Haemodynamic consequences and uterine contractions following 0.5 or 1.0 litre crystalloid infusion before obstetric epidural analgesia

Zamora, Jorge E.; Rosaeg, Ola P.; Lindsay, M. Patrice; Crossan, Mary Lou

doi:10.1007/bf03011712

Cited by 32 publications

(5 citation statements)

References 19 publications

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“…However, there are several confounding factors that can increase or decrease uterine activity. Two studies, one by Cheek and colleagues 58 and the other by Zamoroa and colleagues, 59 demonstrated decreased uterine activity after the i.v. administration of 1 litre crystalloid solution, but not after infusion of 0.5 litre.…”

Section: First Stage Of Labourmentioning

confidence: 99%

Labour analgesia and obstetric outcomes

Cambic

Wong

2010

British Journal of Anaesthesia

183

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Neuraxial analgesic techniques are the gold standards for pain relief during labour and delivery. Despite the increased use and known benefits of neuraxial labour analgesia, there has been significant controversy regarding the impact of neuraxial analgesia on labour outcomes. Review of the evidence suggests that effective neuraxial labour analgesia does not increase the rate of Caesarean delivery, even when administered early in the course of labour; however, its use is associated with a prolonged second stage of labour. Effective second-stage analgesia might also be associated with an increased rate of instrumental vaginal delivery.

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Section: First Stage Of Labourmentioning

confidence: 99%

Labour analgesia and obstetric outcomes

Cambic

Wong

2010

British Journal of Anaesthesia

183

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“…20-23 Prophylactic intravenous volume and/or vasopressor administration is commonly used prior to regional anesthesia to minimize the occurrence of hypotension. 16,22,24 In our previously published studies, we have observed that Class III obese women (Body Mass Index, BMI ≥40 kg/m 2 ) undergoing regional anesthesia for childbirth have more anesthesia-related hypotension and fetal heart rate abnormalities than lean gravidas. 25,26 These factors may contribute to the increased cesarean delivery rate and associated perioperative morbidity among Class III obese women, such as hemorrhage, endometritis, wound infection, venous thromboembolism, and respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

Vricella

Louis

Chien

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective The impact of obesity on maternal blood volume in pregnancy has not been reported. We compared the blood volumes of obese and normal weight gravidas using a validated Hydroxyethyl Starch (HES) dilution technique for blood volume estimation. Study Design Blood volumes were estimated in 30 normal weight (pregravid body mass index; BMI < 25 kg/ m2) and 30 obese (pregravid BMI > 35 kg/m2) gravidas after 34 weeks gestation using a modified HES dilution technique. Blood samples obtained before and 10 minutes after HES injection were analyzed for plasma glucose concentrations after acid hydrolysis of HES. Blood volume was calculated from the difference between glucose concentrations measured in hydrolyzed plasma. Results Obese gravidas had higher pregravid and visit BMI (mean [Std Dev]): pregravid (41[4] vs 22[2] kg/m2, p=0.001); visit BMI (42[4] vs 27[2] kg/m2, p=0.001), but lower weight gain (5[7] vs. 12[4] kg, p=0.001) than normal weight women. Obese gravidas had similar estimated total blood volume to normal weight women (8103 ± 2452 vs. 6944 ± 2830 mL, p = 0.1), but lower blood volume per kilogram weight (73 ± 22 vs. 95 ± 30 mL/kg, p = 0.007). Conclusion Obese gravidas have similar circulating blood volume, but lower blood volume per kilogram body weight, than normal weight gravidas near term.

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“…One liter of crystalloid solution, but not 0.5 liter is demonstrated to decrease uterine activity due to the release of antidiuretic hormone which temporarily decreases the production of oxytocin as both hormones are released by the posterior pituitary gland. 12,13 In contrast, there are studies which demonstrate augmentation of uterine activity and reduction in the duration of labor due to decreased plasma epinephrine and sympatholysis with epidural analgesia. 14,-17 Neonatal status at birth was similar and acceptable in both the groups.…”

Section: Fig 2: Quality Of Analgesiamentioning

confidence: 99%

First Stage of Labor: Is It Prolonged by Epidural Analgesia in Comparison to Systemic Analgesia? A Prospective Controlled Trial

Philip¹,

Rakhee²,

Ipe³

et al. 2014

jemds

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BACKGROUND: Neuraxial labor analgesia might prolong, shorten or not alter the first stage of labor. Prolongation can have deleterious effects on the progress of labor and mode of delivery which can be undesirable for the parturient and neonate. No randomized controlled trial has investigated the duration of first stage of labor as a primary outcome, with epidural analgesia compared to systemic analgesia. Methods: 500American Society of Anesthesiologists (ASA) physical status I primigravidae, aged 18-35 years, gestational age>37 weeks with singleton cephalic presentation were divided into study (epidural) and control (systemic analgesia) groups. The systemic group received tramadol 2mg/kg and phenergan 0.5mg/kg intramuscularly sixth hourly. The study group received 10ml 0.1% Ropivacaine with 50mcg Fentanyl bolus. 0.1% Ropivacaine with Fentanyl 0.0001% was given as infusion at 5ml/hr. For break through pain and at full cervical dilatation, 5ml bolus of the drug was given. The first stage was from active phase of labor to full cervical dilatation (10cm). Maternal& neonatal outcome and analgesia were monitored. Results: 203 parturients in the study group and 208 in the control group completed the study. First stage was significantly prolonged in the study group compared to the control group (367.39±76.72min v/s 308.22±89.31min, p value=0.000, 95% CI= (-75.33, -43.00)). The safety of mother and neonate was ensured. Quality of analgesia was excellent or good in 70% of the parturients in study group and 25% in the control group. Conclusion: Epidural analgesia compared to systemic analgesia, prolongs the first stage of labor, but is not associated with adverse maternal or neonatal outcome.

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Haemodynamic consequences and uterine contractions following 0.5 or 1.0 litre crystalloid infusion before obstetric epidural analgesia

Cited by 32 publications

References 19 publications

Labour analgesia and obstetric outcomes

Labour analgesia and obstetric outcomes

Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method

First Stage of Labor: Is It Prolonged by Epidural Analgesia in Comparison to Systemic Analgesia? A Prospective Controlled Trial

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