Document resource
Background and Aims Labor analgesia offers well-established benefits for both maternal and neonatal outcomes, encompassing clinical and psychological domains. Effective pain management during labor requires a tailored approach, with multiple techniques documented in the literature. Spina bifida, a congenital neural tube defect, presents unique anesthetic challenges due to anatomical variations in the spine and potential neurological deficits. This case report explores the feasibility and safety of neuraxial analgesia in a parturient with spina bifida.Methods A 35-year-old pregnant woman, Gravida 2 Para 0, with a medical history of spina bifida, gestational diabetes, polycystic ovary syndrome, and irritable bowel syndrome, was admitted at 38 weeks’ gestation for labor induction due to intrahepatic cholestasis of pregnancy. At 3 cm cervical dilation, the patient experienced severe, unrelieved pain despite non-pharmacological strategies and multiple intravenous analgesics. The anesthesia team was consulted. The patient expressed concern regarding neuraxial analgesia, believing herself to be ineligible. A CT scan confirmed spina bifida at the L5-S1 level. After careful assessment of the clinical scenario and a review of the available literature, a risk-benefit analysis supported the decision to proceed with epidural analgesia via catheter placement at the L3-L4 level, which was performed without complications.Results Epidural administration of 12 mL boluses of 0.2% ropivacaine every hour provided effective labor analgesia and allowed for a spontaneous vaginal delivery of a healthy newborn with APGAR scores of 10 at 1, 5, and 10 minutes. No complications were reported on follow-up.Conclusions Effective pain control is a cornerstone of modern obstetric care, contributing to better maternal and fetal outcomes. Epidural analgesia remains one of the most effective methods. While spina bifida presents certain challenges, it should not be considered an absolute contraindication to neuraxial techniques. This case report highlights epidural analgesia as a viable and safe option for labor pain management in selected patients with spina bifida.