FETAL HEART RATE AND pH OF FETAL CAPILLARY BLOOD DURING EPIDURAL ANALGESIA IN LABOR

M, Zilianti; Salazar,; Aller, Juan F.; Agüero, O

doi:10.1097/00132586-197202010-00039

“…When the same lidocaine dose schedule without added epinephrine was tried, the analgesia was often inadequate, maternal and neonatal blood lidocaine levels higher, and the risk of accumulation more evident. It was observed that the mean duration of labour among primiparous women was significantly longer in cases receiving epidural blocks than in a randomly selected group of control patients who had not received regional anaesthesia.Changes in foetal heart rate patterns, decrease in foetal pH, and metabolic acidosis in the neonatal period have been described in connection with lumbar epidural anaesthesia (6,13,19,26). A reduction of the normal beat to beat variations in foetal heart rate recordings which is sometimes observed during epidural anaesthesia has been suggested to be caused by the administered local anaesthetic drug and not by asphyxia (2).In the present publication the influence of the epidural anaesthesia on uterine activity, on foetal heart rate pattern, and on the acid-base status of the foetus, and on the neonates at birth, will be reviewed.…”

mentioning

confidence: 99%

Low Dose Intermittent Epidural Anaesthesia with Lidocaine for Vaginal Delivery

Zador¹,

Englesson²,

Nilsson³

1974

Acta Obstet Gynecol Scand

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Abstracr.In 190 women with uncomplicated pregnancies, intermittent epidural analgesia was given by means of injections of about 50 mg lidocaine without ( Series I), or with epinephrine 1 :200,000 (series 11) at one hour intervals during the first stage of labour. During the second stage the analgesia was maintained by 100 mg of lidocaine at an average interval of one hour. The mean total dose of lidocaine administered in series I was 409 mg, and 258 mg in series 11. The degree of pain relief in series I1 was most satisfactory according to results obtained by a specially designed scoring system. In series I the method was

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“…Fall in maternal blood pressure (as occurring in th e vaso-vagal refl ex) is known t o res ult in fetal bradycardia (5) . The ma te rna l va o-vagal refl ex is by its na ture a hort self-limiting occurrence a nd may cause tra ns ie nt s igns of fetal di s tress.…”

Section: Discussionmentioning

confidence: 99%

Fetal Heart Rate Response to Maternal Hypotension during Amniocentesis

Ron

¹

,

Yaffe

²

,

Polishuk

³

1976

Intl J Gynecology & Obste

2

0

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“…Bradycardia and late deceleration patterns have also been observed with increased frequency during epidural anaesthesia (26). It was previously believed that such changes were the sequela of maternal hypotension caused by the anaesthesia.…”

Section: Cord Bloodmentioning

confidence: 98%

“…When the same lidocaine dose schedule without added epinephrine was tried, the analgesia was often inadequate, maternal and neonatal blood lidocaine levels higher, and the risk of accumulation more evident. It was observed that the mean duration of labour among primiparous women was significantly longer in cases receiving epidural blocks than in a randomly selected group of control patients who had not received regional anaesthesia.Changes in foetal heart rate patterns, decrease in foetal pH, and metabolic acidosis in the neonatal period have been described in connection with lumbar epidural anaesthesia (6,13,19,26). A reduction of the normal beat to beat variations in foetal heart rate recordings which is sometimes observed during epidural anaesthesia has been suggested to be caused by the administered local anaesthetic drug and not by asphyxia (2).…”

mentioning

confidence: 99%

“…Changes in foetal heart rate patterns, decrease in foetal pH, and metabolic acidosis in the neonatal period have been described in connection with lumbar epidural anaesthesia (6,13,19,26). A reduction of the normal beat to beat variations in foetal heart rate recordings which is sometimes observed during epidural anaesthesia has been suggested to be caused by the administered local anaesthetic drug and not by asphyxia (2).…”

mentioning

confidence: 99%

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Low Dose Intermittent Epidural Anaesthesia with Lidocaine for Vaginal Delivery II

Zador

¹

,

Nilsson

²

1974

Acta Obstet Gynecol Scand

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A bsfruci. Intermittent lumbar epidural block, using lidocaine without (series I), or with epinephrine (series II), for pain relief in.labour was carried out in a total of 190 women with uncomplicated pregnancies. In a number of randomly selected cases in these two series the uterine contractility, the foetal heart rate pattern, and the acid-base balance of the mothers and their foetuses were studied. Transitory decrease in uterine activity, primarily due to depressed intensity of the contractions, was observed after each injection in both series. This phenomenon was, however, much more pronounced in cases where epinephrine was added to the local anaesthetic solution. In both series the effect on the contractions declined with the number of injections. Ominous foetal heart rate patterns were rare and occurred almost exclusively in association with transient maternal hypotension. Good correlation was found between maternal arterial, and arterialized capillary blood with respect to the acid-base components. The acid-base values in foetal scalp blood, maternal capillary blood, and in umbilical cord blood showed a less pronounced tendency to metabolic acidosis in cases where epidural blocks were given than in cases in a non-anaesthetized control group. Prolongation of the second stage was accompanied by the development of metabolic acidosis in anaesthetized, as well as in nonanaesthetized cases. In the epidural series, however, this acidosis tended to appear later and to develop more slowly, indicating an overall good and stable intrauterine foetal condition. In a previous publication by the authors (24) a low dose regimen for lumbar epidural anaesthesia during labour and delivery was evaluated regarding analgetic effect, maternal and foetal blood levels of lidocaine with special reference to the risk of accumulation of the local anaesthetic agent. It was concluded that adequate analgesia could be obtained with hourly injections of 10 ml of 0.5 per cent lidocaine with epinephrine 1:200,000 during the first stage of labour, and with 10 ml doses of 1 per cent lidocaine with epinephrine 1 :200,000 hourly during the second stage. The maternal, foetal and cord blood levels of lidocaine were low, and the risk of accumulation of the drug to the proximity of assumed toxic levels was found to be minimal. When the same lidocaine dose schedule without added epinephrine was tried, the analgesia was often inadequate, maternal and neonatal blood lidocaine levels higher, and the risk of accumulation more evident. It was observed that the mean duration of labour among primiparous women was significantly longer in cases receiving epidural blocks than in a randomly selected group of control patients who had not received regional anaesthesia.Changes in foetal heart rate patterns, decrease in foetal pH, and metabolic acidosis in the neonatal period have been described in connection with lumbar epidural anaesthesia (6,13,19,26). A reduction of the normal beat to beat variations in foetal heart rate recordings which is sometimes observed ...

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FETAL HEART RATE AND pH OF FETAL CAPILLARY BLOOD DURING EPIDURAL ANALGESIA IN LABOR

Cited by 18 publications

References 0 publications

Low Dose Intermittent Epidural Anaesthesia with Lidocaine for Vaginal Delivery

Low Dose Intermittent Epidural Anaesthesia with Lidocaine for Vaginal Delivery

Fetal Heart Rate Response to Maternal Hypotension during Amniocentesis

Low Dose Intermittent Epidural Anaesthesia with Lidocaine for Vaginal Delivery II

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