title: Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies.
abstract: OBJECTIVE
  Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology.
  
  
  METHODS
  Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E) group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7-15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T) group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4-6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score.
  
  
  RESULTS
  Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001) regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group.
  
  
  CONCLUSIONS
  Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.
authors.affiliation: Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Sukhen
authors.initials: S
authors.lastname: Samanta
authors.affiliation: Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kajal
authors.initials: K
authors.lastname: Jain
authors.affiliation: Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Neerja
authors.initials: N
authors.lastname: Bhardwaj
authors.affiliation: Department of Obstetric and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Vanita
authors.initials: V
authors.lastname: Jain
authors.affiliation: Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Sujay
authors.initials: S
authors.lastname: Samanta
authors.affiliation: Department of Ophthalmology, ASG Eye Hospital, Jodhpur, Rajasthan, India.
authors.forename: Rini
authors.initials: R
authors.lastname: Saha
keywords: Epidural; foetal acidaemia; growth retardation; high-risk; intrauterine; labour analgesia; maternal satisfaction; pregnancy; ropivacaine; tramadol