Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review.
OBJECTIVE
To evaluate fetal and maternal adverse effects of intrathecal opioid analgesia during labour.


METHODS
A systematic search was performed, in Medline, Embase, the Cochrane Library, bibliographies, and personal contact with authors, in any language, up to February 2001.


METHODS
selection Full reports on randomised comparisons of any analgesia with intrathecal opioid (experimental group) with any non-intrathecal opioid regimen (control group) during labour.


METHODS
Dichotomous data from 24 trials (3513 women).


RESULTS
With intrathecal opioids, there was a significant increase in the risk of fetal bradycardia: odds ratio 1.8 (95% confidence interval 1.0 to 3.1), number-needed-to-harm 28. The risk of caesarean section due to fetal heart rate abnormalities was similar (6.0% versus 7.8%). The incidence of pruritus was significantly higher with intrathecal opioids: relative risk 29.6 (95% CI 13.6 to 64.6), number-needed-to-harm 1.7.


CONCLUSIONS
Intrathecal opioids for labour increase the risk of fetal bradycardia and maternal pruritus. The risk of subsequent caesarean section is not increased.
Mardirosoff
Chahé
C
Department of Anaesthesiology, Polyclinique de Savoie, Annemasse, France.
Dumont
Lionel
L
Boulvain
Michel
M
Tramèr
Martin R
MR
D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced*; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced*; D006801:Humans; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D000701:Analgesics, Opioid