthesia.
Highlights
Epidural labor analgesia is widely practiced worldwide, and in the USA, more than 70% of pregnant women opt for it [1]
This study aimed to examine the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia
After adjustment for potential confounders, chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections
Summary
Epidural labor analgesia is widely practiced worldwide, and in the USA, more than 70% of pregnant women opt for it [1]. When an emergency cesarean section is proposed for a parturient who is receiving epidural labor analgesia, epidural analgesia can be converted to operative anesthesia by injecting local anesthetics through the existing epidural catheter. This process is often referred to as epidural conversion [3] and it is thought to be an advantage of having epidural labor analgesia. The risk factors of failed conversion of epidural labor analgesia to cesarean delivery anesthesia have been widely studied [3,4,5,6,7,8,9,10]
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