title: Blood pressure and fetal heart rate changes with patient-controlled combined spinal epidural analgesia while ambulating in labour.
abstract: 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.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  Queen Charlotte's and Chelsea hospital, London.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: al-Mufti
authors.forename: R
authors.initials: R
authors.lastname: Morey
authors.forename: A
authors.initials: A
authors.lastname: Shennan
authors.forename: B
authors.initials: B
authors.lastname: Morgan
mesh_terms: D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000494:pharmacology; D000779:Anesthetics, Local / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects*; D002045:Bupivacaine / Q000494:pharmacology; D015148:Cardiotocography; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D011187:Posture / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies; D011674:Pulse / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine