Neuraxial analgesia and fetal bradycardia.
OBJECTIVE
To review the most recent data on labor analgesia and the risk of fetal heart rate changes.


RESULTS
Fetal heart rate changes are more common with intrathecal opioids, especially when high doses are used. Intrathecal clonidine seems to increase the risk of hypotension and fetal heart rate changes. Intravenous fluid preloading is useful in high-dose labor epidural analgesia, but its use remains controversial with low-dose techniques of epidural analgesia. Despite the potential of neuraxial analgesia to induce fetal bradycardia, neonatal outcome is usually reassuring.


CONCLUSIONS
Despite the potential of neuraxial analgesia to cause fetal heart rate problems, neuraxial analgesia is the most effective and safest form of labor analgesia. Specific techniques of labor analgesia, such as high-dose spinal opioids or intrathecal clonidine, must be avoided based on the most recent evidence. Maternal and neonatal outcome is good following regional analgesia.
Van de Velde
Marc
M
Department of Anesthesiology, University Hospitals Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. marc.vandevelde@uz.kuleuven.ac.be