According to the recent study conducted by Allana Munro and colleagues, epidural top-ups were required by females facing difficult labor and those with higher assisted vaginal and cesarean deliveries.

The observational and retrospective study was conducted to evaluate the relationship of epidural top-ups in the second stage of labor with neonatal and obstetrical problems. The study was based on a hypothesis that epidural top-up helps to lower operative deliveries by correcting insufficient analgesia in the second stage of labor.

The data for the study was extracted by conducting a population-based cohort search by utilizing perinatal data from 1 Jan 2013 to 31 Dec 2014. Top-up cases were evaluated by using database information. The descriptive statistics were used to compare different delivery methods and neonatal features among women either with top-ups or without top-ups. Predictive factors of the delivery method were determined using logistic regression.

A total of 1462 females at their second stage of labor received epidural analgesia for one hour, but only 7% of women required a top-up approach. The females who received top-ups showed 89% labor induction, 303 min longer second-stage, 41% assisted vaginal and 26% cesarean deliveries as compared to females without top-ups (76%, 171 min, 17% and 11% respectively). Women found with predictors of harsh labor, high assisted vaginal and cesarean deliveries need top-ups epidurals. This governs the role of top-ups in the second stage of labor.