Post-epidural Collapse: A Rare Obstetric Emergency

Abstract

Aim and objective: To understand and be efficient enough to deal with rare maternal and fetal complications of obstetric analgesia. Background: Epidural analgesia is the most effective method for pain relief during labor. Although complications related to this procedure are rare nowadays due to the expertise achieved, but a potential life-threatening complication of unexpected high block cannot be neglected. Case descriptions: We have encountered two normal parturients who developed sudden cardiorespiratory disturbance within few minutes of administration of epidural analgesia. On a background of worsening maternal clinical status, an emergency cesarean section was performed for severe persistent fetal bradycardia. While one patient recovered completely with no intraoperative complications, the other patient required intubation and intensive care. Postoperatively, echocardiography revealed decreased left ventricular ejection fraction with generalized left ventricular hypokinesia which improved subsequently on medical management. Working hypothesis for cardiomyopathy (Takotsubo) was considered in this case. Conclusion: We should not underestimate the complications that can arise with epidural analgesia, and hence it should always be provided by expert anesthetists in an appropriate set up with resuscitation equipment and drugs. An awareness of such rare complications can prepare obstetricians and nursing staff along with anesthetists to tackle them. Clinical significance: Along with the anesthetists, the obstetrics team should also be able to anticipate such rare entities and take appropriate steps for favorable maternal and fetal outcome.