Uterine and umbilical blood flow velocity during epidural anaesthesia for caesarean section.
The purpose of this study was to use colour Doppler to determine the effect of epidural anaesthesia on the uterine and umbilical blood flow velocities. After determining the precision of the technique, Doppler insonation of the uterine and umbilical arteries was performed in consenting non-labouring patients requesting epidural anaesthesia for Caesarean section. Patients in Group I were normal and those in Group II were at high risk for uteroplacental blood flow abnormalities. The pulsatility indexes (PI) of both uterine and umbilical arteries were compared at the following times: control, after fluid and after anaesthesia using repeated measure analysis of variance. In Group I (n = 30) the PI increased from 0.72 to 0.82 in the left uterine artery and from 0.71 to 0.85 in the right uterine artery (P < 0.05). In Group II (n = 10) the PI increased from 0.67 to 0.85 in the left uterine artery (NS) and from 0.98 to 1.38 in the right uterine artery (P < 0.05). There was no change in the PI in the umbilical artery. We conclude that the PI of the uterine arteries increases after epidural anaesthesia with lidocaine, epinephrine and fentanyl but there is no change in the umbilical PI. While these changes do not appear to be clinically important in the low-risk population, further studies are required to determine the impact on fetuses at high risk for in utero hypoxaemia.
Halpern
S
S
Department of Anaesthesia, Women's College Hospital, Toronto, Ontario, Canada.
Glanc
P
P
Myhr
T
T
Ryan
M
M
Fong
K
K
Amankwah
K
K
Ohlsson
A
A
D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001158:Arteries; D001783:Blood Flow Velocity / Q000502:physiology; D002585:Cesarean Section; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D005315:Fetal Diseases / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D000860:Hypoxia / Q000503:physiopathology; D008012:Lidocaine / Q000494:pharmacology; D011247:Pregnancy; D011673:Pulsatile Flow / Q000187:drug effects / Q000502:physiology; D012307:Risk Factors; D018615:Ultrasonography, Doppler, Color; D014469:Umbilical Arteries / Q000502:physiology*; D014599:Uterus / Q000098:blood supply*
D008012:Lidocaine; D005283:Fentanyl; D004837:Epinephrine