Document Detail

Blood pressure and fetal heart rate changes with patient-controlled combined spinal epidural analgesia while ambulating in labour.
MedLine Citation:
PMID:  9166196     Owner:  NLM     Status:  MEDLINE    
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 > or = 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.
R al-Mufti; R Morey; A Shennan; B Morgan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British journal of obstetrics and gynaecology     Volume:  104     ISSN:  0306-5456     ISO Abbreviation:  Br J Obstet Gynaecol     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-06-19     Completed Date:  1997-06-19     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  7503752     Medline TA:  Br J Obstet Gynaecol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  554-8     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London, UK.
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MeSH Terms
Analgesia, Epidural*
Analgesia, Obstetrical*
Analgesia, Patient-Controlled* / methods
Analgesics, Opioid / pharmacology
Anesthetics, Local / pharmacology
Blood Pressure / drug effects*
Bupivacaine / pharmacology
Fentanyl / pharmacology
Heart Rate, Fetal / drug effects*
Obstetric Labor Complications / prevention & control*
Posture / physiology*
Prospective Studies
Pulse / drug effects
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 437-38-7/Fentanyl

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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