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Maternal factors implicated in fetal bradycardia after combined spinal epidural for labour pain

Published online by Cambridge University Press:  01 September 2008

J. Nicolet ,
A. Miller ,
I. Kaufman ,
M. C. Guertin  and
A. Deschamps
J. Nicolet
Affiliation:
McGill University Health Centre, Royal Victoria Hospital, Department of Anesthesiology, Montreal, Quebec, Canada
A. Miller
Affiliation:
McGill University Health Centre, Royal Victoria Hospital, Department of Anesthesiology, Montreal, Quebec, Canada
I. Kaufman
Affiliation:
McGill University Health Centre, Royal Victoria Hospital, Department of Anesthesiology, Montreal, Quebec, Canada
M. C. Guertin
Affiliation:
University of Montreal, Montreal Heart Institute, Coordinating Centre, Montreal, Quebec, Canada
A. Deschamps*
Affiliation:
Montreal Heart Institute, Department of Anesthesiology and Research Institute, Montreal, Quebec, Canada
*
Correspondence to: Alain Deschamps, Department of Anesthesiology and Research Institute, Montreal Heart Institute, University of Montreal, 5000 rue Bélanger, Montreal, Quebec, CanadaH1T 1C8. E-mail: a.deschamps@umontreal.ca; Tel: +514 376 3330, ext 3732; Fax: +514 376 8784
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Summary

Background and objective

Combined spinal epidural analgesia is effective for fast relief of severe labour pain but has been associated with worrisome decreases in fetal heart rate. Since the reasons for this phenomenon remain elusive, some anaesthesiologists may abstain from using this technique. We postulated that factors unrelated to the neuraxial technique could play a role in the decrease in fetal heart rate. To our knowledge, no prospective study has previously looked into this possibility.

Methods

We collected prospective data on 223 consecutive patients who received combined spinal epidural analgesia (123) or epidural analgesia (100). Maternal blood pressure, analogue pain scores, exogenous infusion of oxytocin, cervical dilatation, maternal age, parity and ethnicity were collected and correlated with the occurrence of decreases in fetal heart rate post combined spinal epidural.

Results

Univariate analysis showed a correlation between the incidence of fetal bradycardia and higher maternal pain scores, older maternal age, and combined spinal epidural analgesia. Multivariate analysis revealed that only pain scores and maternal age were independent predictors of fetal bradycardia post neuraxial blockade.

Conclusions

Maternal pain scores and older maternal age are factors unrelated to the neuraxial technique that are independent predictors of fetal bradycardia after neuraxial analgesia for labour.

Keywords

ANAESTHESIA OBSTETRICALANAESTHESIA SPINALMATERNAL FACTORS, age, painBRADYCARDIA, fetus
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 9 , September 2008 , pp. 721 - 725
Copyright
Copyright © European Society of Anaesthesiology 2008

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