Fetal bradycardia and uterine hyperactivity following subarachnoid administration of fentanyl during labor.
OBJECTIVE
Changes in uterine tone have been postulated as the cause of fetal bradycardia following subarachnoid administration of fentanyl for labor analgesia. Such a case occurred in a 20-year-old parturient with an intrauterine pressure catheter in place.


METHODS
The patient was given intravenous terbutaline, after which contractions ceased for 20-30 minutes and then resumed.


RESULTS
The patient underwent successful cesarean delivery. Retrospective analysis of the data revealed a significant increase in uterine tone and contractions following fentanyl administration.


CONCLUSIONS
This case supports the view that changes in uterine tone, producing a hyperdynamic contractile state and a resulting decrease in uteroplacental perfusion, may explain the fetal bradycardia following subarachnoid opioid administration. Cases that do not resolve spontaneously may respond to intravenous terbutaline.
Friedlander
J D
JD
Department of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, New York 10032, USA.
Fox
H E
HE
Cain
C F
CF
Dominguez
C L
CL
Smiley
R M
RM
D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D011247:Pregnancy; D013346:Subarachnoid Space; D014599:Uterus / Q000187:drug effects*
D000701:Analgesics, Opioid; D005283:Fentanyl