The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia

Eberle, Robert L.; Norris, Mark C.; Eberle, Angela Mallozzi; Naulty, J.Steven; Arkoosh, Valerie A.

doi:10.1016/s0002-9378(98)70266-2

Cited by 47 publications

(33 citation statements)

References 18 publications

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“…3 Our results are consistent with those of Eberle et al . 10 who also did not notice a difference in fetal heart rate decelerations between those placed supine with leftward tilt and those placed on their left side.…”

Section: Discussionmentioning

confidence: 77%

“…Eberle et al . 10 noted a greater incidence of asymmetric blocks in women placed in the left lateral decubitus position than in those positioned supine with 30 tilt. However, their study was primarily designed to assess the effect of maternal position on fetal heart rate abnormalities and not incomplete analgesia, so a formal evaluation of the quality of the block, (pain scores, dermatomal levels, etc.,) was not reported.…”

Section: Discussionmentioning

confidence: 93%

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Improved epidural analgesia in the parturient in the 30° tilt position

Beilin

Abramovitz

Zahn

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To compare the incidence of incomplete analgesia when epidural local anesthetic is administered with the parturient supine in a 30° leftward tilt or in the left lateral decubitus position.Methods: After placement of a multiorifice catheter 5 cm into the epidural space, 293 women in active labour were randomly positioned either to the left lateral decubitus position (lateral group) or supine with a 30° leftward tilt (tilt group) and then received 13 mL bupivacaine 0.25%. The success of the epidural block was determined by asking the patient if she required additional medication 15 min later. The incidence of complications (fetal heart rate decelerations, hypotension, and ephedrine usage) was noted.Results: In the lateral group, 38% required additional medication compared with 24% in the tilt group (P = 0.006). There were no differences between groups in the incidence of maternal hypotension or fetal heart rate decelerations, but more women (10%) received ephedrine in the lateral than in the tilt group (4%), P = 0.035. Conclusions:Placing the parturient supine with a 30° leftward tilt is associated with a greater success rate of labour epidural analgesia without an increase in complications than in women in the left lateral decubitus position. This advantage should be considered when positioning the parturient after epidural catheter placement.Objectif: Comparer l'incidence d'analgésie incomplète lorsqu'un anesthésique local épidural est administré chez une parturiente installée en décubitus dorsal, inclinée à 30 o vers la gauche, ou en décubitus latéral gauche.Méthode : Après la mise en place d'un cathéter à orifices multiples à 5 cm dans l'espace épidural, 293 femmes en travail actif ont été installées, en décubitus latéral gauche (groupe latéral), ou en décubitus dorsal avec une inclinaison de 30 o vers la gauche (groupe incliné) et ont reçu 13 mL de bupivacaïne à 0,25 %. La réussite du blocage épidural a été établie en demandant aux patientes, 15 min plus tard, si l'analgésie était suffisante. L'incidence de complications (décélération de la fréquence cardiaque foetale, hypotension et usage d'éphédrine) a été notée.Résultats : Dans le groupe latéral, 38 % des femmes ont demandé des médicaments supplémentaires en comparaison de 24 % dans le groupe incliné (P = 0,006). Il n'y a pas eu de différence intergroupe quant à l'incidence d'hypotension maternelle ou de décélération de la fréquence cardiaque foetale, mais davantage de femmes (10 %) ont reçu de l'éphédrine dans le groupe latéral, comparé au groupe incliné (4 %), P = 0,035.Conclusion : L'installation d'une parturiente en décubitus dorsal, inclinée à 30 o vers la gauche, comparée à la position de décubitus latéral gauche, est associée à un taux de succès plus élevé d'analgésie épidurale pendant le travail sans complications additionnelles. C'est un avantage à considérer quand on cherche une position appropriée pour une parturiente après la mise en place d'un cathéter épidural.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 93%

Improved epidural analgesia in the parturient in the 30° tilt position

Beilin

Abramovitz

Zahn

et al. 2000

Can J Anesth/J Can Anesth

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“…Umbilical artery Doppler flow velocity waveforms were similar with supine, 5°or 10°left or 5°o r 10°right tilt [22]. On the other hand, there was no difference in fetal heart rate patterns after regional analgesia in women managed supine with measured 30°lateral tilt compared to those who laboured in the lateral position [23]. However, significant fetal problems may develop in a small minority of women who have persisting severe aortic compression with this amount of tilt, that will be relieved on turning to the full lateral position [19].…”

Section: ó 2003 Blackwell Publishing Ltdmentioning

confidence: 77%

“…Detmer points out that: 'Doctors…see quality as being mainly their own individual responsibility rather than a collective effort encompassing other people, processes, and, especially systems' [23]. We must move beyond this attitude.…”

mentioning

confidence: 99%

Patient safety and quality: can anaesthetists play a greater role?

Jorm¹

2003

Anaesthesia

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“…Furthermore these results are not corroborated by later studies. Eberle and co-workers concluded that the risk of prolonged foetal deceleration after epidural bupivacaine or intrathecal sufentanil labour analgesia is unrelated to analgesic technique [27]. Fogel et al.…”

Section: Epidural Analgesiamentioning

confidence: 99%

Labour analgesia effects on foetal heart rate. A mini-review

Engel¹,

Velde²,

Nijhuis³

et al. 2011

OJOG

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Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal wellbeing is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.

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The effect of maternal position on fetal heart rate during epidural or intrathecal labor analgesia

Cited by 47 publications

References 18 publications

Improved epidural analgesia in the parturient in the 30° tilt position

Improved epidural analgesia in the parturient in the 30° tilt position

Patient safety and quality: can anaesthetists play a greater role?

Labour analgesia effects on foetal heart rate. A mini-review

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