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

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