What is the rate of cesarean section (C-section) after administration of epidural (regional) anesthesia?

From the Guidelines

Epidural anesthesia during labor does not significantly increase the rate of cesarean sections (C-sections). The available evidence suggests that the rate of C-section after administration of epidural anesthesia is not significantly different from those without epidural anesthesia 1. Studies have shown that there is no significant difference in the rate of instrumental delivery or C-section rate between patients who received an intrathecal catheter and those who received a primary functioning epidural catheter 1.

Key Findings

• No significant difference in time from neuraxial insertion until birth, rate of instrumental delivery, or C-section rate between intrathecal catheter and primary functioning epidural catheters 1
• No difference in duration of the second stage of labor or C-section rate between intrathecal catheter and re-sited epidural catheters 1
• Accidental dural puncture, which may be managed by intrathecal catheter or re-sited epidural catheter, was associated with a prolonged second stage of labor, but the effect could not be assigned to either technique 1

Clinical Implications

The benefits of effective pain management during labor with epidural anesthesia generally outweigh the minimal, if any, increased risk of cesarean delivery associated with epidural use. Most major obstetrical organizations support providing epidural analgesia when requested without concern that it will lead to unnecessary surgical deliveries. The use of epidural anesthesia should be based on individual patient needs and preferences, rather than concerns about increasing the risk of C-section.

From the FDA Drug Label

A prospective meta-analysis on 6 of these studies provided detailed evaluation of the delivered newborns and showed no difference in clinical outcomes compared to bupivacaine. Table 8 Labor and Delivery Meta-analysis: Mode of Delivery Delivery Mode Ropivacaine Hydrochloride N= 199 Bupivacaine N= 188 N % N % Spontaneous Vertex 116 58 92 49 Vacuum Extractor 26 27 Forceps 33 40 Cesarean Section 29 15 21 11 *p=0.004 versus bupivacaine

The rate of Cesarean Section after administration of epidural (regional) anesthesia with Ropivacaine Hydrochloride is 15% 2.

From the Research

Rate of Cesarean Section after Administration of Epidural Anesthesia

• The rate of cesarean section after administration of epidural anesthesia is not directly stated in the provided studies, but the rate of conversion to general anesthesia for urgent cesarean among women with labor epidural analgesia is reported to be 3.4% 3.
• A study found that despite a rapid increase in epidural analgesia during labor, the rates of cesarean delivery overall and for dystocia remained the same 4.
• Another study reported that the incidence of general anesthesia for cesarean section in parturients with pre-existing epidural analgesia for labor was 4.1% 5.
• The total rate of failure (including general anesthesia and inadequate anesthesia) was reported to be 5.9% in a study of 501 patients who had a cesarean section after epidural labor analgesia 5.

Factors Associated with Conversion to General Anesthesia

• Factors associated with conversion to general anesthesia for urgent cesarean among women with labor epidural analgesia include:
  • Cervical dilation ≥ 5 cm at the time of epidural placement 3
  • Asymmetric sensory blockade 3
  • Need for ≥ 2 rescue top-ups 3
  • Category 1 cesarean 3
  • Maternal height and the number of clinician top-ups in labor 5

Epidural Anesthesia for Elective Caesarean Section

• Studies have compared the effects of different local anesthetics, such as ropivacaine and bupivacaine, for epidural anesthesia in elective cesarean section 6, 7.
• These studies found that both ropivacaine and bupivacaine provided effective epidural anesthesia for cesarean section, with similar outcomes and adverse event profiles 6, 7.