title: Maternal pulse pressure at admission is a risk factor for fetal heart rate changes after initial dosing of a labor epidural: a retrospective cohort study.
abstract: OBJECTIVE
  To examine low maternal admission pulse pressure (PP) as a risk factor for new onset postepidural fetal heart rate (FHR) abnormalities.
  
  
  METHODS
  Retrospective cohort study of nulliparous, singleton, vertex-presenting women admitted to labor and delivery after 37 0/7 weeks that received an epidural during labor. Women with a low admission PP were compared with those with a normal admission PP. The primary outcome was new onset FHR abnormalities defined as recurrent late or prolonged FHR decelerations in the first hour after initial dosing of a labor epidural.
  
  
  RESULTS
  New onset FHR abnormalities, defined as recurrent late decelerations and/or prolonged decelerations, occurred in 6% of subjects in the normal PP cohort compared with 27% in the low PP cohort (odds ratio, 5.6; 95% confidence interval, 2.1-14.3; P < .001). A multivariate logistic regression analysis generated an adjusted odds ratio of 28.9 (95% confidence interval, 3.7-221.4; P < .001).
  
  
  CONCLUSIONS
  New onset FHR abnormalities after initial labor epidural dosing occur more frequently in women with a low admission PP than those with a normal admission pulse. Admission PP appears to be a novel predictor of new onset postepidural FHR abnormalities.
authors.affiliation: Department of Obstetrics and Gynecology, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Miller
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Cypher
authors.forename: Peter E
authors.initials: PE
authors.lastname: Nielsen
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Foglia
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000009:adverse effects*; D001794:Blood Pressure; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005323:Fetal Monitoring; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D016015:Logistic Models; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011674:Pulse; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local
keywords: intrapartum fetal heart monitoring; obstetric anesthesia; pregnancy hemodynamics