title: Long-term epidural block treatment in patients with early threatening preterm delivery and vaginal fetal engagement.
abstract: We report on an exceptional therapy with epidural anesthesia and tunnelling of the peridural catheter over a time period of 2-14 days in patients with threatening early preterm labor, intact membranes and vaginal engagement of the infants (4 singleton, 8 twin and 2 triplet pregnancies). A combination of bupivacaine (0.125%) and fentanyl (2 microg/mL) was used up to a maximum of 20 mL/h during the treatment period. Long-term follow-up of the infants was normal in 19/20 infants. The advantages, such as prolongation of pregnancy without maternal pain and disadvantages such as the risk of fetal and maternal infection and of sudden delivery are discussed. The online version of the Journal (see http://dx.doi.org/10.1515/jpm.2008.081_supp-1) allows video illustrations of a triplet pregnancy, in which the first triplet was born after one week of epidural anesthesia and the pregnancy continued under epidural anesthesia for the remaining two triplets staying with intact membranes in the vagina (delayed interval delivery) for six more days. The results of this pilot series suggest that prolongation of these pregnancies under epidural anesthesia might be an option in exceptional cases when viability is questionable or when corticosteroid therapy is desired before final delivery. Further evaluation of this strategy is needed but only in tertiary centers with 24-h presence of qualified obstetric and neonatal care and intensive surveillance.
authors.affiliation: Department of Perinatology, Isala Kliniken, Zwolle, The Netherlands. clara-angela@wxs.nl
authors.forename: Birgit
authors.initials: B
authors.lastname: Arabin
authors.forename: Karel
authors.initials: K
authors.lastname: Kuizenga
authors.forename: Diny
authors.initials: D
authors.lastname: van Zoeren
authors.forename: Diny V
authors.initials: DV
authors.lastname: Zveren
authors.forename: Jim V
authors.initials: JV
authors.lastname: Eyck
mesh_terms: D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000295:instrumentation / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000295:instrumentation / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use; D001034:Apgar Score; D002045:Bupivacaine / Q000627:therapeutic use; D002408:Catheters, Indwelling; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases; D019102:Infant, Very Low Birth Weight; D048949:Labor Pain / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D014310:Triplets; D014427:Twins
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine