Labor risk factors for fetal heart rate abnormality after combined spinal‐epidural analgesia

Abstract

Labor analgesia is widely used throughout the world, especially in developed countries; indeed, it is used in 83% of all deliveries in France, 1 50% in Sweden, 2 63% in England, 3 61% in the USA, 4 and its utilization varies among individual hospitals. In contrast, labor analgesia is only used in 6% of deliveries in Japan, although the usage is increasing. 5 Combined spinal-epidural analgesia (CSEA) has become the favored approach to labor analgesia in recent years because of its rapid analgesic effect compared with epidural analgesia. 6 The effects of CSEA in labor on the incidence of oxytocin augmentation and fetal heart rate (FHR) abnormality, duration of labor, incidence of instrumental delivery or cesarean delivery, and fetal outcomes have been well investigated. [6][7][8][9][10] Monitoring of FHR during labor is widely used. Although its interpretation is subjective, FHR abnormalities are the most influential indicator for labor management. CSEA is reportedly associated with an increased incidence of FHR abnormality. 11 An improvement in pain scores and increased level of sympathetic block have been reported to be associated with FHR abnormality after CSEA, 12,13