The influence of epidural analgesia with local anaesthetic and opioid on fetal oxigen saturation during labor

M. Lerinţiu, Gabriela Caracostea, F. Stamatian
Clinica Ginecologie I, Secţia ATI, Spitalul Clinic Judeţean de Urgenţa Cluj-Napoca

Abstract

Objective. The use of maternal epidural analgesia in labor may be associated with non-reassuring fetal heart rate (FHR) patterns due to fetal hypoxia. We aimed to assess changes in the fetal oxygen saturation (FSpO2) during epidural analgesia in labor.

Methods. In a prospective observational study, twenty healthy parturients were enrolled following the inclusion criteria. Informed consent was obtained.Epidural analgesia with ropivacaine 0.1% (1mg/ml) associated with fentanyl (2.5microg/ml) was performed. The values of fetal oxygen saturation were registered continuosly 10 minutes before the administration of the analgesic drugs and during the following 30 minutes after administration. Fetal pulse oximetry (FSPO2) was measured simultaneously with cardiotocography (CTG). Maternal blood pressure, umbilical cord blood analysis, Apgar score and neonatal outcomes were evaluated.

Results. The average value for oxygen fetal saturation before the analgesic drug administration was of 44.3 + 8.8%; during the first 10 minutes after administration it decreased to 41.3 + 7.2% (p=0.25) and during the following 20 minutes slightly increased to 43.05 + 6.9% (p=0.63). There was no direct relationship between the appeareance of an alterate CTG pattern and the FSpO2 < 30% (RR = 1.11; CI 95% [0.76-1.64]) p=0.19. An unsignificant correlation was obtained between FSpO2 values within the first 30 minutes of epidural analgesia and the neonatal acidotic status (PH < 7.00 RR = 0.33; CI 95% [0.04-3.09] and BE >- 12mmol/l RR = 1; CI 95% [0.21-4.71]).

Conclusions. There were no differences in FSpO2 values in the first 30 minutes following epidural administration of analgesic drugs. In the case of a non-reassuring CTG pattern during epidural analgesia, the knowledge of the fetal oxygenation may be useful to obtain information upon the real status of the fetus intrapartum.

Keywords: fetal, pulse oximetry, epidural, intra-partum

Influenţa analgeziei peridurale materne, cu anestezic local şi opioid, asupra circulaţiei feto-placentare monitorizată prin pulsoximetrie fetală intrapartum

Jurnalul Român de Anestezie Terapie intensivă 2007 Vol.14 Nr.1, 32-37