Lumbar Epidural Analgesia in Labour

Thalme, B; Belfrage, Patrick; Raabe, Nils

doi:10.3109/00016347409156885

Cited by 75 publications

(19 citation statements)

References 13 publications

(4 reference statements)

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“…In the newborn infants, determinations of blood gases, acid-base balance, and lactate were made on arterial blood obtained during the first 2 h of life. All results were in accordance with reference values for normal infants reported by other investigators (1, 2,4,7,10,15,16,27,28). Clinical observations during the early neonatal period and the first week of life were all normal.…”

Section: Control Groupsupporting

confidence: 81%

Hypoxanthine Concentration in Plasma during the First Two Hours after Birth in Normal and Asphyxiated Infants

Bratteby¹,

Swanström²

1982

Pediatr Res

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SummaryThe measurement of arterial plasma concentration of hypoxanthine in 16 healthy newborn infants showed a prominent increase after birth compared with the umbilical cord levels. Peak values were found 10-20 min after birth with a maximal value of 11.9 pmole/liter in the normal newborns. In five asphyxiated infants the postnatal pattern of hypoxanthine was the same as for normal infants but the increase was even more prominent. A mean peak value of 33.7 pmole/liter was noted in the asphyxiated infants. Our results indicate that the hypoxanthine concentration is influenced not only by the degree of hypoxia, but also by the peripheral circulation and the time interval between the hypoxic event and the blood sampling. It is concluded that hypoxanthine assay may be of clinical value for the detection of past hypoxia as a semiquantitative test. SpeculationIt is possible to differentiate a group of asphyxiated infants from normal infants by measurements of plasma hypoxanthine concentration. A new biochemical measure of perinatal hypoxia thus appears available. Knowledge about the change in hypoxanthine concentration is however of much greater value than that of a single plasma sample which may be &isleading.The theoretical connection between lack of oxygen, reduced cellular energy contents, and the catabolism of energy-rich phosphates (e.g., ATP, ADP) has been known for a long time. Until recently, however, the estimation of purine metabolites has not been used in clinical practice as a measure of hypoxia. With a micromethod for determination of the hypoxanthine concentration in plasma, Saugstad (18) found this metabolite to be a sensitive sign of hypoxia in experimental animals (20,21,22,23,24) and his preliminary clinical results also indicated a constant and slow decrease of this concentration after a period of fetal hypoxia. He therefore proposed that hypoxanthine measurements could be used for a retrograde estimation of past episodes of hypoxia in the newborn infant (19). In the umbilical cord plasma a hypoxanthine level of 11 pmole/liter was found to discriminate newborn infants with normal deliveries from infants with signs of intrauterine asphyxia (19). Lipp et al. (1 l), however, found that the hypoxanthine concentration in umbilical cord plasma from asphyxiated newborn infants overlapped in a rather broad range the values obtained from normal infants. This was true for both arterial and venous cord blood.In view of this discrepancy, the present study was undertaken in order to investigate the change in postnatal arterial hypoxanthine concentration in a number of normal and asphyxiated newborn infants who had been carefully monitored during delivery and in the early postnatal period. In some of these infants, the hypoxanthine concentration was also measured in venous cord blood and in the immediate neonatal period in blood samples obtained from the umbilical vein.

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Section: Control Groupsupporting

confidence: 81%

Hypoxanthine Concentration in Plasma during the First Two Hours after Birth in Normal and Asphyxiated Infants

Bratteby¹,

Swanström²

1982

Pediatr Res

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“…Table 1 describes the studies that have been included in the meta‐analysis 6–9,14–22 . These include some studies in which old‐fashioned epidural analgesia using local anaesthetic without opioid was used, and others using the more up‐to‐date low dose combinations.…”

Section: Methodsmentioning

confidence: 99%

“…If these potentially adverse intrapartum effects of epidural analgesia were harmful to the baby, this would be reflected in the neonatal acid–base status. Early studies published in 1974, however, reporting funic pH and base excess, suggested that epidural analgesia was associated with reduced fetal/neonatal acidosis and even appeared to protect the fetus from the detrimental effects of a prolonged second stage of labour 6–9 .…”

Section: Introductionmentioning

confidence: 99%

Analgesia in labour and fetal acid–base balance: a meta‐analysis comparing epidural with systemic opioid analgesia

Reynolds

Sharma

Seed

2002

BJOG

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Objective To assess the effect of epidural versus systemic labour analgesia on funic acid -base status at birth.Design A systematic review of trials, both randomised and non-randomised, comparing epidural with systemic opioid analgesia. Population Babies of 2102 mothers taking part in trials comparing epidural with systemic analgesia in five countries. Methods From the published and unpublished figures obtained from authors, fetal pH data from 12 studies (eight randomised) (1098 babies in the epidural group þ 1004 controls) and base excess from 8 studies (four randomised) (856 epidural þ 842 controls) were subjected to random effect meta-analysis. Main outcome measures Umbilical artery pH and base excess values.Results Fetal pH was higher in the epidural than in the control group in the randomised trials (difference þ0.009, 95% CI þ0.002 to þ0.015), but when all studies were included, the difference was not significant (þ0.004, 95% CI À0.005 to þ0.014). Fetal base excess was higher in the epidural group in the four randomised studies (difference þ0.779 mEq/L, 95% CI þ0.056 to þ1.502) and in all eight studies (difference þ0.837 mEq/L, 95% CI þ0.330 to þ1.343). Conclusion Umbilical artery pH is influenced by maternal hyperventilation. Base excess is therefore a better index of metabolic acidosis after labour. Epidural analgesia is associated with improved neonatal acid -base status, suggesting that placental exchange is well preserved in association with maternal sympathetic blockade and good analgesia. Although epidural analgesia may cause maternal hypotension and fever, longer second stage of labour and more instrumental vaginal deliveries, these potentially adverse factors appear to be outweighed by benefits to neonatal acid -base status.

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“…81 They showed that epidural analgesia reduced maternal hypocarbia and maternal and fetal metabolic acidosis and lactate, 83 while greatly mitigating the fall in fetal pH that otherwise occurs during the second stage of labour. These favourable findings were largely ignored by all but a few anaesthesiologists.…”

Section: Neonatal Acid-base Statusmentioning

confidence: 98%

Labour analgesia and the baby: good news is no news

Reynolds

2011

International Journal of Obstetric Anesthesia

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Lumbar Epidural Analgesia in Labour

Cited by 75 publications

References 13 publications

Hypoxanthine Concentration in Plasma during the First Two Hours after Birth in Normal and Asphyxiated Infants

Hypoxanthine Concentration in Plasma during the First Two Hours after Birth in Normal and Asphyxiated Infants

Analgesia in labour and fetal acid–base balance: a meta‐analysis comparing epidural with systemic opioid analgesia

Labour analgesia and the baby: good news is no news

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