Combined spinal-epidural labour analgesia in a parturient with a vagal nerve stimulator

Abstract

Presentation
A G2P1 woman in her 30s at 37 weeks’ gestation with drug-resistant juvenile myoclonic epilepsy and an implanted VNS presented in early labour.

Diagnosis
Her epilepsy was well-controlled with a VNS implanted six years earlier and maintained on antiepileptic drugs.

Treatment
Following an interdisciplinary antenatal discussion, combined spinal–epidural (CSE) labour analgesia was administered with the VNS left active. Continuous maternal and fetal monitoring was undertaken, and a magnet was immediately available for device deactivation if required. Labour progressed uneventfully, resulting in a spontaneous vaginal delivery of a healthy infant. No perioperative complications or device-related issues occurred.

Discussion
This case suggests that neuraxial labour analgesia can be delivered successfully in a parturient with a functioning vagal nerve stimulator when management is individualised, multidisciplinary planning is undertaken in advance, and close intrapartum monitoring with immediate access to the device magnet is ensured.