Fetal effects of combined spinal-epidural vs epidural labour analgesia: A prospective, randomised double-blind study
Date
2014
Authors
Patel, N. P
El-Wahab, N
Fernando, R
Wilson, S
Robson, Stephen
Columb, M. O
Lyons, G. R
Journal Title
Journal ISSN
Volume Title
Publisher
Blackwell Publishing Inc.
Abstract
We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labouranalgesia using either combined spinal-epidural or epidural. One hundred andfifteen healthy women requestingneuraxial analgesia in thefirst 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 neuraxi-al block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heartrate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant dif-ferences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status betweengroups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the inci-dence of abnormal fetal heart rate patterns following neuraxial analgesia (p<0.0001); two before compared witheight after analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epiduralgroup. These changes comprised increased decelerations (p=0.0045) (combined spinal-epidural group nine beforeand 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p<0.0001) (combinedspinal-epidural group zero before and seven after analgesia, epidural group zero before and eight after), and a reduc-tion in acceleration rate (p=0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h 1before and 9.9(6.1) h 1after analgesia, epidural group 11.0 (7.3) h 1before and 8.4 (5.9) h 1after). These fetal heart rate changesdid not affect neonatal outcome in this healthy population
Description
Keywords
bupivacaine, ephedrine, fentanyl, oxytocin, prostaglandin, acid base balance, alkalosis, Apgar score, Bromage scale, cardiotocography, controlled study, double blind procedure, drug effect, epidural anesthesia, fetus heart rate
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Source
Anaesthesia
Type
Journal article
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Restricted until
2099-12-31