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Blood pressure and fetal heart rate changes with patient‐controlled combined spinal epidural analgesia while ambulating in labour
Author(s) -
AlMufti Raghad,
Morey Richard,
Shennan Andrew,
Morgan Barbara
Publication year - 1997
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1997.tb11531.x
Subject(s) - medicine , combined spinal epidural , anesthesia , blood pressure , heart rate , fetal heart rate , fetus , cardiology , pregnancy , biology , genetics
Objective To determine the effect of patient‐controlled combined spinal epidural analgesia (PCEA) on maternal pulse and blood pressure, and fetal heart rate in primigravid women, when adapting different positions in labour. Design A prospective study. Setting Queen Charlotte's and Chelsea hospital, London. Participants Fifty‐five primigravid women in labour at 37 weeks of gestation; 40 women had supervised standing top‐ups given by an anaesthetist. A further 15 women had PCEA top‐ups given in each of standing, sitting and lying positions. Main outcome measures Maternal pulse rate, blood pressure and fetal heart rate changes following epidural top‐ups. Results In the first 40 women there was no clinically significant fall in their blood pressure (< 5 mmHg). The subsequent 15 women who had PCEA top‐ups had no fall in blood pressure in the standing and sitting positions, though the average blood pressure fell significantly when a top‐up was given in the lying position. Maternal heart rate increased significantly at 12 min post top‐up when the women were in the standing position ( P = 0.0018). In the 15 women who had PCEA top‐ups, the CTG showed improvement in decelerations when women were in the standing position but deterioration when in the lying position ( P < 0.01). Conclusion Patient‐controlled epidural analgesia top‐ups with maternal mobility may be beneficial to the fetus possibly by reducing the hypotension normally associated with top‐ups in the lying position.