: More complications than expected were found, probably as a result of the comprehensive study design. Half of the complications were retrieved exclusively from administrative files. Complications occur significantly more often after epidural blockade than after spinal blockade, and the complications are different. Obstetric patients carry significantly lower incidence of complications. Osteoporosis is proposed as a previously neglected risk factor. Close surveillance after central neuraxial blockade is mandatory for safe practice.

Objective The aim of this study was to investigate the occurrence of hyponatraemia following delivery, with a hypothesis that hyponatraemia has a high prevalence in labouring women.Design Prospective observational study.Setting Consultant-led delivery suite in County Hospital, Kalmar, Sweden.Sample A total of 287 pregnant women at term (37 full gestational weeks).Methods Oral fluids were allowed during labour. Blood samples were collected on admission, after delivery, and from the umbilical artery and vein.Main outcome measure Hyponatraemia defined as plasma sodium £130 mmol/l after delivery.Results Hyponatraemia was found in 16 (26%) of the 61 mothers who received more than 2500 ml of fluid during labour. Twothirds of fluids were orally ingested. Decrease in plasma sodium concentration during labour correlated with duration of labour and the total fluid volume administered. Analysis by multivariate logistic regression showed that hyponatraemia was significantly correlated with fluid volume (P < 0.001) but not with oxytocin administration or epidural analgesia. Hyponatraemia correlated significantly with prolonged second stage of labour, instrumental delivery, and emergency caesarean section for failure to progress (P = 0.002).Conclusions Hyponatraemia is not uncommon following labour. Tolerance to a water load is diminished during labour; therefore, even moderate fluid volumes may cause hyponatraemia. Women should not be encouraged to drink excessively during labour. Oral fluids, when permitted, should be recorded, and intravenous administration of hypotonic fluids should be avoided. When abundant drinking is unrecognised or intravenous fluid administration liberal, life-threatening hyponatraemia may develop. The possibility that hyponatraemia may influence uterine contractility merits further investigation.

Estimation of the incidence of neurological complications following central neuraxial blockades to women affected by significant disease on the basis of case reports and small series of patients is impossible. Prospective registration of high-risk patients may increase our knowledge. Application of central neuraxial blockade must follow individual evaluation.

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