Labour analgesia and obstetric outcome in heart disease complicating pregnancy in tertiary care center

Subha Sivagami Sengodan, Dhivya Sharona


Background: One of the most severe pain experienced by a woman is during child birth. It is imperative to understand the pain transmission for providing labour analgesia. Hemodynamic status in labour fluctuates greatly during uterine contraction and true labour pains. Therefore, pregnant women with cardiovascular disease need epidural anaesthesia during labour depending upon the type of cardiovascular disease. Objective of this study was to assess the impact of labour analgesia and the obstetric outcome and cardiac events during labour.

Methods: This is an observational study conducted in 46 pregnant women with cardiovascular disease during the period of January 2019 to December 2019 (12 months).

Results: A total of 46 antenatal mother with cardiovascular disease was admitted in the department of obstetrics and gynecology over a period of one year out of which 25 patients who had epidural analgesia during labour and 21 patients who had no epidural analgesia during labour. Cardiovascular events significantly reduced in epidural group (25 patients) and there was no increase in cesarean section in epidural group.

Conclusions: The data showed there was significant decrease in cardiovascular events related to arrhythmia hence decreased maternal morbidity and mortality. There was no associated increase in cesarean section rate but slight increase in instrumental vaginal delivery.


Analgesia, Arrhythmia, Epidural anesthesia, Heart disease complicating pregnancy, Instrumental delivery, Labour maternal morbidity and mortality

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Sharma SK, McIntire DD, Wiley J, Leveno KJ. Labor analgesia and caesarean delivery: an individual patient meta-analysis of nulliparous women. Anesthesiol. 2004;100:142e8.

Marucci M, Cinnella G, Perchiazzi G, Brienza N, Fiore T. Patient-requested neuraxial analgesia for labor: impact on rates of cesarean and instrumental vaginal delivery. Anesthesiol. 2007;106:1035e45.

Anim Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2005;19(4):CD000331.

Lieberman E, O’Donoghue C. Unintended effects of epidural analgesia during labour: a systematic review. Am J Obstec Gynecol. Supplement. 2002;186:5;s31-68.

Reynolds F, Sharma SK, Seed PT. Analgesia in labour and fetal acid - base balance: a meta-analysis comparing epidural with systematic opioid analgesia. Br J Obstet Gynaecol. 2002;109:1344.

Liu EHC, Sia ATH. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ. 2004;328(7453):1410.

Leighton BL, Stephen Halpern H. The effect of epidural analgesia on labor, maternal and neonatal outcomes: a systematic review. Am J Obstec Gynecol Supplements. 2002;186:5;s69-77.

Chen SY, Lin PL, Yang YH. The effects of different epidural analgesia formulas on labor and mode of delivery in nulliparous women. Taiwanese J Obstet Gynecol. 2014;53(1):8-11.

Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Syst Rev. 2011;12CD000331.

Singh SK, Yahya N, Misiran K, Masdar A, Nor NM, Yee LC. Combined spinal-epidural analgesia in labour: its effects on delivery outcome. Braz J Anesthesiol. 2016;66(3):259-64.