title: Maternal microcirculation and sidestream dark field imaging: a prospective assessment of the association between labour pain and analgesia on the microcirculation of pregnant women.
abstract: BACKGROUND
  Pregnancy places significant demands on the cardiovascular system leading to measurable changes in the macrocirculation and potentially the microcirculation. During labour, both uterine contractions and labour pain can further impact cardiovascular status. The objective of this observational study was to compare sublingual microcirculation in labouring parturients before and after epidural analgesia.
  
  
  METHODS
  Healthy pregnant, labouring women requesting epidural analgesia were approached to participate. Participants with cardiovascular disease, diabetes, obesity, smoking or caffeine intake were excluded. The sidestream dark field device was applied to the sublingual mucosa obtaining images of at least 20 seconds in 5 visual fields before and after epidural analgesia. Video clips were analyzed randomly and blindly. The primary outcome was mean microvascular flow index (MFI).
  
  
  RESULTS
  Twelve participants completed this study. The results demonstrate no statistically significant difference in the MFI during labour pain (2.9±0.1) compared to after epidural analgesia (3.0±0.04, p = 0.31). Furthermore, there were no statistically significant differences in any secondary outcomes.
  
  
  CONCLUSIONS
  Our findings indicate that epidural analgesia may not impact sublingual microcirculation in labouring women. This agrees with literature supporting epidural analgesia as a safe, appropriate method of pain relief during labour with limited impact on peripheral macro or microcirculation.
authors.affiliation: Department of Women's & Obstetric Anesthesia, IWK Health Centre, Halifax, NS, Canada.|Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: R B
authors.initials: RB
authors.lastname: George
authors.affiliation: Dalhousie University School of Medicine, Halifax, NS, Canada.
authors.forename: J
authors.initials: J
authors.lastname: DesRoches
authors.affiliation: Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.|Department of Anesthesiology and Intensive Care Medicine, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Czech Republic.
authors.forename: I
authors.initials: I
authors.lastname: Abdo
authors.affiliation: Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.|Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.|Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D008833:Microcirculation; D011247:Pregnancy; D011446:Prospective Studies
keywords: Microcirculation; epidural; sidestream dark field imaging