An audit of the labour epidural analgesia service at a regional hospital in Gauteng Province, South Africa

Abstract

Background. Neuraxial analgesia in the form of a labour epidural has been shown to be the most effective analgesic strategy for the labouring mother. In developed countries, data are readily available as to the number of women receiving labour epidural analgesia, as well as the complication rates of labour epidurals. However, data for South Africa (SA) on labour epidural analgesia services are limited, and there were no published data for Rahima Moosa Mother and Child Hospital (RMMCH), Johannesburg, SA. 

Objective. To describe the labour epidural analgesia service at RMMCH over the period of 1 year. 

Methods. A retrospective audit using consecutive convenience sampling was done reviewing all epidural records at RMMCH from 1 January to 31 December 2014. 

Results. During the study period, labour epidural analgesia was administered for 187 (1.6%) of 11 853 deliveries. Epidural records were collected for all administered labour epidurals. The most common indications documented were labour analgesia (41.7%) and primigravida (28.9%). Labour epidurals were not administered for specific medical conditions. The incidence of complications was 22.6%, and these were minor and self-limiting. Hypotension was the most common complication (12.3%). Patient satisfaction with labour epidural analgesia, where documented, was high (98.4%). 

Conclusion. This audit revealed a low incidence of labour epidural analgesia at RMMCH during the study period. The incidence of complications was in keeping with that seen in developed countries. Poor documentation was noted to be a problem.