Combined spinal epidural (CSE) analgesia, fetal bradycardia, and uterine hypertonus

Neuraxial analgesia and fetal bradycardia

“…No signs of hypotension were present, in most patients uterine hyperactivity was present, and in two an emergency operative delivery was performed. Several retrospective trials have since been carried out, and most authors have concluded that FHR changes are more common with intrathecal opioids (Table 1) [4,5,[9][10][11][12][13]. This issue has however remained controversial [2,14].…”

“…Although a type 2 error cannot be excluded from this trial, it seems that low-dose epidurals do not benefit from fluid preloading. 3.9 3.9 Kahn and Hubert [4] 5.6 Ã 2.5 Palmer et al [11] 12 6 Van de Velde et al [13] 11.4 Ã 5.9…”

“…However, some authors have reported an increased incidence of Cesarean delivery for reasons of presumed fetal jeopardy following neuraxial analgesia [3]. It has also been suggested that fetal bradycardia is more common following intrathecal opioid administration or combined spinal epidural (CSE) analgesia than it is with epidural techniques of analgesia [4,5].…”

Labour analgesia effects on foetal heart rate. A mini-review

“…Five out of the nine patients with foetal bradycardia also exhibited uterine hyperactivity detected by external or internal pressure transducer. This uterine hyperactivity following intrathecal fentanyl has since been confirmed on several occasions [23][24][25].…”