Background and Aims Epidural analgesia is accepted as the gold standard for pain relief in labour. Maternal obesity is increasingly common and is known to be associated with morbidity. The American Society of Anesthesiologists suggests early placement of an epidural in women with obesity to reduce the need for general anaesthesia if an emergent procedure becomes necessary. We wanted to review the use of epidural analgesia and how commonly it was used for emergent caesarean section.
Methods We conducted a retrospective review from 2019 to 2022. This was done by searching the notes for women with a BMI >40 kg.m-2. The search identified age, BMI, use of epidural analgesia and type of anaesthetic.
Results We identified a total of 780 women with an average BMI of 42.7 kg.m-2. 166 women (21.2%) had an epidural placed for pain relief in labour. The mode of delivery following epidural analgesia is shown in the attached chart.
Conclusions Our results show a low uptake of epidural analgesia in this group which is similar to the rate in the non-obese population. The most common mode of delivery following epidural analgesia was spontaneous vaginal delivery. Only 29% of epidurals were used for category 1 and 2 LSCS. This questions the recommendation about an early epidural in this group. We either need to advocate more strongly for epidurals to improve their usage in this group or stop giving this advice and accept that only in a small minority of cases will an epidural prevent use of a GA in an emergent procedure.
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