Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: a randomized, dose-ranging, placebo-controlled study

Ginosar, Yehuda; Nadjari, M.; Hoffman, Amnon; Firman, N.; Davidson, Elyad; Weiniger, Carolyn F.; Rosen, Laura; Weissman, Charles; Elchalal, Uriel

doi:10.1093/bja/aen402

Cited by 19 publications

(19 citation statements)

References 24 publications

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“…This concern is not supported by the current study as there was no change in the U-PI in NT and HT pregnancies, before and after anaesthetic blockade. In contrast, previous studies have shown that in pre-eclamptic women, epidural anaesthesia may help reduce uterine artery vasospasm and may improve intrapartum foetal well-being [18, 19]. However, in pregnant women with chronic arterial hypertension, this benefit has not been demonstrated.…”

Section: Discussionmentioning

confidence: 95%

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The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study

Guedes-Martins

Graça

Saraiva

et al. 2014

BMC Pregnancy Childbirth

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BackgroundDespite the known effects of neuraxial blockade on major vessel function and the rapid decrease in uterine vascular impedance, it is unclear how the blockade affects the utero-placental circulation in the near-term. We hypothesize that among women with chronic hypertension, a loss of sympathetic tonus consequent to spinal block may cause significant changes in the utero-placental haemodynamics than the changes typical in normal pregnant women. Therefore, the main study objective was to analyse the effect of spinal anaesthesia for caesarean section on uterine and umbilical arterial impedance in pregnant women at term diagnosed with stage-1 chronic hypertension.MethodsA prospective, longitudinal study was performed in singleton pregnant women (203 low-risk and 33 with hypertension) scheduled to undergo elective caesarean section. The mean arterial blood pressure and pulsatility indexes for the uterine and umbilical arteries were recorded before and after spinal anaesthesia was performed using 8–9 mg hyperbaric bupivacaine (5 mg/mL) and 2–2.5 μg sufentanil (5 μg/mL). Multiple linear regression models with errors capable of correlation or with unequal variances were fitted using the generalized least squares.ResultsIn normotensive women, the mean arterial blood pressure decreased after administering spinal anaesthesia (p < 0.05). The pulsatility index of the uterine and umbilical arteries did not change after spinal anaesthesia. In the hypertensive women, the mean arterial blood pressure (p < 0.05) and uterine artery pulsatility index (p < 0.05) decreased. In both groups, the umbilical artery pulsatility index did not change after spinal anaesthesia.ConclusionsIn stage-1 chronic hypertensive pregnant women at term, spinal anaesthesia for caesarean section reduces uterine artery impedance but not umbilical artery impedance.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-291) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 95%

“…However, maternal hypotension may develop soon after anaesthetic administration [13–17] as a consequence of sympathetic blockade, which causes arterial and arteriolar vasodilation [18, 19]. Venodilation may also occur, which decreases the cardiac preload and cardiac output, and promotes bradycardia and maternal hypotension.…”

Section: Introductionmentioning

confidence: 99%

The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study

Guedes-Martins

Graça

Saraiva

et al. 2014

BMC Pregnancy Childbirth

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“…Patients with severe preeclampsia may have compromised placental blood flow, as measured by Doppler indices. In a study by Ginosar et al [67], the control patients (standard care) required prompt delivery within 2 days for fetal indications but in patients treated with antepartum epidural analgesia, delivery was able to be delayed for an average of 19 days. While the sample size was small, and the maternal risk to benefit ratio remains to be determined, this may be an important finding.…”

Section: Labor Analgesiamentioning

confidence: 99%

Updates in Preeclampsia

Sanders

Hess

2015

Curr Anesthesiol Rep

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Hypertensive disorders of pregnancy, specifically preeclampsia, cause significant morbidity and mortality in both the mother and fetus. Changes in the diagnostic criteria have attempted to improve the ability to identify and initiate treatment. Recently, it has been discovered that a placenta-derived anti-angiogenic environment directly contributes to the pathological cause of preeclampsia. The early identification of these anti-angiogenic markers may enhance diagnosis of the disease in the future. Patients with preeclampsia need to be treated with caution in regard to airway and coagulation; however, neuraxial anesthesia, when appropriate, is preferred. During labor, the increase in placental blood flow secondary to epidural analgesia can improve fetal perfusion. Spinal and epidural anesthesia are safe for cesarean delivery in mothers with preeclampsia, and may be preferred over general anesthesia. Preeclampsia is a complex disorder that impacts day to day decisions of anesthesia care provider.

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“…[19] In a study involving 10 parturients with preeclampsia and uterine flow abnormalities, a decrease in uterine artery resistance with the increase in uterine blood flow was described in parturients who received antepartum continuous epidural analgesia with 0.1% ropivacaine when compared to those preeclamptic parturients who did not receive epidural analgesia. [20] These physiologic effects of neuraxial anesthesia are potentially beneficial in preeclamptic states. The administration of labor epidural analgesia is associated with better neonatal acid base status compared to no analgesia and systemic opioids.…”

Section: Effect Of Ra On Uteroplacental Blood Flowmentioning

confidence: 99%

Regional anesthesia in patients with pregnancy induced hypertension

Ankichetty

Chin

Chan

et al. 2013

J Anaesthesiol Clin Pharmacol

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Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.

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Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: a randomized, dose-ranging, placebo-controlled study

Abstract: ACET reduces uterine artery resistance in pre-eclampsia <32 weeks. Uteroplacental re-distribution is a novel observation and warrants further investigation.

Cited by 19 publications

References 24 publications

The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study

The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study

Updates in Preeclampsia

Regional anesthesia in patients with pregnancy induced hypertension

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