title: Maternal positioning affects fetal heart rate changes after epidural analgesia for labour.
abstract: Adverse fetal heart rate (FHR) changes suggestive of fetal hypoxia are seen in patients with normal term pregnancies after initiation of epidural block for labour analgesia. It was our hypothesis that, in some parturients, these changes were a consequence of concealed aortocaval compression resulting in decreased uterine blood flow. We expected that the full lateral position compared with the wedged supine position would provide more effective prophylaxis against aortocaval compression. To test our hypothesis we studied the role of maternal positioning on FHR changes during onset of epidural analgesia for labour. Eighty-eight ASA Class I or II term parturients were randomized into two groups: those to be nursed in the wedged supine position and those to be nursed in the full lateral position during induction of an epidural block. External FHR monitoring was employed to assess the fetal response to initiation of labour epidural analgesia. Epidural catheters were sited with the parturients in the sitting position and the patients then assumed the study position. After a negative test dose, a standardized regimen of bupivacaine 0.25% was employed to provide labour analgesia. The quality and efficacy of the block were assessed using VAS pain scores, motor block scores and sensory levels. The results demonstrated that there was no difference in the quality of analgesia provided nor in the incidence of asymmetric blocks. There was no difference in the observed incidence of FHR changes occurring during the initiation of the epidural block.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anaesthesia, Ottawa General Hospital, University of Ottawa, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Preston
authors.forename: E T
authors.initials: ET
authors.lastname: Crosby
authors.forename: D
authors.initials: D
authors.lastname: Kotarba
authors.forename: H
authors.initials: H
authors.lastname: Dudas
authors.forename: R D
authors.initials: RD
authors.lastname: Elliott
mesh_terms: D015360:Analgesia, Epidural / Q000451:nursing; D016362:Analgesia, Obstetrical / Q000451:nursing; D001011:Aorta / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005316:Fetal Distress / Q000209:etiology; D005323:Fetal Monitoring; D006340:Heart Rate, Fetal / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D007743:Labor, Obstetric; D009407:Nerve Block; D010146:Pain / Q000517:prevention & control; D011187:Posture / Q000502:physiology*; D011247:Pregnancy; D011312:Pressure; D011446:Prospective Studies; D016683:Supine Position / Q000502:physiology; D013997:Time Factors; D014599:Uterus / Q000098:blood supply; D014684:Venae Cavae / Q000502:physiology
chemical_list: D002045:Bupivacaine