Fetal effects of combined spinal‐epidural vs epidural labour analgesia: a prospective, randomised double‐blind study

Abstract

SummaryWe have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p < 0.0001); two before compared with eight after analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p < 0.0001) (combined spinal-epidural group zero before and seven after analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h À1 before and 9.9 (6

Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study

“…These findings are similar to those from a recent study that looked at FHR decelerations both before and after CSE and epidural analgesia. 16 They showed that fetal decelerations occurred in 3.2-14.5% of parturients prior to CSE and that the incidence of these decelerations increases after initiating analgesia. They also concluded that these changes in FHR did not affect neonatal outcomes.…”

Effects of Epidural Analgesia on Labor, Delivery and Neonatal Outcomes in Patients Performed Epidural Analgesia During Labor

“…Bu durum, epidural uygulaması sonrası uterus hipertonisine yol açan plazma adrenalin ve noradrenalin dengesinde bozulma ile açıklanmış-tır. 9 Hill ve ark., %0,25'lik bupivakain kullanılarak uygulanan epidural analjezinin, intravenöz meperidin ile karşılaştırıldığında fetal kalp hızı paternleri üzerine olumsuz etkisinin olmadığını göstermişlerdir. 10 Reynold ve ark., sekiz çalışmayı temel alarak yaptıkları sistematik derlemede, meperidinle sağlanan analjeziye göre %0,25'lik bupivakain kullanılarak uygulanan epidural analjezinin yenidoğanın asit baz dengesi üzerinde olumlu etkisinin olduğunu bildirmişlerdir.…”

A reply

“…We thank Jain et al. for their interest in our paper , and for the discussion points raised. We decided to use 2.5 ml premixed bupivacaine 0.1%/fentanyl 2 μg.ml −1 because this is used at our hospitals for combined spinal‐epidural (CSE) anaesthesia, and so was familiar to anaesthetists.…”