Neurological complications following obstetric neuraxial anaesthesia: a four-year United Kingdom population-based study of epidural haematoma and epidural abscess (2014–2017)

Background

Epidural haematoma and epidural abscess are rare but serious complications of obstetric neuraxial anaesthesia. We investigated their incidence, diagnosis, management, and outcomes in the UK.

Methods

This prospective, population-based study used the UK Obstetric Surveillance System to collect data on all cases of epidural haematoma or abscess occurring in obstetrician-led UK maternity units between January 2014 and December 2017.

Results

Six cases of epidural haematoma and 11 of epidural abscess were confirmed, giving estimated incidences of 1.97 (95% CI 0.72 to 4.29) and 3.61 (95% CI 1.80 to 6.46) per 1,000,000 maternities, respectively. Women with haematoma commonly reported pain or tenderness (3/6) and fever (2/6). All women with abscess presented with pain; eight had tenderness, six fever, and four lower limb motor block. Diagnosis was confirmed by MRI in all cases. Risk factors for haematoma included perinatal anticoagulant therapy (1/6) and multiple catheter attempts in one woman. Among women with abscess, aseptic precautions were potentially suboptimal in around 70% of cases. No immunodeficiency was reported. Two women with haematoma and six with abscess underwent surgery, with antibiotics used in one and four of these cases, respectively. Three women with abscess received antibiotics alone. Expectant management was used in two-thirds of haematoma cases and one abscess case. There were no maternal deaths, ICU admissions, stillbirths, or neonatal deaths, though three women experienced major maternal morbidity.

Conclusions

Epidural abscess and haematoma were rare complications of obstetric neuraxial anaesthesia in the UK, with most women recovering well, though a minority experienced major morbidity.