Skip to main content

Advertisement

SpringerLink
Log in

Obstetrical epidural and spinal anesthesia in multiple sclerosis

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

To examine obstetrical epidural and spinal anesthesia use in women with multiple sclerosis (MS) and the relationship with MS clinical factors. This was a retrospective cohort study, linking clinical data from women with MS in the British Columbia (BC) MS database to obstetrical data (1998–2009) from the BC Perinatal Database Registry. We compared epidural use in 431 deliveries to women with MS and 2,959 deliveries from the general population, as well as spinal use in cesarean deliveries (128 to women with MS and 846 in the general population), considering parity and using multivariate models. We also examined the association between epidural or spinal anesthesia and MS clinical factors—disease duration and disability [Expanded Disability Status Scale (EDSS) score]. Of 431 deliveries to women with MS, 116 were exposed to epidural anesthesia and of 128 cesarean deliveries, 82 were exposed to spinal anesthesia. The use of epidural anesthesia was similar in nullipara (adjusted OR = 0.86, 95 % CI = 0.63–1.18, p = 0.36), but more likely in multipara with MS (adjusted OR = 1.75, 95 % CI = 1.20–2.54, p = 0.004). Spinal anesthesia use in cesarean deliveries was comparable between the MS and general population cohorts (adjusted OR = 0.84, 95 % CI = 0.55–1.31, p = 0.45). Women who delivered 5 to <10 years after MS onset were less likely to have an epidural (adjusted OR = 0.57, 95 % CI = 0.34–0.95, p = 0.03) vs. those delivering within 5 years. EDSS was not associated with use of either type of anesthesia (adjusted p > 0.1). Contrary to previous studies, epidural anesthesia use differed between women with MS and the general population and was influenced by parity and MS disease duration; these findings warrant further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Evans C, Beland SG, Kulaga S et al (2013) Incidence and prevalence of multiple sclerosis in the Americas: a systematic review. Neuroepidemiology 40:195–210

    Article  PubMed  Google Scholar 

  2. Sellner J, Kraus J, Awad A et al (2011) The increasing incidence and prevalence of female multiple sclerosis—a critical analysis of potential environmental factors. Autoimmun Rev 10:495–502

    Article  PubMed  Google Scholar 

  3. Compston A, Coles A (2002) Multiple sclerosis. Lancet 359:1221–1231

    Article  PubMed  Google Scholar 

  4. Shirani A, Zhao Y, Kingwell E et al (2012) Temporal trends of disability progression in multiple sclerosis: findings from British Columbia, Canada (1975–2009). Mult Scler 18:442–450

    Article  PubMed  Google Scholar 

  5. Schrock SD, Harraway-Smith C (2012) Labor analgesia. Am Fam Physician 85:447–454

    PubMed  Google Scholar 

  6. Confavreux C, Hutchinson M, Hours MM et al (1998) Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group. N Engl J Med 339:285–291

    Article  PubMed  CAS  Google Scholar 

  7. Pastò L, Portaccio E, Ghezzi A et al (2012) Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study. BMC Neurol 12:165

    Article  PubMed  Google Scholar 

  8. Dalmas AF, Texier C, Ducloy-Bouthors AS et al (2003) Obstetrical analgesia and anaesthesia in multiple sclerosis. Ann Fr Anesth Reanim 22:861–864

    Article  PubMed  Google Scholar 

  9. Bader AM, Hunt CO, Datta S et al (1988) Anesthesia for the obstetric patient with multiple sclerosis. J Clin Anesth 1:21–24

    Article  PubMed  CAS  Google Scholar 

  10. Vukusic S, Hutchinson M, Hours M et al (2004) Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain 127:1353–1360

    Article  PubMed  Google Scholar 

  11. Jalkanen A, Alanen A, Airas L (2010) Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler 16:950–955

    Article  PubMed  CAS  Google Scholar 

  12. Dahl J, Myhr KM, Daltveit AK et al (2006) Planned vaginal births in women with multiple sclerosis: delivery and birth outcome. Acta Neurol Scand Suppl 183:51–54

    Article  PubMed  CAS  Google Scholar 

  13. van der Kop ML, Pearce MS, Dahlgren L et al (2011) Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol 70:41–50

    Article  PubMed  Google Scholar 

  14. Lu E, Zhao Y, Zhu F et al (2013) Birth hospitalization in mothers with multiple sclerosis and their newborns. Neurology 80:447–452

    Article  PubMed  Google Scholar 

  15. Sadovnick AD, Ebers GC, Wilson RW et al (1992) Life expectancy in patients attending multiple sclerosis clinics. Neurology 42:991–994

    Article  PubMed  CAS  Google Scholar 

  16. Sweeney VP, Sadovnick AD, Brandejs V (1986) Prevalence of multiple sclerosis in British Columbia. Can J Neurol Sci 13:47–51

    PubMed  CAS  Google Scholar 

  17. British Columbia Perinatal Health Program (2010) British Columbia perinatal database registry annual report 2008. www.perinatalservicesbc.ca/NR/rdonlyres/3DEC78D6-BDC3-4602-B09B-FB0EE1C7B7D9/0/SurveillanceAnnualReport2008.pdf. Accessed 17 Aug 2012

  18. Poser CM, Paty DW, Scheinberg L et al (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231

    Article  PubMed  CAS  Google Scholar 

  19. Polman CH, Reingold SC, Edan G et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald criteria”. Ann Neurol 58:840–846

    Article  PubMed  Google Scholar 

  20. Taylor MJ (2006) The management of multiple pregnancy. Early Hum Dev 82:365–370

    Article  PubMed  Google Scholar 

  21. Silver RM, Heuser CC (2010) Stillbirth workup and delivery management. Clin Obstet Gynecol 53:681–690

    Article  PubMed  Google Scholar 

  22. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    Article  PubMed  CAS  Google Scholar 

  23. Youngstrom PC, Baker SW, Miller JL (1996) Epidurals redefined in analgesia and anesthesia: a distinction with a difference. J Obstet Gynecol Neonatal Nurs 25:350–354

    Article  PubMed  CAS  Google Scholar 

  24. Gomar C, Fernandez C (2000) Epidural analgesia-anaesthesia in obstetrics. Eur J Anaesthesiol 17:542–558

    PubMed  CAS  Google Scholar 

  25. Hawkins JL (2010) Epidural analgesia for labor and delivery. N Engl J Med 362:1503–1510

    Article  PubMed  CAS  Google Scholar 

  26. Bucklin BA, Hawkins JL, Anderson JR et al (2005) Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology 103:645–653

    Article  PubMed  Google Scholar 

  27. Vrouenraets FP, Roumen FJ, Dehing CJ et al (2005) Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 105:690–697

    Article  PubMed  Google Scholar 

  28. Dickinson JE, Godfrey M, Evans SF et al (1997) Factors influencing the selection of analgesia in spontaneously labouring nulliparous women at term. Aust N Z J Obstet Gynaecol 37:289–293

    Article  PubMed  CAS  Google Scholar 

  29. Finkelsztejn A, Brooks JB, Paschoal FM Jr, Fragoso YD (2011) What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG 118:790–797

    Article  PubMed  CAS  Google Scholar 

  30. Dahl J, Myhr KM, Daltveit AK, Hoff JM, Gilhus NE (2005) Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology 65:1961–1963

    Article  PubMed  CAS  Google Scholar 

  31. Novikova N, Cluver C (2012) Local anaesthetic nerve block for pain management in labour. Cochrane Database Syst Rev 4:CD009200

    PubMed  Google Scholar 

  32. Pittock SJ, Mayr WT, McClelland RL et al (2004) Disability profile of MS did not change over 10 years in a population-based prevalence cohort. Neurology 62:601–606

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was funded by the Canadian Institutes of Health Research (Operating Grant MOP-106607; PI: Dr. Helen Tremlett). The British Columbia Multiple Sclerosis database is funded by CIHR, MS Society of Canada, National MS Society, the UBC MS/MRI Research Group and an unrestricted grant from Dr. Donald Paty.

We thank the MS patients and the staff of Perinatal Services BC, BCMS database and Pharmacoepidemiology in the MS Research Group for providing data used in this study. We gratefully acknowledge the BC MS Clinic neurologists who contributed to the study through patient examination and data collection (current members listed here by primary clinic): UBC MS Clinic: A. Traboulsee, MD, FRCPC (UBC Hospital MS Clinic Director and Acting Head of the UBC MS Programs); A-L. Sayao, MD, FRCPC (Clinical Director of the BCMS Database); V. Devonshire, MD, FRCPC; S. Hashimoto, MD, FRCPC (UBC and Victoria MS Clinics); J. Hooge, MD, FRCPC (UBC and Prince George MS Clinics); L. Kastrukoff, MD, FRCPC (UBC and Prince George MS Clinics); J. Oger, MD, FRCPC Kelowna MS Clinic: D. Adams, MD, FRCPC; D. Craig, MD, FRCPC; S. Meckling, MD, FRCPC. Prince George MS Clinic: L. Daly, MD, FRCPC. Victoria MS Clinic: O. Hrebicek, MD, FRCPC; D. Parton, MD, FRCPC; K Atwell-Pope, MD, FRCPC. The views expressed in this paper do not necessarily reflect the views of each individual acknowledged.

Conflicts of interest

Dr. Lu was funded by the Canadian Institutes of Health Research (Canada Graduate Scholarships: Master’s and Doctoral Research Awards), the Multiple Sclerosis Society of Canada (MSc and PhD Research Studentships) and the University of British Columbia (Graduate Entrance Scholarship, Faculty of Medicine Graduate Awards and Four Year Doctoral Fellowship).

Dr. Sadovnick has received: research support from the MS Society of Canada Scientific Research Foundation, and CIHR; speaker honoraria and/or travel expenses to attend conferences from: Biogen-Idec, Merck-Serono, Teva Neurosciences, Bayer.

Dr. Traboulsee has received: honoraria from EMD Serono, Teva Neurosciences, Bayer, Biogen Idec, Chugai Pharmaceuticals and Roche.

Dr. Tremlett is funded by the Multiple Sclerosis Society of Canada (Don Paty Career Development Award), Michael Smith Foundation for Health Research and is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. Dr. Tremlett has received: research support from the US National Multiple Sclerosis Society, CIHR, and UK MS Trust; speaker honoraria and/or travel expenses to attend conferences from the Consortium of MS Centres, US National MS Society, the University of British Columbia Multiple Sclerosis Research Program, Serono Symposia International Foundation (2008), Swiss MS Society (2009), Bayer Pharmaceutical (speaker, 2010, honoraria declined), Teva Pharmaceuticals (speaker 2011), ECTRIMS (2011), UK MS Trust (2011), Novartis Canada (2012) and the Chesapeake Health Education Program, US Veterans Affairs (2012, honorarium declined). Unless otherwise stated, all speaker honoraria are either donated to an MS charity or to an unrestricted grant for use by her research group.

Ms. van der Kop, Drs. Zhao, Dahlgren, Preston and Synnes report no competing interests.

Author information

Authors and Affiliations

  1. Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Room S178, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada

    Ellen Lu, Yinshan Zhao, Mia van der Kop, A. Dessa Sadovnick, Anthony Traboulsee & Helen Tremlett

  2. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Leanne Dahlgren

  3. Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Roanne Preston

  4. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Mia van der Kop

  5. Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Anne Synnes

  6. Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    A. Dessa Sadovnick

Authors
  1. Ellen Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yinshan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leanne Dahlgren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roanne Preston
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mia van der Kop
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anne Synnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Dessa Sadovnick
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anthony Traboulsee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Helen Tremlett
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helen Tremlett.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 76 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lu, E., Zhao, Y., Dahlgren, L. et al. Obstetrical epidural and spinal anesthesia in multiple sclerosis. J Neurol 260, 2620–2628 (2013). https://doi.org/10.1007/s00415-013-7035-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-013-7035-7

Keywords

Search

Navigation