Uterine artery, umbilical, and fetal cerebral Doppler velocities after epidural analgesia during labor

Valentin, M.; Ducarme, Guillaume; Ceccaldi, Pierre-François; Bougeois, B.; Luton, Dominique

doi:10.1016/j.ijgo.2012.03.034

Cited by 10 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although, many methods and drugs have been developed to reduce this pain, lumbar epidural analgesia (LEA) remains the most widely used method for pain control during labor [1]. However, it remains debated whether this method is prone to causing adverse events, as local anesthetics potentially suppress the intensity of uterine contractions and decrease uterine blood flow [2]. Many randomized controlled trials (RCTs) have been performed to address this question, and a meta-analysis of the corresponding results [3] demonstrated that LEA does not adversely affect the mode of delivery, such as increasing the cesarean section rate.…”

Section: Introductionmentioning

confidence: 99%

The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute

et al. 2019

View full text Add to dashboard Cite

Purpose: Lumbar epidural analgesia (LEA) is the most widely used method in reducing labor pain. Previous RCTs have shown that LEA does not increase cesarean section rates; however, the results are inconsistent and may vary depending on the different backgrounds. Therefore, we aimed to study whether LEA would affect the course of labor in our institute. Methods: Delivery records from October 2013 to April 2016 were collected. Deliveries at gestational age < 36 weeks and multiple pregnancies were excluded. All cases were divided into the non-epidural labor (NEL) group or the epidural labor (EL) group. We performed a propensity score matching analysis to balance intergroup differences. Our primary outcome was a mode of delivery (spontaneous, assisted vaginal, cesarean). Secondary outcomes were lengths of labor and outcomes of the neonates. Results: During the study period, 2632 cases met the inclusion criteria. All analyses were performed after propensity score matching (218 pairs). The percentage of assisted vaginal delivery increased by the use of LEA (11.5% in NEL group vs 25.7% in EL group; p < 0.001), but the rate of cesarean section was similar (12.8% vs 17.0%; p = 0.23). The durations of the first and second stages of labor were prolonged by the use of LEA in both primipara and multipara women. Outcomes of the neonates were similar in both groups. Conclusion: Use of LEA did not increase the rate of cesarean section when analyzed by propensity score-matched analysis in our institute.

show abstract

Section: Introductionmentioning

confidence: 99%

The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute

et al. 2019

View full text Add to dashboard Cite

show abstract

“…During spinal anesthesia for cesarean delivery, maternal hypotension is a major complication with the incidence up to 60–70% [ 1 ]. Prolonged hypotension leads to decreased uteroplacental blood flow [ 2 , 3 ] and fetal acidosis [ 4 ]. Vasopressors such as ephedrine, phenylephrine, and norepinephrine are therefore commonly recommended to reduce the incidence of hypotension.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Different Norepinephrine Regimens for Prevention of Spinal Hypotension in Cesarean Section: A Randomized Trial

Chen

Huang

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

The aim of this paper is to evaluate the efficacy and safety of three different norepinephrine dosing regimens for preventing spinal hypotension in cesarean section. In this randomized double-blinded controlled study, 120 parturients scheduled for elective section delivery under spinal anesthesia were assigned to 1 of 4 groups. In the control group, patients received saline infusion. In three norepinephrine groups, the infusion dosage regimens were 5, 10, and 15 μg/kg/h, respectively. Hypotension was treated with a rescue bolus of 10 μg norepinephrine. The study protocol was continued until the end of surgery. The primary outcome was the proportion of participants that underwent hypotension. The proportion of hypotension participants was significantly reduced in the norepinephrine groups (37.9%, 20%, and 25%, respectively) compared to that in the control group (86.7%). However, the highest dose of norepinephrine (15 μg/kg/h) resulted in more hypertension episodes. In addition, blood pressure was better maintained in the norepinephrine 5 μg/kg/h and 10 μg/kg/h groups than in the control group and 15 μg/kg/h group. No significant differences in other hemodynamic variables, adverse effects, maternal and neonatal blood gases, or Apgar scores were observed among the groups. In summary, for patients who undergo cesarean delivery under spinal anesthesia, infusion of 5–10 μg/kg/h norepinephrine was effective to reduce hypotension incidence without significant adverse effects on maternal and neonatal outcomes. Clinical Trial Registration Number is ChiCTR-INR-16009452.

show abstract

“…Doppler ultrasound has been used to measure the flow resistance indices of the uterine arteries during the menstrual cycle 1 2 , pregnancy 3 , and labour 4 5 . Throughout the menstrual cycle, a lack of significant uterine artery (UtA) impedance changes 2 or higher UtA impedance early and late in the cycle, compared with reduced levels mid-cycle or in the luteal phase, has been reported 6 7 .…”

mentioning

confidence: 99%

Uterine artery impedance during the first eight postpartum weeks

Guedes-Martins

Gaio

Saraiva

et al. 2015

Sci Rep

View full text Add to dashboard Cite

The aim of this study was to construct reference ranges for the uterine artery (UtA) mean pulsatility (PI) and resistance (RI) indices from 1–8 weeks postpartum. A prospective, cross-sectional, and observational study was performed with 320 healthy women from week 1 through week 8 postpartum. UtAs were examined transvaginally using colour and pulsed Doppler imaging, and the means of the right and left values of the PI and RI, as well as the presence or absence of a bilateral protodiastolic notch, were recorded. The 5th, 50th and 95th reference percentile curves for the UtA-PI and UtA-RI were derived using regression models. The adjusted reference intervals uncovered a convergence trend at the week 8 time-point, although impedance was lower at the week 1 time-point in multiparous women compared with primiparous women. The notching prevalence was 22.5% (9/40) at week 1 and 95.0% (38/40) at week 8. The study revealed consistent evidence of a progressive increase of postpartum uterine impedance and provided new average UtA-PI and UtA-RI reference charts for weeks 1 through 8. Multiparity does not change the trend but does impart a lower rate of increase, likely as a consequence of previous vascular structural and functional differences.

show abstract

Uterine artery, umbilical, and fetal cerebral Doppler velocities after epidural analgesia during labor

Cited by 10 publications

References 19 publications

The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute

The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute

Efficacy and Safety of Different Norepinephrine Regimens for Prevention of Spinal Hypotension in Cesarean Section: A Randomized Trial

Uterine artery impedance during the first eight postpartum weeks

Contact Info

Product

Resources

About