Epidural Analgesia Not Directly linked to Postpartum Hemorrhage, reveals study

This prospective study was performed at the University Hospital Zurich. Included were 699 women with vaginal deliveries after 34 weeks of pregnancy. Blood loss was assessed by a validated measurement technique. Risk factors for increased blood loss were assessed and stratified by epidural analgesia use. Significant variables were entered into a stepwise multivariate regression analysis. RESULTS: In the univariate analysis, women with epidural analgesia showed a significantly higher blood loss, compared to women without epidural analgesia. However, after multivariate regression analysis no association between increased blood loss and epidural anesthesia was observed.

Furthermore, women with epidural analgesia were more often primiparous, experienced more often uterine atony and postpartum hemorrhage, bleeding from perineal laceration, vacuum extraction, longer second stage of labor and bigger neonatal head circumference. Epidural analgesia itself is not associated with increased postpartum blood loss. However, there is a higher incidence of PPH in deliveries with obstetric risk factors, in which more frequent use of epidural analgesia is observed. In other words, not epidural analgesia is the cause of PPH, but difficult obstetric settings are associated with both higher use of epidural analgesia and increased blood loss.

Reference:

Sachs, Maike Katja, et al. "Epidural Anesthesia During Labor and Delivery and Postpartum Hemorrhage." Journal of Perinatal Medicine, 2025.