Skip to main content Accessibility help

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

  • J. Nicolet (a1), A. Miller (a1), I. Kaufman (a1), M. C. Guertin (a2) and A. Deschamps (a3)...


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.


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.


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.


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.


Corresponding author

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:; Tel: +514 376 3330, ext 3732; Fax: +514 376 8784


Hide All
1.Rawal, N, Van Zundert, A, Holmstrom, B, Crowhurst, JA. Combined spinal–epidural technique. Reg Anesth 1997; 22: 406423.
2.DeBalli, P, Breen, TW. Intrathecal opioids for combined spinal–epidural analgesia during labour. CNS Drugs 2003; 17: 889904.
3.Cascio, M, Pygon, B, Bernett, C, Ramanathan, S. Labour analgesia with intrathecal fentanyl decreases maternal stress. Can J Anesth 1997; 44: 605609.
4.Tsen, LC, Thue, B, Datta, S, Segal, S. Is combined spinal–epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 1999; 91: 920925.
5.Wong, CA, Scavone, BM, Peaceman, AM et al. The risk of Cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med 2005; 352: 655665.
6.Birnbach, DJ, Ojea, LS. Combined spinal–epidural (CSE) for labor and delivery. Intern Anesth Clin 2002; 40: 2748.
7.COMET. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. The Lancet 2001; 358: 1923.
8.Gambling, DR, Sharma, SK, Ramin, SM et al. A randomized study of combined spinal–epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology 1998; 89: 13361344.
9.Sia, AT, Camann, WR, Ocampo, CE, Goy, RW, Tan, HM, Rajammal, S. Neuraxial block for labour analgesia – is the combined spinal epidural (CSE) modality a good alternative to conventional epidural analgesia? Singapore Med J 2003; 44: 464470.
10.Norris, MC, Fogel, ST, Conway-Long, C. Combined spinal–epidural versus epidural labor analgesia. Anesthesiology 2001; 95: 913920.
11.Vercauteren, M, Bettens, K, Van Springel, G, Schols, G, Van Zundert, J. Intrathecal labor analgesia: can we use the same mixture as is used epidurally? Inter J Obst Anesth 1997; 6: 242246.
12.Palmer, CM, Maciulla, JE, Cork, RC, Nogami, WM, Gossler, K, Alves, D. The incidence of fetal heart rate changes after intrathecal fentanyl labor analgesia. Anesth Analg 1999; 88: 577581.
13.Mardirosoff, C, Dumont, L, Boulvain, M, Tramer, MR. Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review. BJOG 2002; 109: 274281.
14.Van de Velde, M. Neuraxial analgesia and fetal bradycardia. Curr Opin Anaesth 2005; 18: 253256.
15.Segal, S, Csavoy, AN, Datta, S. The tocolytic effect of catecholamines in the gravid rat uterus. Anesth Analg 1998; 87: 864869.
16.Clarke, VT, Smiley, RM, Finster, M. Uterine hyperactivity after intrathecal injection of fentanyl for analgesia during labor: a cause of fetal bradycardia? Anesthesiology 1994; 81: 1083.
17.Leighton, BL, Halpern, SH, Wilson, DB. Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women. Anesthesiology 1999; 90 (4): 10391046.
18.Nielsen, PE, Erickson, JR, Abouleish, EI, Perriatt, S, Sheppard, C. Fetal heart rate changes after intrathecal sufentanil or epidural bupivacaine for labor analgesia: incidence and clinical significance. Anesth Analg 1996; 83: 742746.
19.Van de Velde, M, Vercauteren, M, Vandermeersch, E. Fetal heart rate abnormalities after regional analgesia for labor pain: the effect of intrathecal opioids. Reg Anesth Pain Med 2001; 26: 257262.
20.Van de Velde, M, Teunkens, A, Hanssens, M, Vandermeersch, E, Verhaeghe, J. Intrathecal sufentanil and fetal heart rate abnormalities: a double-blind, double placebo-controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor. Anesth Analg 2004; 98: 11531159.


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

  • J. Nicolet (a1), A. Miller (a1), I. Kaufman (a1), M. C. Guertin (a2) and A. Deschamps (a3)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed