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Objective

To estimate the association between epidural dosing and risk of uterine rupture in women attempting VBAC.

Study Design

A nested case-control study within a multicenter retrospective cohort of> 25, 000 women with a prior cesarean was performed, comparing cases of uterine rupture to women without rupture (controls) while attempting VBAC. Extensive data extraction included all medications in 15-minute increments. In women who attempted VBAC with an epidural anesthetic, dose timing, frequency, and quantity were compared between cases and controls. Time-to-event analyses were performed to estimate the association between epidural dosing and risk for uterine rupture while accounting for duration of labor and confounding effects.

Results

Of 804 women in the nested case-control study; 504 (62.7%) had an epidural, with no statistical difference in epidural usage rates between cases and controls …