Low dose epidural bupivacaine/fentanyl not mask uterine rupture

Traditionally it was once considered that epidural analgesia in labour was contraindicated in the presence of a caesarean section scar because of fear that the symptoms and signs of uterine rupture would be masked.’ Evidence has accumulated to refute this assertion2 but the use of epidural opioids remains controversial3 The advantages of adding opioids to epidural infusions are many,4 yet opioids are frequently om itted in cases where there has been a previous caesarean section.