title: Prophylactic ephedrine and combined spinal epidural: maternal blood pressure and fetal heart rate patterns.
abstract: OBJECTIVE
  Labor analgesia with the combined spinal epidural approach has been associated with maternal hypotension and fetal heart rate (FHR) changes. The purpose of this study was to estimate whether prophylactic intramuscular ephedrine before combined spinal epidural prevents these complications.
  
  
  METHODS
  In a prospective double blind trial, 100 healthy patients with term singletons received intramuscular ephedrine 25 mg or placebo by random allocation before combined spinal epidural. During the first hour after analgesia, maternal heart rate, blood pressure, and need for treatment of significant hypotension were recorded. Fetal heart rate tracings for 1 hour before and for 1 hour after administration of anesthetic were evaluated. Categorical variables were compared with Fisher exact test. Continuous variables were compared with one way analysis of variance for repeated measures. P < .05 was considered significant.
  
  
  RESULTS
  Prophylactic ephedrine reduced the incidence of maternal hypotension after combined spinal epidural (P < .007). In controls, there was a significant increase in the incidence and frequency of late decelerations in the hour following combined spinal epidural compared with the previous hour (P < .005 and P < .01). Compared with controls, there was an increased incidence of fetal tachycardia in patients who received prophylactic ephedrine (P < .006), which was associated with increased FHR reactivity (P < .03).
  
  
  CONCLUSIONS
  Although prophylactic ephedrine prevents maternal hypotension and fetal late decelerations, it is associated with fetal tachycardia. The value of prophylactic ephedrine at combined spinal epidural should be weighed against potential changes in fetal heart rate patterns.
  
  
  METHODS
  I.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York 10032, USA. jec32@columbia.edu
authors.forename: Jane
authors.initials: J
authors.lastname: Cleary-Goldman
authors.forename: Maria
authors.initials: M
authors.lastname: Negron
authors.forename: Jason
authors.initials: J
authors.lastname: Scott
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Downing
authors.forename: William
authors.initials: W
authors.lastname: Camann
authors.forename: Lynn
authors.initials: L
authors.lastname: Simpson
authors.forename: Pamela
authors.initials: P
authors.lastname: Flood
mesh_terms: D018663:Adrenergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D001794:Blood Pressure; D004311:Double-Blind Method; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D018663:Adrenergic Agents; D004809:Ephedrine