Incidence, risk factors and management of epidural haematoma and abscess

Summary

Approximately 140,000 epidurals are placed annually for labour analgesia in the UK. There are two major but rare complications which merit study as they both occur in an occult manner leading to problems with diagnosis and further management. Vertebral canal haematoma is a very rare but potentially devastating complication occurring either during placement or more typically after removal of an epidural catheter. Epidural abscess formation tends to follow a slower course, with symptoms developing over several days. Diagnosis in both cases can be difficult but delay in recognition and treatment leads rapidly to permanent neurological deficit. These complications are commonly mentioned in the pre-procedure counselling given to women. Existing estimates of the incidence of epidural haematoma are based on retrospective studies or meta-analyses of the same and are subject to ascertainment bias in that it is unlikely that all obstetric cases are reported in the available literature. The data themselves come from studies from up to and over 20 years old and practice may have changed not least in the increasing use of Low Molecular Weight Heparin (LMWH). The aims of this study are to use the UK Obstetric Surveillance System (UKOSS) to describe the incidence, management and outcomes of women with an epidural haematoma or abscess in the UK and examine potential risk factors.