Painless childbirth? Epidural and spinal techniques in obstetric anesthesia

Schyns-van den Berg, A.M.J.V. (2025)

Doctoral Thesis

This dissertation explores complications and side effects of neuraxial anesthesia techniques during childbirth. Using electrohysterography, a prospective observational cohort study evaluates epidural analgesia effects on uterine contraction frequency during active labour, finding a statistically significant though clinically negligible decrease. A RCT investigating intrathecal morphine during spinal anesthesia for Cesarean delivery demonstrates that intrathecal morphine offers no protective effect against chronic postsurgical pain.

A secondary analysis reveals that postpartum depression emerges as a strong predictor of chronic postsurgical pain at three and six months. Another secondary analysis shows an association between preexisting depression and anxiety and postspinal hypotension after spinal anesthesia initiation.
When comparing dosing strategies for Cesarean delivery in short-stature parturients, height-based dosing provides better balance between hemodynamic stability and adequate anesthesia than height/weight-adjusted dosing.

The EPMAP study addresses European practices in post-dural puncture headache management and factors associated with epidural blood patch failure. Results show that only 33% of women experience complete resolution of symptoms. Key predictors of failure include migraine history, higher lumbar level of accidental dural puncture, and early EBP provision, within 48 hours. These studies provide insights in side effects and complications of neuraxial techniques in obstetric anesthesia.

• Obstetrics
• Anesthesia
• Electrohysterography
• Epidural analgesia
• Spinal anesthesia
• Postdural puncture headache
• Accidental dural puncture
• Chronic postsurgical pain
• Caesarean delivery
• Postspinal hypotension

• All authors: Schyns-van den Berg, A.M.J.V.
• Supervisor: Dahan, A.
• Co-supervisor: Karemaker, J.M.; Marel, C.D. van der
• Committee: Sarton, E.Y.; Akker, T.H. van den; Koopman-van Gemert, A.M.M.; Stolker, R.J.; Van de Velde, M.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2025-12-02
• ISBN (print): 9789493483040
• DOI: doi:10.60602/ZVBE-F370