Fluid loading to reduce abnormalities of fetal heart rate and maternal hypotension during epidural analgesia in labour.

Collins, Kelly; Bevan, David R.; Beard, R. W.

doi:10.1136/bmj.2.6150.1460

Cited by 39 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20-23 Prophylactic intravenous volume and/or vasopressor administration is commonly used prior to regional anesthesia to minimize the occurrence of hypotension. 16,22,24 In our previously published studies, we have observed that Class III obese women (Body Mass Index, BMI ≥40 kg/m 2 ) undergoing regional anesthesia for childbirth have more anesthesia-related hypotension and fetal heart rate abnormalities than lean gravidas. 25,26 These factors may contribute to the increased cesarean delivery rate and associated perioperative morbidity among Class III obese women, such as hemorrhage, endometritis, wound infection, venous thromboembolism, and respiratory depression.…”

Section: Introductionmentioning

confidence: 97%

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Vricella

Louis

Chien

et al. 2015

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

Objective The impact of obesity on maternal blood volume in pregnancy has not been reported. We compared the blood volumes of obese and normal weight gravidas using a validated Hydroxyethyl Starch (HES) dilution technique for blood volume estimation. Study Design Blood volumes were estimated in 30 normal weight (pregravid body mass index; BMI < 25 kg/ m2) and 30 obese (pregravid BMI > 35 kg/m2) gravidas after 34 weeks gestation using a modified HES dilution technique. Blood samples obtained before and 10 minutes after HES injection were analyzed for plasma glucose concentrations after acid hydrolysis of HES. Blood volume was calculated from the difference between glucose concentrations measured in hydrolyzed plasma. Results Obese gravidas had higher pregravid and visit BMI (mean [Std Dev]): pregravid (41[4] vs 22[2] kg/m2, p=0.001); visit BMI (42[4] vs 27[2] kg/m2, p=0.001), but lower weight gain (5[7] vs. 12[4] kg, p=0.001) than normal weight women. Obese gravidas had similar estimated total blood volume to normal weight women (8103 ± 2452 vs. 6944 ± 2830 mL, p = 0.1), but lower blood volume per kilogram weight (73 ± 22 vs. 95 ± 30 mL/kg, p = 0.007). Conclusion Obese gravidas have similar circulating blood volume, but lower blood volume per kilogram body weight, than normal weight gravidas near term.

show abstract

Section: Introductionmentioning

confidence: 97%

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Vricella

Louis

Chien

et al. 2015

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…Collins et al in 1978, showed that fluid preloading significantly reduces abnormalities in fetal heart rate (FHR) (34% to 12%) and maternal hypotension (28% to 2%) during epidural analgesia. 63 They excluded patients with preeclampsia and pre-existing hypertension. However, Collins original study used bupivacaine 0.375%, a concentration that is not commonly used in current practice, and probably the cause for significant hypotension.…”

Section: Fluid Preloadingmentioning

confidence: 99%

Progress in analgesia for labor: focus on neuraxial blocks

Ranasinghe

Birnbach

2009

IJWH

View full text Add to dashboard Cite

Neuraxial analgesia is widely accepted as the most effective and the least depressant method of providing pain relief in labor. Over the last several decades neuraxial labor analgesia techniques and medications have progressed to the point now where they provide high quality pain relief with minimal side effects to both the mother and the fetus while maximizing the maternal autonomy possible for the parturient receiving neuraxial analgesia. The introduction of the combined spinal epidural technique for labor has allowed for the rapid onset of analgesia with minimal motor blockade, therefore allowing the comfortable parturient to ambulate. Patient-controlled epidural analgesia techniques have evolved to allow for more flexible analgesia that is tailored to the individual needs of the parturient and effective throughout the different phases of labor. Computer integrated systems have been studied to provide seamless analgesia from induction of neuraxial block to delivery. New adjuvant drugs that improve the effectiveness of neuraxial labor analgesia while decreasing the side effects that may occur due to high dose of a single drug are likely to be added to future labor analgesia practice. Bupivacaine still remains a popular choice of local anesthetic for labor analgesia. New local anesthetics with less cardiotoxicity have been introduced, but their cost effectiveness in the current labor analgesia practice has been questioned.

show abstract

“…2,5 Decreased fetal cerebral oxygenation, measured with Maternal epidural analgesia in labor may be associated with nonreassuring fetal heart rate (FHR) patterns. This has variously been attributed to epidural agent-induced maternal hypotension resulting in reduced uterine blood flow, 1,2 which may be minimized or avoided by intravenous preload 1,3 ; or near-infrared spectroscopy, has been demonstrated with the mother supine. 11 When FHR changes do occur following administration of epidural analgesia, they may not require expedited delivery for nonreassuring fetal status, 4,6 as the fetus may recover with simple measures such as maternal position change, or discontinuation of oxytocin.…”

mentioning

confidence: 99%

Effect of Maternal Epidural Analgesia on Fetal Intrapartum Oxygen Saturation

East

Colditz²

2002

Am J Perinatol

View full text Add to dashboard Cite

The use of maternal epidural analgesia in labor may be associated with nonreassuring fetal heart rate (FHR) patterns. Fetal oxygen saturation (FSpO2) monitoring may improve assessment of fetal well-being during this time. Mean FSpO2 values were compared over seven 5-minute epochs: 5 minutes prior to an epidural event (combined insertion of epidural/top-up epidural analgesia and infusion pump bolus), to 30 minutes following the event, including possible effects of maternal position and FHR pattern on FSpO2 values. Mean FSpO2 values were significantly different between the 5 minutes prior (49.5%) versus 16-20 minutes (44.3%, p <0.05), 21-25 minutes (43%, p <0.01), and 26-30 minutes (43.8%, p <0.05) epochs; and 6-10 minutes (48.3%) versus 21-25 minutes (43%, p <0.05) epochs, but were not influenced by FHR pattern or maternal position. There were no differences in mean FSpO2 values following administration of an epidural infusion bolus. We conclude that fetal oxygenation was affected following initial or top-up epidural analgesia and that fetal intrapartum pulse oximetry may be useful in assessing fetal status following these events.

show abstract

Fluid loading to reduce abnormalities of fetal heart rate and maternal hypotension during epidural analgesia in labour.

Cited by 39 publications

References 13 publications

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Progress in analgesia for labor: focus on neuraxial blocks

Effect of Maternal Epidural Analgesia on Fetal Intrapartum Oxygen Saturation

Contact Info

Product

Resources

About