A new treatment of severe pre-eclampsia by long-term epidural anaesthesia

Kanayama, Naohiro; Belayet, Hossain Md; Khatun, Selina; Tokunaga, Naoki; Sugimura, Motoi; Kobayashi, Takao; Terao, Toshihiko

doi:10.1038/sj.jhh.1000783

Cited by 25 publications

(16 citation statements)

References 19 publications

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“…The sympathetic blockade provoked by epidural analgesia causes vasodilation in the lower half of the body that may increase placental perfusion in women with preeclampsia, if perfusion pressure is maintained. There have been several studies in which the effect of epidural analgesia was analyzed in patients with preeclampsia and IUGR and are in agreement with the results obtained in our study [40][41][42][43][44].…”

Section: Discussionsupporting

confidence: 92%

Early Effect of Epidural Analgesia on Fetal Acid-base Balance in the First Stage of Labour

Delgado¹,

García²,

León³

et al. 2018

Clinics Mother Child Health

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Introduction: Epidural analgesia is a consolidated therapeutic technique generally used for the relief of labor pain. Since its introduction in obstetrics, there have been many studies that evaluate the effect that this type of analgesia has over the course of labor, and its possible repercussions on the mother and the fetus/newborn by analyzing data at birth. However, there exist very few studies that analyze the early effect that epidural analgesia has on the fetus. Objectives: The main objective of this study is to analyze the early effects of epidural analgesia on the fetal status by evaluating the possible changes in the acid-base fetal state, the most precise way to evaluate fetal wellbeing during labor, and cardiotocographic (CTG) tracing of the fetal heart rate after the administration of an epidural. Methods: This is a prospective study of 193 patients, in which a determination of the fetal acid-base equilibrium was done before the administration of epidural analgesia and repeated 60 min afterwards, evaluating possible changes in the results motivated by analgesia. Results: There was a statistically significant descent on fetal blood pH after the administration of epidural analgesia, as well as a significant increase in the number of fetal heart traces with alterations. The descent of fetal pH was greater in patients that had some gestational associated conditions. Conclusion: The administration of epidural analgesia during the first stage of labor caused, as an early effect, a significant descent in fetal blood pH, without that descent being clinically relevant over the fetal status in healthy fetuses. There must be a strict control in fetuses with some initial alteration in the CTG tracings. Keywords Acid-base balance; Epidural; Early effect of epidural in fetus; Fetal blood pH C li nics in M o th er an d C h il d Healt h

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Section: Discussionsupporting

confidence: 92%

Early Effect of Epidural Analgesia on Fetal Acid-base Balance in the First Stage of Labour

Delgado¹,

García²,

León³

et al. 2018

Clinics Mother Child Health

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“…Kanayama et al [5] reported benefi cial effects of epidural local anesthetic administration on clinical parameters and fetal outcome in patients with pre-eclampsia. We took a different approach; instead of including mothers with a specifi c disease state, we studied fetuses with growth retardation independent of cause.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Kanayama et al [5] reported that lumbar epidural local anesthetic (bupivacaine 0.25%, 2 ml/h for 15-26 days) improved blood pressures, platelet count and serum protein levels, and increased duration of pregnancy and birth weight of infants in severely pre-eclamptic women, as compared with a control group receiving standard therapy. These benefi cial effects may be related to the ability of epidural local anesthetics to improve placental blood fl ow.…”

mentioning

confidence: 99%

Epidural Local Anesthetics: A Novel Treatment for Fetal Growth Retardation?

Strümper

Louwen²,

Durieux³

et al. 2005

Fetal Diagn Ther

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Background: Chronically compromised uterine perfusion may lead to placental insufficiency and subsequent intrauterine growth restriction (IUGR). Various therapeutic approaches (e.g. vasodilators, low-dose aspirin, intravenous glucose infusion, and hemodilution) are often of limited efficacy. Local anesthetics have been shown to improve placental blood flow in pre-eclamptic women. We hypothesized that epidural administration of local anesthetics might improve outcome in IUGR independent of the underlying cause. In preparation for a clinical trial to test this hypothesis, we performed a pilot study in 10 patients. Methods: After approval of the study protocol, 10 pregnant women presenting with oligohydramnios and IUGR were included in the study. In addition to our standard protocol (magnesium, glucose, betamethasone), each patient received an epidural catheter (T10/T12) with continuous infusion of bupivacaine 0.175% at a rate of 5 ml/h. Uteroplacental circulation was monitored by Doppler sonography and the amount of amniotic fluid was estimated daily. Results: Epidural insertion and infusion was performed without complications. Four patients continued to deteriorate rapidly, amniotic fluid volume did not change and uterine artery pulsatility index (PI) tended to increase. In the remaining 6 patients the clinical status stabilized, amniotic fluid volume tended to increase and uterine artery PI tended to decrease during treatment. This improvement was associated with a prolonged interval to cesarean section and increased infant birth weight. Conclusion: Our data suggest that, even if the underlying cause of IUGR is not pre-eclampsia, epidural local anesthetic administration might improve placental blood flow and be beneficial in a subgroup of patients. A clinical trial to test this hypothesis appears warranted.

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“…On the contrary, previous studies have reported that mild to moderate intensity exercise did not increase muscle sympathetic nerve activity in non‐pregnant subjects . The growing uterus in the TM3 subjects presses the abdominal sympathetic ganglion and restricts the movement of the thorax, which might explain the increased sympathetic activity during mild intensity exercise …”

Section: Discussionmentioning

confidence: 71%

Differences in autonomic neural activity during exercise between the second and third trimesters of pregnancy

Nakagaki

Inami

Minoura

et al. 2016

J of Obstet and Gynaecol

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Aim: To test the hypothesis that autonomic neural activity in pregnant women during exercise varies according to gestational age. Methods: This cross-sectional study involved 20 healthy women in their second (n = 13) or third (n = 7) trimester of pregnancy. Incremental cardiopulmonary exercise testing was performed with an electromagnetic cycle ergometer. Heart rate variability was analyzed by frequency analysis software. Results: The low-frequency to high-frequency (LF/HF) ratio, an indicator of the sympathetic nervous system, was significantly higher in third trimester than in second trimester subjects (P < 0.05) at 1, 2, and 3 min of incremental exercise testing. In contrast, the HF/total power ratio, an indicator of rapidly acting parasympathetic activity, was significantly higher in second trimester than in third trimester subjects (P < 0.05) at 2 and 3 min. In addition, a negative correlation was found between gestational age and the 'accumulation half-time' of the LH/HF ratio, the time point at which the sum of the LF/HF ratio reached 50% of that accumulated in the total 6 min of exercise testing (r = À0.49, P = 0.028). Conclusions:The autonomic response to exercise in pregnant women differs between the second and third trimesters. These differences should be considered when prescribing exercise to pregnant women.

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A new treatment of severe pre-eclampsia by long-term epidural anaesthesia

Cited by 25 publications

References 19 publications

Early Effect of Epidural Analgesia on Fetal Acid-base Balance in the First Stage of Labour

Early Effect of Epidural Analgesia on Fetal Acid-base Balance in the First Stage of Labour

Epidural Local Anesthetics: A Novel Treatment for Fetal Growth Retardation?

Differences in autonomic neural activity during exercise between the second and third trimesters of pregnancy

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