Effects of epidural analgesia on uterine artery Doppler in labour

Fratelli, N.; Prefumo, Federico; Andrico, S.; Lorandi, A.; Recupero, D.; Tomasoni, Gabriele; Frusca, T.

doi:10.1093/bja/aeq317

Cited by 19 publications

(10 citation statements)

References 14 publications

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“…This concern was previously addressed in studies performing Doppler velocimetry of umbilical and uterine arteries during epidural analgesia in normal labour patients at term. However, the results were rather conflicting as some authors reported no change in uterine and foetal [40–42] circulations, whereas others found a significant decrease in the resistance of the uterine and umbilical arteries [43]; others even reported an association between the epidural analgesia, maternal hypotension, and increased resistance indexes for the uterine arteries [44, 45]. The variations in reported findings are the likely result of substantially different study conditions.…”

Section: Discussionmentioning

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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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: 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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“…It should be considered that the flow data were obtained under general anesthesia (ketamine/azaperone). It is known that different anesthetic methods [28][29][30] and agents, e.g.,xylazine [31,32], may influence uterine and fetal blood supply. However, ketamine does not seem to affect uterine blood flow [33,34], whereas azaperone can cause moderate hypotension and lowering of heart rate in pigs [35,36].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy Guided Doppler Ultrasound Measurement of Fetal Blood Flow Indices During Early to Mid-Gestation in Pigs

Brüssow

Kurth

Vernunft

et al. 2012

Journal of Reproduction and Development

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Abstract. The objectives of this study were to obtain relevant blood flow indices of umbilical arteries (UmA) of porcine fetuses using a laparoscopic ultrasound probe and to relate these data with fetal size at early to mid gestation. Fetal parameters and flow indices, i.e., fetal length and area, fetal heart rate (FHR), systolic pulse duration (T1), interpulse duration (T2), T2/T1 ratio, peak systolic velocity (PSV), time averaged velocity (TAV), resistance index (RI) and pulsatility index (PI), were measured in 182 fetuses of 26 pregnant Landrace gilts on pregnancy day (PD) 36 (122 fetuses from 17 gilts), PD42 (19 fetuses from 3 gilts) and PD51 (42 fetuses from 6 gilts). Fetal heart rate was higher on PD36 than on PD42 (P<0.05). No differences (P>0.05) were obtained concerning systolic pulse duration, flow velocities and RI. On PD42, the PI was lower (P<0.05), while the interpulse duration (P=0.06) and T2/T1 ratio tended (P=0.08) to be higher on PD42 compared with PD36 and to PD51. To find differences in UmA blood flow parameters concerning fetal size, i.e., fetal length, fetuses were retrospectively grouped as follows: small (lower 25%), medium (mean 50%) and large (upper 25%), respectively. Although, fetuses differed in size (P<0.001) within and between days of pregnancy, FHR, PSV, TAV, RI and PI did not differ (P>0.05) among the size classes. Only systolic pulse duration tended to be longer (P=0.05) in large compared with small fetuses on PD36, and interpulse duration was lower in large fetuses on PD36 in comparison with PD51 (P<0.05). Though there was no link between fetal blood flow indices and fetal intrauterine growth retardation (IUGR), with further studies based on these flow indices, it might be possible to evaluate nutrient-or stress-related influences on fetal growth and development, particularly in the case of IUGR. Key words: Female pig, Fetal blood flow, Laparoscopy, Pregnancy, Ultrasonography (J. Reprod. Dev. 58: [243][244][245][246][247] 2012) T he profitability of pig production considerably depends on the number of live born and fostered piglets. Breeding efforts result nowadays in a greater than before number of piglets. However, pre-and postnatal losses are concomitantly increasing (up to 30%) [1]. Furthermore, intrauterine growth retardation (IUGR), resulting in lighter body weight at birth, is a significant problem in pig production [2]. Lighter birth weight piglets show reduced survival rate, compromised postnatal development [3] as well as decreased carcass and meat quality [4]. Uterine and umbilical blood flows maintain the placental transport and exchange of respiratory gases, nutrients and wastes, and thereby support fetal growth and metabolism [5]. As previously demonstrated in the pig, the blood flow to the fetus was reduced with increasing number of fetuses [6]. Experimental vascular occlusion of the uterine arteries of pigs markedly reduced conceptus development [7]. In utero growth retardation, beside other factors such as uterine capacity and number and position of fetuses ...

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“…Two recent studies did not examine uterine artery resistance [14,20]. One comparing Doppler indices after a very large bolus of ropivacaine plus sufentanil with those in a control group without epidural analgesia in labor showed a significant increase in the uterine artery pulsatility index 30 minutes after the bolus [14].…”

Section: Discussionmentioning

confidence: 99%

“…One comparing Doppler indices after a very large bolus of ropivacaine plus sufentanil with those in a control group without epidural analgesia in labor showed a significant increase in the uterine artery pulsatility index 30 minutes after the bolus [14]. The other found that umbilical artery resistance was reduced during uterine relaxation but increased during contractions, whereas the reverse was true for the fetal MCA [20].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have focused on transient changes in uterine artery blood flow after epidural analgesia [11][12][13][14]. Variations in uterine artery blood flow after epidural analgesia during labor are thought to be due to the interaction of numerous events related to blockade of sympathetic innervations, fluid administration, maternal hypotension, uterine vascular effects of sympathetic block, fluctuations in circulating catecholamines, and possibly drug effects, which all occur in association with epidural analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Uterine artery, umbilical, and fetal cerebral Doppler velocities after epidural analgesia during labor

Valentin

Ducarme

Ceccaldi

et al. 2012

Intl J Gynecology & Obste

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Effects of epidural analgesia on uterine artery Doppler in labour

Abstract: Epidural analgesia using ropivacaine 1 mg ml⁻¹ (20 ml) significantly reduced placental blood flow only transiently during uterine contraction 30 min after the injection. These changes did not seem to affect neonatal outcomes.

Cited by 19 publications

References 14 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

Laparoscopy Guided Doppler Ultrasound Measurement of Fetal Blood Flow Indices During Early to Mid-Gestation in Pigs

Uterine artery, umbilical, and fetal cerebral Doppler velocities after epidural analgesia during labor

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