Prophylactic intravenous preloading for regional analgesia in labour.
BACKGROUND
Fetal heart rate changes are common following regional analgesia during labour. Reduced uterine blood flow from maternal hypotension may contribute to this. Intravenous fluid preloading (volume expansion) may help to reduce maternal hypotension.


OBJECTIVE
The objective of this review was to assess the effects of prophylactic intravenous fluid preloading prior to epidural analgesia during labour on maternal and fetal well-being.


METHODS
The Cochrane Pregnancy and Childbirth Group trial register and the Cochrane Controlled Trials Register were searched. Date of last search: December 1997.


METHODS
Randomised and quasi-randomised trials comparing prophylactic intravenous preloading before epidural analgesia during labour with a control group (dummy or no preloading).


METHODS
The reviewer assessed trial quality and extracted data.


RESULTS
One study involving 102 women was included. There was potential for considerable bias in this trial. Preloading with intravenous fluids was associated with a reduction in hypotension (relative risk 0.07, 95% confidence interval 0.01 to 0.53). It was also associated with a reduction in fetal heart rate abnormalities (relative risk 0.36, 95% confidence interval 0.16 to 0.83). No differences were detected in other perinatal and maternal outcomes.


CONCLUSIONS
There are methodological limitations in the only trial of preloading with intravenous fluids prior to epidural analgesia. However preloading may have beneficial fetal and maternal effects in healthy women. Further investigation of the risks and benefits of intravenous preloading for women with pregnancy complications is required.
Hofmeyr
G J
GJ
Department of Obstetrics and Gynaecology, Coronation Hospital and University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. 091just@chiron.wits.ac.za
D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D005260:Female; D005440:Fluid Therapy; D006340:Heart Rate, Fetal; D006801:Humans; D007022:Hypotension / Q000517:prevention & control*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control*