Trial of labor: a study of 110 patients.

STUDY

OBJECTIVE

The purpose of the study was to determine whether epidural analgesia is unsafe for trial of labor (TOL).

DESIGN

Retrospective chart review.

SETTING

Inpatient obstetric department at a university medical center.

PATIENTS: One hundred ten ASA physical status I and II term parturients who attempted a TOL between December 1987 and June 1988.

INTERVENTIONS: All the parturients previously had low transverse uterine incisions and received continuous electronic fetal and uterine pressure monitoring throughout labor. All the parturients were offered epidural analgesia during labor with bupivacaine 0.25%.

MEASUREMENTS AND MAIN

RESULTS

Sixty-seven percent of the parturients had successful vaginal delivery. Fifty-one of the 110 parturients had epidural analgesia for labor. There were two complete uterine ruptures; neither had epidural catheters. Both of the complete ruptures presented with monitored fetal distress rather than abdominal pain. Both mothers and their infants recovered uneventfully.

CONCLUSIONS

Uterine rupture presents as monitored fetal distress rather than abdominal pain. Thus, epidural analgesia can be used in patients attempting a TOL.