TELEMETRY OF FETAL HEART RATE AND MATERNAL BLOOD PRESSURE FROM HOME

Background The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the local anesthetic-sparing efficacy of epidural epinephrine by its effect on the MLAC of bupivacaine. Methods In this double-blind, randomized, prospective study, 70 parturients who were at 7 cm or less cervical dilation and who requested epidural analgesia were allocated to one of two groups. After lumbar epidural catheter placement, 20 ml bupivacaine (n = 35) or bupivacaine with epinephrine 1:300,000 (n = 35) was administered. The concentration of bupivacaine was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores, with 10 mm or less within 30 min defined as effective. Results The MLAC of bupivacaine alone was 0.091% wt/vol (95% confidence interval, 0.081-0.102). The addition of epinephrine 1:300,000 (66.7 microg) resulted in a significant reduction (P < 0.01) in the MLAC of bupivacaine to 0.065% wt/vol (95% confidence interval, 0.047-0.083). The lowest maternal blood pressure was significantly lower in the bupivacaine-epinephrine group (P = 0.03). There were statistically significant reductions in fetal heart rate (P = 0.011) in the bupivacaine-epinephrine group that were not clinically significant. Conclusions The addition of epidural epinephrine 1:300,000 (66 microg) resulted in a significant 29% reduction in the MLAC of bupivacaine. Coincident reductions in fetal heart rate and maternal blood pressure were also observed that were not clinically significant.

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Prophylactic Ephedrine and Combined Spinal Epidural. Maternal Blood Pressure and Fetal Heart Rate Patterns

Obstetric Anesthesia Digest ◽

10.1097/00132582-200603000-00036 ◽

2006 ◽

Vol 26 (1) ◽

pp. 31-32

Author(s):

&NA;

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Maternal Blood ◽

Combined Spinal Epidural ◽

Spinal Epidural ◽

Maternal Blood Pressure

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Effects of maternal betamethasone administration on fetal and maternal blood pressure and heart rate in the baboon at 0.7 of gestation

American Journal of Obstetrics and Gynecology ◽

10.1067/mob.2002.121654 ◽

2002 ◽

Vol 186 (4) ◽

pp. 812-817 ◽

Cited By ~ 71

Author(s):

S.V. Koenen ◽

C.A. Mecenas ◽

G.S. Smith ◽

S. Jenkins ◽

P.W. Nathanielsz

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Maternal Blood ◽

Maternal Blood Pressure

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Analgesic and Hemodynamic Effects of Intrathecal Clonidine as the Sole Analgesic Agent during First Stage of Labor

Anesthesiology ◽

10.1097/00000542-199908000-00012 ◽

1999 ◽

Vol 91 (2) ◽

pp. 388-396 ◽

Cited By ~ 50

Author(s):

Astrid Chiari ◽

Christine Lorber ◽

James C. Eisenach ◽

Eckart Wildling ◽

Claus Krenn ◽

...

Keyword(s):

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Maternal Blood ◽

Labor Analgesia ◽

Double Blind Study ◽

Double Blind ◽

Intrathecal Clonidine ◽

Dose Dependent ◽

First Stage Of Labor

Background Intrathecal clonidine produces dose-dependent postoperative analgesia and enhances labor analgesia from intrathecal sufentanil. The authors evaluated the dose-response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects. Methods Thirty-six parturients requesting labor analgesia were included in this prospective, randomized, double-blind study. Parturients with < 6 cm cervical dilatation received either 50, 100, or 200 microg intrathecal clonidine. The authors recorded visual analog pain score (VAPS), maternal blood pressure and heart rate, ephedrine requirements, and sedation at regular intervals and fetal heart rate tracings continuously. Duration of analgesia was defined as time from intrathecal clonidine administration until request for additional analgesia. Results Clonidine produced a reduction in VAPS with all three doses. The duration of analgesia was significantly longer in patients receiving 200 microg (median, 143; range, 75-210 min) and 100 microg (median, 118; range, 60-180 min) than 50 microg (median, 45; range, 25-150 min), and VAPS was lower in the 200-microg than in the 50-microg group. In the 200-microg group, hypotension required significantly more often treatment with ephedrine than in the other groups. No adverse events or fetal heart rate abnormalities occurred. Conclusions Fifty to 200 microg intrathecal clonidine produces dose-dependent analgesia during first stage of labor. Although duration and quality of analgesia were more pronounced with 100 and 200 microg than with 50 microg, the high incidence of hypotension requires caution with the use of 200 microg for labor analgesia.

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Relation of Bradycardia and Blood Pressure of the Fetal Lamb in Utero to Mild and Severe Hypoxia

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1958.193.2.249 ◽

1958 ◽

Vol 193 (2) ◽

pp. 249-256 ◽

Cited By ~ 40

Author(s):

S. R. M. Reynolds ◽

W. M. Paul

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Fetal Heart Rate ◽

Umbilical Artery ◽

Fetal Heart ◽

Periodic Breathing ◽

In Utero ◽

Severe Hypoxia ◽

Vagal Activity ◽

Moderate Hypoxia

Fetal lambs of mostly 130–145 days gestation age, were subjected to hypoxia by having the ewe breathe 13%, 10% and 6% oxygen. The umbilical artery and umbilical veins were catheterized with the fetus still in utero along with the maternal carotid artery. Blood pressures and heart rates were recorded, as well as maternal respiratory movement through an intrapleural trochar. Samples of ewe arterial and fetal venous bloods were taken for O2 and CO2 tension analysis by the Riley method. With mild or moderate hypoxia, umbilical artery mean and pulse pressures generally increase; fetal heart rate may increase, decrease, or fluctuate. With severe hypoxia, mean and pulse pressures in the umbilical artery decrease along with the fetal heart rate. When periodic breathing occurred in the ewe, reciprocal effects on the ewe and fetal circulations were observed; as the ewe heart rate and blood pressure went up during apnea, the fetal heart rate and blood pressure went down and vice versa when respiratory movements were resumed. Bradycardia in its initial stages may be momentarily stopped by injection of atropine into the fetus. The critical O2 tension for depression of the fetal circulation is between 10–30 mm Hg. Bradycardia is not indicative of mild or moderate hypoxia; blood pressure improves with mild or moderate hypoxia; when blood pressure and heart rate both decline in severe hypoxia, it is indicative of fetal heart failure and imminent fetal death. The initial hypoxic bradycardia results from vagal activity since it can be blocked briefly by atropine and since the heart rate may fluctuate between beats from a slow to a fast rate. Fetal heart rate and blood pressure respond quickly to change of the gas content of the ewe's blood as demonstrated by changes occurring during periodic breathing in the ewe.

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Variability of Fetal Heart Rate Deceleration, Blood Pressure, and Acid Base Alterations During Defined Repetitive Hypoxic Stress

Fetal Heart Rate Monitoring ◽

10.1007/978-3-642-70358-4_11 ◽

1985 ◽

pp. 94-103

Author(s):

E. Kastendieck ◽

W. Künzel ◽

A. Jensen

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Hypoxic Stress ◽

Heart Rate Deceleration ◽

Acid Base ◽

Rate Deceleration

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Bupivacaine Augments Intrathecal Fentanyl for Labor Analgesia

Anesthesiology ◽

10.1097/00000542-199907000-00015 ◽

1999 ◽

Vol 91 (1) ◽

pp. 84-89 ◽

Cited By ~ 25

Author(s):

Craig M. Palmer ◽

Gretchen Van Maren ◽

Wallace M. Nogami ◽

Diane Alves

Keyword(s):

Blood Pressure ◽

Muscle Strength ◽

Fetal Heart ◽

Intrathecal Injection ◽

Maternal Blood ◽

Labor Analgesia ◽

Regional Analgesia ◽

Lower Extremity Muscle ◽

Spinal Epidural ◽

Maternal Blood Pressure

Background fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low-dose bpivacaine added to intrathecal fentanyl for labor analgesia Methods Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 microg; bupivacaine, 1.25 mg, with fentanyl, 25 microg; or bupivacaine, 2.5 mg, with fentanyl, 25 microg, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded. Results Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 microg, than the group receiving plain fentanyl (108 vs. 92 min; P < 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P < 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged. Conclusions The addition of 2.5 mg isobaric bupivacaine to 25 microg fentanyl for intrathecal labor analgesia modestly increases duration and speeds onset of analgesia compared with plain intrathecal fentanyl.

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