Considerations of Epidural Analgesia in a Patient With Suspected Uterine Rupture

The practice of epidural analgesia in laboring women began to emerge in the 1970s. It is now a common method of pain relief for patients in labor and is used by 63% of women in the hospital setting. The patient who has had a previous cesarean delivery can benefit from having an epidural anesthetic placed early to expedite an emergency, such as a uterine rupture, if necessary. At one time there was a concern for placing an epidural anesthetic in laboring women who had a previous cesarean delivery. It was feared that the epidural anesthesia would mask abdominal pain that may present with a ruptured uterus and delay diagnosis. This worry was quickly dispelled with literature that strongly suggested that epidural analgesia did not disguise the signs or delay diagnosis of uterine rupture. The case presented is one in which pain of a uterine rupture was experienced with a functioning epidural catheter in situ, and successful anesthetic management.