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

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.