The effect of heart rate variability on request for labour epidural analgesia

Abstract

SummaryMaternal heart rate variability of 62 parturients were compared based on their choice of using (epidural group, 44 women) or not using (control, 18 women) epidural analgesia. Baseline heart rate variability and visual analogue scores were recorded when the cervix of the parturient dilated to 2-4 cm, and paired data were collected 1 h later. We found that parturients in the epidural group had greater heart rate variability at the beginning of labour. Multiple logistic regression analysis identified percentage of absolute difference in successive RR intervals exceeding 20 ms as the best indicator of choosing epidural analgesia. Almost all heart rate variability measures were unchanged 1 h later in both groups. We concluded that parturients who chose epidural analgesia had greater heart rate variability, and that percentage of absolute difference in successive RR intervals exceeding 20 ms could reflect their likelihood of requesting epidural analgesia at the beginning of labour.

The Analgesia Nociception Index: a pilot study to evaluation of a new pain parameter during labor

“…4,5 In parturients with a high maternal HRV, absolute differences in successive R-R intervals over 20 min may be predictive of a request for epidural analgesia. 6 In spontaneously breathing obstetric patients, the role of ventilation may introduce bias into the analysis of the R-R signal and derivation of ANI, and the effects remain unknown. 16 In contrast to regular mechanical ventilation in a patient receiving general anesthesia, or to the respiratory pattern of a conscious subject with sinus arrhythmia, the respiratory pattern of a woman in labor is unpredictable and variable in response to uterine contractions.…”

“…4,5 In labor, an objective measurement of the balance between analgesia and nociception could provide additional information on the way the autonomic nervous system (ANS) reacts to pain and epidural analgesia, which may help prevent epidural overdose and provide an independent indicator of the need for epidural analgesia. 6 The aim of this pilot study was to evaluate the clinical performance of an Analgesia Nociception Index (ANI) in a population of parturients before epidural analgesia, both during and between uterine contractions.…”

Electrocardiography versus photoplethysmography in assessment of maternal heart rate variability during labor

“…Computerized analysis of maternal heart rate (MHR) recordings obtained by electrocardiography (ECG) may help in the assessment of different clinical maternal-fetal conditions, during the antepartum period (DiPietro et al 2003 ; Lao et al 2009 ; Pinto et al 2014 ; Söhnchen et al 2011 ; Tejera et al 2011 ; Van Leeuwen et al 2009 ; Weissman et al 2009 ) and in the detection of MHR-fetal heart rate (FHR) ambiguities during labor (Bernardes and Ayres-de-Campos 2012 ; Hanson 2010 ; Murray 2004 ; Sherman et al 2002 ).…”