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EP078 Motor blockade in labor analgesia: look at the bright side
  1. Ana Franco1,
  2. Roberto Ameiro2,
  3. Nuno Lareiro1,
  4. Raquel Pontes2 and
  5. Tiago Gomes2
  1. 1Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  2. 2Department of Anesthesiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal


Background and Aims Vaginismus is a condition characterized by an aversion to vaginal penetration due to actual or anticipated pain. This can pose challenges during pregnancy and delivery.

Methods We report a case of a 25-year-old pregnant woman from Bangladesh with severe vaginismus admitted in the labor unit for induction at 41 weeks of gestation. It should be noted that the patient wished to experience a eutocic delivery. Therefore, induction was initiated with endovaginal prostaglandin under fetal monitoring, despite the background. A few hours later, the patient started to develop contractions and did not tolerate further obstetric evaluations due to severe pain on vaginal examination. After a multidisciplinary discussion, we decided to proceed with epidural anesthesia before any further examinations. Ropivacaine 0.5% was used to produce analgesia and motor blockade ate S2-S4 level to reduce spasming. The remaining vaginal evaluations were uneventful. A trial of vaginal labor was attempted, but eventually induction failure was presumed, and the patient underwent cesarean section under epidural anesthesia. Postoperative analgesia included intravenous paracetamol and ketorolac and fixed epidural boluses of ropivacaine. Maternal and fetal outcomes were favorable, and the parturient reported satisfaction with the adopted approach. Recent improvements in labor epidural analgesia have prioritized pain relief without motor blockade. Vaginismus increases the risk of requiring instrumentation, or cesarean delivery, as well as perineal and vaginal trauma.

Conclusions Early epidural analgesia with some degree of motor blockade can be a valid approach in the management of the laboring woman with vaginismus, facilitating vaginal delivery, reducing complications, and ensuring patient satisfaction.

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