title: Epidural analgesia with ropivacaine and sufentanil is associated with transient fetal heart rate changes.
abstract: OBJECTIVE
  Fetal heart rate (FHR) changes have been reported after regional labor analgesia. In this prospective single-blinded study, we aimed to assess whether epidural analgesia with ropivacaine and sufentanil is associated with significant changes in fetal heart rate.
  
  
  METHODS
  Fetal heart rate traces from 120 women in active labor requesting epidural analgesia were recorded and analyzed by two reviewers 90 minutes before and after epidural analgesia for baseline fetal heart rate, accelerations, decelerations and long-term variability.
  
  
  RESULTS
  A significantly decreased number of fetal heart rate accelerations (ANOVA P=0.0001) and a higher percentage of segments with decelerations (P<0.05) were observed in the three segments after analgesia as compared to the three preceding segments. The minimum number of accelerations occurred during the 30 minutes immediately after analgesia was initiated. The reviewers were concordant in finding a significant change from the 60 minutes before to the 60 minutes after analgesia, a period in which there
  
  
  CONCLUSIONS
  Epidural analgesia with ropivacaine and sufentanil is associated with fetal heart rate changes. These modifications are transient and should be considered when evaluating fetal heart rate monitoring during labor to prevent inappropriate obstetric management decisions to proceed with operative labor.
authors.affiliation: Department of Anesthesia and Intensive Care, Women and Children's Hospital Vittore Buzzi, ICP, Milan, Italy. andrea.wolfler@icp.mi.it
authors.forename: A
authors.initials: A
authors.lastname: Wolfler
authors.forename: I
authors.initials: I
authors.lastname: Salvo
authors.forename: G
authors.initials: G
authors.lastname: Sortino
authors.forename: F
authors.initials: F
authors.lastname: Bonati
authors.forename: F
authors.initials: F
authors.lastname: Izzo
mesh_terms: D000328:Adult; D000577:Amides / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D016037:Single-Blind Method; D017409:Sufentanil / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil