Perinatal mortality after epidural analgesia

A retrospective survey has been carried out of 6442 births during 1973-1974 in Cardiff. Lumbar epidural block had been administered to the mothers of 13-7% (885) of the births, the principle indication being relief of pain. In the management of the mother special emphasis was laid upon avoiding aorto-caval compression. The perinatal mortality associated with epidural block (14-8 per 1000) was not significantly different from that after other forms of analgesia (19-2 per 1000). There were less first week deaths in babies weighing less than 2-5 kg after epidural block (0 of 45) than in those who had other methods of pain relief (41 of 414) (P = 0-023). The choice of maternal medication did not influence the perinatal mortality rate of the immature baby, but there is a positive but non-significant, trend in favour of epidural block in the premature baby. This improvement in mortality could simply be related to the increased use of forceps delivery associated with epidural block. A controlled trial of epidural block is therefore indicated in the management of the premature fetus. In babies over 2-5 kg, or, those who were immature, epidural block was not associated with a reduction or increase in perinatal mortality.