[Concealed rupture of the uterus during continuous epidural anaesthesia (author's transl)]

A thirty-nine year old gravida 2 was allowed to have a trial of labor 4 years after Cesarean section. A continuous epidural anaesthesia was applied. During the well placed epidural anaesthesia pain in the cesarean section scar area started. Despite a normal fetal heart rate and normal intra-uterine pressure, normal pulse and blood pressure the trial of labor was discontinued and a repreat caesarean section for impending rupture of the uterus was performed. During the caesarean section a 2 cm. long concealed rupture without bleeding was found in the old scar. The importance of stringent criteria for indications for continuous epidural anaesthesia is stressed. The lowest effective dose of local anaesthesia need to be used. Continual intensive monitoring is necessary in order to detect a pathological pain during a continuous epidural anaesthesia.