Examining the influence of maternal bradycardia on neonatal outcome using automated data collection

Brenck, Florian; Hartmann, Bernd; Jost, Andreas; Röhrig, Rainer; Obaid, Reyad S.; Brüggmann, Dörthe; Harbach, Heinz W.; Jünger, Alexander

doi:10.1016/j.ijoa.2007.01.005

Cited by 4 publications

(4 citation statements)

References 34 publications

(32 reference statements)

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“…Although phenylephrine has almost no β‐adrenergic activity, metaraminol has both α‐1 and β‐adrenergic activity , which theoretically might help preserve cardiac output. Cardiac output and heart rate are closely linked, so despite a lack of evidence of differences in outcomes , avoidance of bradycardia is also thought to be an important management aim . We found that the groups did not differ significantly with respect to the incidence of bradycardia or the lowest maternal heart rate, as did similar comparative studies .…”

Section: Discussionmentioning

confidence: 50%

A randomised double‐blind trial of phenylephrine and metaraminol infusions for prevention of hypotension during spinal and combined spinal–epidural anaesthesia for elective caesarean section

et al. 2017

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Prophylactic vasopressor administration is commonly recommended to reduce maternal hypotension during spinal anaesthesia for caesarean section. Metaraminol has undergone limited investigation in obstetric anaesthesia for this purpose, particularly in comparison with phenylephrine. In this multicentre, randomised, double-blind, non-inferiority study, we compared prophylactic phenylephrine or metaraminol infusions, started immediately after spinal anaesthesia, in 185 women who underwent elective caesarean section. Phenylephrine was initially infused at 50 μg.min , and metaraminol at 250 μg.min . The primary outcome was the difference in umbilical arterial pH between groups; secondary outcomes included other neonatal acid-base measures, and maternal haemodynamic changes. The mean (SD) umbilical arterial pH was 7.28 (0.06) in the phenylephrine group vs. 7.31 (0.04) in the metaraminol group (p = 0.0002). The estimated mean (95%CI) pH difference of 0.03 (0.01-0.04) was above the pre-determined lower boundary of clinical non-inferiority, and also met the criterion for superiority. Umbilical artery lactate concentration was 2.8 (1.2) mmol.l in the phenylephrine group vs. 2.3 (0.7) mmol.l in the metaraminol group (p = 0.0018). Apgar scores did not significantly differ between groups. There was a higher incidence of hypotension, defined as systolic arterial pressure < 90% baseline, in the phenylephrine group; there was a higher incidence of hypertension and severe hypertension (systolic arterial pressure > 110% and > 120% baseline, respectively) in the metaraminol group. There was no significant difference between groups in the incidence of nausea, vomiting or maternal bradycardia. We conclude that, when used as an infusion to prevent hypotension after spinal anaesthesia for elective caesarean section, metaraminol is at least non-inferior to phenylephrine with respect to neonatal acid-base outcomes.

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Section: Discussionmentioning

confidence: 50%

A randomised double‐blind trial of phenylephrine and metaraminol infusions for prevention of hypotension during spinal and combined spinal–epidural anaesthesia for elective caesarean section

et al. 2017

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“…Of note, although reductions in cardiac output have been correlated with HR changes,[26] bradycardia has not been shown to affect the neonatal outcome. [27] We found a higher incidence of bradycardia with the use of high-dose phenylephrine infusion than reported in previous studies. [1112] This is likely due to our definition of bradycardia as a HR less than 60 bpm and not 50 bpm as reported in other investigations.…”

Section: Discussionmentioning

confidence: 39%

Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference?

Bottiger

Bezinover

Mets

et al. 2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:Patients undergoing elective cesarean delivery (CD) have a high-risk of spinal-induced hypotension (SIH). We hypothesized that a colloid preload would further reduce SIH when compared with a crystalloid preload.Material and Methods:Eighty-two healthy parturients undergoing elective CD were included in the study. Patients were randomly assigned to two groups (41 patients in each group) to receive either Lactated Ringer's solution (1500 ml) or hydroxyethyl starch (6% in normal saline, 500 ml) 30 min prior to placement of spinal anesthesia. All patients were treated with a phenylephrine infusion (100 mcg/min), titrated during the study.Results:There was no statistical difference between groups with regards to the incidence of hypotension (10.8% in the colloid group vs. 27.0% in the crystalloid group, P = 0.12). There was also no difference between groups with respect to bradycardia, APGAR scores, and nausea and vomiting. Significantly less phenylephrine (1077.5 ± 514 mcg) was used in the colloid group than the crystalloid group (1477 ± 591 mcg, P = 0.003).Conclusion:The preload with 6% of hydroxyethyl starch before CD might be beneficial for the prevention of SIH.

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“…Pharmacological associations of maternal bradycardia described in the literature include magnesium sulfate, 9 , 12 betamethasone, 10 ergotamine, 11 and anesthetics. 25 We observed that when bradycardia was associated with medications or anesthesia, the time to recovery was much shorter than when it is associated with preeclampsia, underlying or cardiac causes.…”

Section: Discussionmentioning

confidence: 77%

Post-partum maternal bradycardia: A case series and literature review

et al. 2023

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Background Unlike tachyarrhythmias, which are common in pregnancy, there is a paucity of data regarding maternal bradycardias. Our objective was to describe the characteristics, associated conditions, and prognosis of women who develop bradycardia post-partum. Method We conducted a retrospective chart review of patients referred to the Obstetrical Medicine service at British Columbia Women's Hospital from January 2012 to May 2020 for post-partum maternal bradycardia. Results Twenty-four patients with post-partum bradycardia were included (age 34.2 ± 4.8 years; heart rate 40.4 ± 8.1 beats per minute; blood pressure 131/72 mm Hg). Sinus bradycardia (79.2%) was the most common rhythm. Dyspnea (29.4%) and chest pain (23.5%) were common symptoms. Mean time to resolution of bradycardia was 3.6 ± 3.8 days. Associated conditions potentially explaining the bradycardia were preeclampsia (54.1%), underlying (16.7%), medications (8.3%), and neuraxial anesthesia (8.3%). Conclusions Maternal bradycardia is an uncommon condition complicating the post-partum period, that is generally self-limiting, with the majority only require clinical observation.

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Examining the influence of maternal bradycardia on neonatal outcome using automated data collection

Cited by 4 publications

References 34 publications

A randomised double‐blind trial of phenylephrine and metaraminol infusions for prevention of hypotension during spinal and combined spinal–epidural anaesthesia for elective caesarean section

A randomised double‐blind trial of phenylephrine and metaraminol infusions for prevention of hypotension during spinal and combined spinal–epidural anaesthesia for elective caesarean section

Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference?

Post-partum maternal bradycardia: A case series and literature review

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