Safety of labor epidural anesthesia for women with severe hypertensive disease

OBJECTIVE: The aim of this study was to determine whether epidural anesthes ia during labor increased the frequencies of cesarean delivery, pulmonary e dema, and renal failure among women with severe hypertensive disease. STUDY DESIGN: We performed a secondary retrospective analysis of a subgroup population within a multicenter double-blind trial of low-dose aspirin the rapy for women at high risk for development of preeclampsia. Subjects in wh om severe hypertensive disease developed were selected. The primary outcome s were the overall frequencies of cesarean delivery among women with severe hypertensive disease who had labor with and without epidural anesthesia. O ther maternal and neonatal outcomes were also compared between women who di d and did not receive epidural anesthesia. RESULTS: Among the women with severe hypertensive disease (n = 444) 327 had labor. Among the women with severe disease who had labor there was no diff erence in either the overall cesarean delivery rate (32.1% vs 28.0%; P = .4 4) or the rate of cesarean delivery for fetal distress or failure to progre ss (27.8% vs 22.0%; P = .26) between women who did and did not receive, epi dural analgesia; Women with chronic hypertension were more likely to have a cesarean delivery overall if they received epidural anesthesia, but there was otherwise no difference in the frequencies of cesarean delivery for the se indications between women with and without epidural anesthesia within ea ch of the high-risk groups. Pulmonary edema was rare and acute renal failur e did not develop in any women. CONCLUSION: Epidural anesthesia use did not increase the frequencies of ces arean delivery,pulmonary edema, and renal failure among women with severe h ypertensive disease.