Effects of Obstetrical Paracervical Blockade on the Fetus

Teramo, Kari

doi:10.3109/00016347109155081

Cited by 16 publications

(5 citation statements)

References 160 publications

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“…This pattern can be considered normal (6,7). No pathological periodic FHR changes or fetal bradycardia, as reported to occur after paracervical block (15,19), have been observed after epidural block in this study. In 6 cases a decreased oscillation of FHR was noted after epidural analgesia.…”

Section: Discussionsupporting

confidence: 54%

Epidural Analgesia in Labour

Raabe

Belfrage

1976

Acta Obstet Gynecol Scand

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The influence of epidural block with bupivacaine (Marcaine-adrenalin) on fetal heart rate, uterine activity, and the frequency and intensity of contractions was studied in twenty-five nulliparae at term. Uterine activity was found to decrease during the first 30 minutes following epidural block. In the time interval 30 to 40 minutes after epidural block uterine activity increased again and attained the same level as during the last 10 minutes before analgesia. The frequency of uterine contractions did not decrease after the block. The lower levels of uterine contractility were due only to a lower amplitude of the contractions. The regularizing effect of epidural analgesia on incoordinate uterine action was noted. The recording of fetal heart rate in the time interval studied revealed no pathological findings. Mode of delivery, mean labour duration and Apgar scores after epidural block were comparable with earlier studies of a larger patient population. This study suggest that epidural analgesia does not induce any important changes in fetal heart rate but temporarily decreases uterine activity.

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Section: Discussionsupporting

confidence: 54%

Epidural Analgesia in Labour

Raabe

Belfrage

1976

Acta Obstet Gynecol Scand

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“…Also lower concentrations of anesthetic agents have been proposed to minimize fetal side-effects after a paracervical block. In previous publications many different anesthetic agents have been used, such as lidocaine, mepivacaine and bupivacaine [2,14]. In this study we used bupivacaine, which is very commonly used as an anesthetic agent in paracervical blocks in Finland, and our study protocol followed the procedure for a paracervical block given in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Does a paracervical block with bupivacaine change vascular resistance in uterine and umbilical arteries?

Räsänen¹,

Jouppila²

1994

Jpme

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Paracervical block during labor following normal, uncomplicated pregnancy is occasionally accompanied by fetal bradycardia. To evaluate whether a paracervical block with bupivacaine causes changes in the vascular resistance of uteroplacental and umbilicoplacental blood flow, a total of 12 singleton, uncomplicated pregnancies in active labor at the end of pregnancy were included to this study. By using pulsed color Doppler ultrasound techniques the pulsatility indices were measured from both uterine and umbilical arteries before, one minute and 20 minutes after a paracervical block with bupivacaine. Pulsatility indices of both uterine and umbilical arteries remained unchanged throughout the study period, as did fetal and maternal heart rates. In two cases fetal bradycardia developed, causing a marked increase in the vascular resistance of the umbilical artery one minute after the paracervical block. In the uterine arteries there was only a minor increase. When the fetal bradycardia ceased the pulsatility indices returned to the levels at the beginning of the study. Paracervical block with bupivacaine in normal pregnancies without signs of chronic or acute fetal distress does not change the vascular resistance in the uterine or umbilical arteries. If fetal bradycardia develops, it seems to be due to the direct effect of bupivacaine on the fetus, mainly on the umbilical vessels.

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“…Teramo (8) has suggested that LA could have a direct effect on CNS and cardiovascular system. In this way fetal bradycardia is the primary event after LA administration, followed by a decrease in fetal blood pH.…”

Section: Discussionmentioning

confidence: 99%

“…Several hypo-theses have been formulated to explain these potentially harmful effects but none are satisfactory (7)(8)(9)(10)(11). It has been shown that LA can induce both uterine and umbilical artery constriction (12-16), but the dosage used has been far in excess of the levels reported for lidocaine (0.2-3.4 pg/ml) (17,18) or bupivacaine (0.08-0.26 pg/ml) (19) in the fetal circulation after epi dural anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Constriction of Human Umbilical Artery Induced by Local Anesthetics

Sá¹,

Meirelles²,

Franco³

et al. 1981

Gynecol Obstet Invest

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In order to study the direct effects of local anesthetics on the umbilical artery, an in vitro perfusion technique, utilizing 3-cm segments of human umbilical artery obtained within 15 min of delivery, has been developed. Basal perfusion pressure (tonus) and the frequency of phasic contractions were determined in 37 arterial segments perfused for 240-min periods with Tyrode’s solution containing lidocaine in concentrations of 2.0, 8.0 or 16 µg/ml or bupivacaine in concentrations of 0.25 or 9.8 µg/ml. A control group consisting of 11 arterial segments was perfused only with Tyrode’s solution. The lowest concentration of each anesthetic approximated that reportedly present in the umbilical arteries following administration of epidural anesthesia during labor. Both lidocaine and bupivacaine induced dose-related increases of up to 100% in tonus above the control levels of approximately 60 mm Hg, statistically significant (p < 0.05) except for 2 µg/ml lidocaine. At the same molar concentration, bupivacaine was more effective than lidocaine (p < 0.05). Both anesthetics also increased the frequency of phasic contractions. These data suggest that these agents may exert their effects on the fetus, at least in part, through a direct constricting action on the umbilical artery.

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Effects of Obstetrical Paracervical Blockade on the Fetus

Cited by 16 publications

References 160 publications

Epidural Analgesia in Labour

Epidural Analgesia in Labour

Does a paracervical block with bupivacaine change vascular resistance in uterine and umbilical arteries?

Constriction of Human Umbilical Artery Induced by Local Anesthetics

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