Evaluation of cerebral perfusion pressure changes in laboring women: effects of epidural anesthesia

Abstract

Objective To compare the effect of epidural anesthesia on cerebral perfusion pressure in laboring women. Study design

Maternal blood pressure before the onset of eclampsia and stroke during labor at term

“…In an earlier study of cerebral perfusion pressure changes in laboring normotensive women by ultrasonography, 11) at the peak of a contraction and during pushing, cerebrovascular resistance was found to rise significantly, although cerebral blood flow did not change. In addition, preeclamptic patients in one study showed a global elevation of cerebral perfusion pressure and lower resistance in cerebral circulation than normotensive pregnant women.…”

Magnesium Sulfate Decreases Cerebral Perfusion Pressure in Preeclampsia

“…(6,(8)(9)(10)(11)(12)(13) These data from our study patients were plotted on the same axes as data collected longitudinally from 65 normal pregnant women followed through pregnancy at monthly intervals (12). Data points outside of the 5 th and 95 th percentile limits of the normative data were considered abnormal.…”

Intrapartum ultrasound

“…Williams and Wilson also investigated the effects of epidural anesthesia on cerebral perfusion pressure in laboring women115. In this study, patients with epidural anesthesia had lower calculated estimated cerebral perfusion pressure (eCPP = Vmean/(Vmean—Vdiastolic) × (mean BP—diastolic BP), where V is middle cerebral artery velocity and BP is blood pressure), resistance area product (RAP = mean BP/Vmean) and cerebral blood flow index compared with those in the non‐epidural group115.…”

“…As a result of the above, pushing during the second stage with the Valsalva maneuver was therefore thought not to expose the patient to a greater risk of middle cerebral vasospasm than uterine contractions during the first stage of labor114. Williams and Wilson also investigated the effects of epidural anesthesia on cerebral perfusion pressure in laboring women115. In this study, patients with epidural anesthesia had lower calculated estimated cerebral perfusion pressure (eCPP = Vmean/(Vmean—Vdiastolic) × (mean BP—diastolic BP), where V is middle cerebral artery velocity and BP is blood pressure), resistance area product (RAP = mean BP/Vmean) and cerebral blood flow index compared with those in the non‐epidural group115.…”