Epidural top-up during second stage of labor and perineal lacerations in primiparous women: a retrospective cohort study (2021-2023)

Objective: To evaluate whether epidural bolus administration during the second stage of labor is associated with the incidence of perineal lacerations. Methods: This retrospective single-centre cohort study (2021-2023) included primiparous women with singleton, cephalic pregnancies who received epidural analgesia and delivered vaginally. Women receiving an epidural top-up during the second stage of labor were compared with those who did not. The primary outcome was the occurrence of perineal lacerations. Multivariable logistic regression was used to identify independent risk factors for perineal trauma. Results: Among 1303 women, 274 (21%) received a top-up. The overall incidence of perineal lacerations did not differ between groups (54.4% with bolus vs. 58.5% without). The second stage was longer in the bolus group (median 75.5 vs. 51 min), but epidural top-up was not independently associated with perineal lacerations. Conclusions: Epidural top-ups in the second stage of labor were not associated with perineal lacerations.