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DOI: 10.1055/s-2002-25312
Effect of Maternal Epidural Analgesia on Fetal Intrapartum Oxygen Saturation
Publication History
Publication Date:
25 April 2002 (online)
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ABSTRACT
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.
KEYWORD
Fetal - pulse oximetry - epidural - labor
REFERENCES
- 1 Hofmeyr G J. Prophylactic intravenous preloading for regional analgesia in labour (Cochrane Review). The Cochrane Library, Issue 1. Oxford: Update Software; 2002
- 2 Al-Mufti R, Morey R, Shennan A, Morgan B. Blood pressure and fetal heart rate changes with patient-controlled combined spinal epidural analgesia while ambulating in labour. Br J Obstet Gynaecol . 1997; 104 554-558
- 3 Collins K M, Bevan D R, Beard R W. Fluid loading to reduce abnormalities of fetal heart rate and maternal hypotension during epidural analgesia in labour. BMJ . 1978; 2 1460-1461
- 4 Palmer C M, Maciulla J E, Cork R C. The incidence of fetal heart rate changes after intrathecal fentanyl labor analgesia. Anesth Analg . 1999; 88 577-581
- 5 Eberle R L, Norris M C, Mallozzi Eberle A. The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia. Am J Obstet Gynaecol . 1998; 179 150-155
- 6 Umstad M P, Ross A, Rushford D D, Permezel M. Epidural analgesia and fetal heart rate abnormalities. Aust N Z J Obstet Gynaecol . 1993; 33 269-272
- 7 Palmer C M, Van Maren G, Nogami W M, Alves D. Bupivacaine augments intrathecal fentanyl for labor analgesia. Anesthesiology . 1999; 91 84-89
- 8 Hoffman III T C, Guzman E R, Richardson M J. Effects of narcotic and non-narcotic continuous epidural anesthesia on intrapartum fetal heart rate tracings as measured by computer analysis. J Matern Fetal Med . 1997; 6 200-205
- 9 Okutomi T, Mochizuki J, Amano K, Hoka S. Effect of epidural epinephrine infusion with bupivacaine on labor pain and mother-fetus outcome in humans. Reg Anesth Pain Med . 2000; 25 228-234
- 10 St Amant S M, Koffel B, Malinow A M. The effects of epidural opioids on fetal heart rate variability when coadministered with 0.25% bupivacaine for labor analgesia. Am J Perinatol . 1998; 15 351-356
- 11 Aldrich C J, D'Antona D, Spencer J AD. The effect of maternal posture on fetal cerebral oxygenation during labour. Br J Obstet Gynaecol . 1995; 102 14-19
- 12 East C E, Dunster K R, Colditz P B. Fetal intrapartum oxygen saturation monitoring: an analysis of 118 cases. Aust N Z J Obstet Gynaecol . 1997; 37 397-401
- 13 Colditz P B, Begg L M, East C E. Fetal pulse oximetry: instrumentation and recent clinical experience. Clin Perinatol . 1999; 26 869-880
- 14 East C E, Begg L M, Colditz P B, Brennecke S P. Update on intrapartum fetal pulse oximetry. Aust N Z J Obstet Gynaecol . 2002; 42 6-11
- 15 East C E, Dunster K R, Colditz P B. Fetal oxygen saturation during maternal bearing down efforts in the second stage of labor. Am J Perinatol . 1998; 15 121-124
- 16 Chua S, Yeong S M, Razvi K, Arulkumaran S. Fetal oxygen saturation during labour. Br J Obstet Gynaecol . 1997; 104 1080-1083
- 17 East C E, Dunster K R, Colditz P B. Fetal oxygen saturation and uterine contractions during labor. Am J Perinatol . 1998; 15 345-349
- 18 Garite T J, Dildy G A, McNamara H. A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns. Am J Obstet Gynecol . 2000; 183 1049-1058
- 19 Seelbach-Göbel B, Heupel M, Kühnert M, Butterwegge M. The prediction of fetal acidosis by means of intrapartum fetal pulse oximetry. Am J Obstet Gynecol . 1999; 180 73-81
- 20 Kühnert M, Seelbach-Göebel B, Butterwegge M. Predictive agreement between the fetal arterial oxygen saturation and fetal scalp pH: results of the German multicenter study. Am J Obstet Gynecol . 1998; 178 330-335
- 21 Swedlow D B. Review of Evidence for a Fetal SpO2 Critical Threshold of 30%. Pleasanton, CA: Nellcor Puritan Bennett 1997
- 22 East C E, Colditz P B. Women's evaluations of their experience with fetal intrapartum oxygen saturation monitoring and participation in a research project. Midwifery . 1996; 12 93-97
- 23 East C E, Colditz P B. Stability of women's perceptions of fetal intrapartum oximetry. J Qual Clin Prac . 1997; 17 27-31
- 24 East C E, Colditz P B. Clinicians' perceptions of placing a fetal oximetry sensor. J Qual Clin Prac . 2000; 20 161-163
- 25 Johnson N, van Oudgaarden E, Montague I A. The effect of maternal epidural analgesia on fetal oxygen saturation. Br J Obstet Gynaecol . 1996; 103 776-778
- 26 Kaita T M, Nikkola E M, Rantala M I. Fetal oxygen saturation during epidural and paracervical analgesia. Acta Obstet Gynecol Scand . 2000; 79 336-340
- 27 Geerinckx K, Vanderick G, Van Steenbergh L A. Bupivacaine 0.125% in epidural block analgesia during childbirth: maternal and foetal plasma concentrations. Br J Anaesth . 1974; 46 937-941
- 28 Banzai M, Sato S, Tezuka N. Placental transfer of lidocaine hydrochloride after prolonged continuous maternal intravenous administration. Can J Anaesth . 1995; 42 338-340
- 29 Phillips K, Umstad M P, Donnelly J G. The effect of epidural bupivacaine on the fetal electrocardiogram. Aust N Z J Obstet Gynaecol . 1996; 36 272-274