Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study
Abstract Background Abnormal cardiotocogram (CTG) tracing may appear after induction of neuraxial labor analgesia. Non-reassuring fetal status (NRFS) indicated by severely abnormal tracings, such as prolonged deceleration (PD) or bradycardia, can necessitate immediate operative delivery. Combined sp...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-023-05473-0 |
| _version_ | 1797863247271952384 |
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| author | Shoko Okahara Rie Inoue Yumi Katakura Hitomi Nagao Saori Yamamoto Shuko Nojiri Jun Takeda Atsuo Itakura Hiroyuki Sumikura |
| author_facet | Shoko Okahara Rie Inoue Yumi Katakura Hitomi Nagao Saori Yamamoto Shuko Nojiri Jun Takeda Atsuo Itakura Hiroyuki Sumikura |
| author_sort | Shoko Okahara |
| collection | DOAJ |
| description | Abstract Background Abnormal cardiotocogram (CTG) tracing may appear after induction of neuraxial labor analgesia. Non-reassuring fetal status (NRFS) indicated by severely abnormal tracings, such as prolonged deceleration (PD) or bradycardia, can necessitate immediate operative delivery. Combined spinal epidural analgesia (CSEA) is known to result in more frequent abnormal tracings than epidural analgesia (EA); however, the corresponding data related to dural puncture epidural (DPE) are unclear. We aimed to evaluate the rates of incidence of severe abnormal CTG after induction of DPE and CSEA. Methods In this study of nulliparous women with full-term pregnancy, data for the DPE intervention group were prospectively collected, while those for the CSEA control group were obtained from medical records. Neuraxial analgesia was performed with cervical dilation ≤ 5 cm, administering initial epidural dosing of 15 mL of 0.125% levobupivacaine with fentanyl 2.5µg/mL for DPE, and intrathecal 0.5% bupivacaine 2.5 mg (0.5ml), fentanyl 10 µg (0.2ml), and 1.3 mL of saline for CSEA. The primary outcome was the incidence of PD, defined as a fetal heart rate reduction ≥ 15 bpm below the baseline and with a lowest value < 80 bpm, and lasting for ≥ 2 min but < 10 min (fetal heart rate < 80 bpm does not have to last for ≥ 2 min), within 90 min after induction of neuraxial labor analgesia. Results A total of 302 patients were analyzed, with 151 in each group. The incidence of PD after DPE induction was significantly lower than that after CSEA induction (4.0% vs. 14.6%, P = 0.0015, odds ratio = 0.243, 95% confidence interval = 0.095–0.617). Conclusion DPE appears to be a safer method compared to CSEA for neuraxial labor analgesia in the early stages of labor for nulliparous women. Trial registration UMIN-CTR: UMIN000035153 . Date registered: 01/01/2019. |
| first_indexed | 2024-04-09T22:32:29Z |
| format | Article |
| id | doaj.art-1b3166b5a36e42c397290eae55d31fdb |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-09T22:32:29Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-1b3166b5a36e42c397290eae55d31fdb2023-03-22T12:38:08ZengBMCBMC Pregnancy and Childbirth1471-23932023-03-012311810.1186/s12884-023-05473-0Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot studyShoko Okahara0Rie Inoue1Yumi Katakura2Hitomi Nagao3Saori Yamamoto4Shuko Nojiri5Jun Takeda6Atsuo Itakura7Hiroyuki Sumikura8Department of Anesthesiology, Juntendo University HospitalDepartment of Anesthesiology, Juntendo University HospitalDepartment of Anesthesiology, Juntendo University HospitalDepartment of Anesthesiology, Juntendo University HospitalDepartment of Anesthesiology, Juntendo University HospitalClinical Research Support Center, Juntendo UniversityDepartment of Obstetrics and Gynecology, Juntendo University HospitalDepartment of Obstetrics and Gynecology, Juntendo University HospitalDepartment of Anesthesiology, Juntendo University HospitalAbstract Background Abnormal cardiotocogram (CTG) tracing may appear after induction of neuraxial labor analgesia. Non-reassuring fetal status (NRFS) indicated by severely abnormal tracings, such as prolonged deceleration (PD) or bradycardia, can necessitate immediate operative delivery. Combined spinal epidural analgesia (CSEA) is known to result in more frequent abnormal tracings than epidural analgesia (EA); however, the corresponding data related to dural puncture epidural (DPE) are unclear. We aimed to evaluate the rates of incidence of severe abnormal CTG after induction of DPE and CSEA. Methods In this study of nulliparous women with full-term pregnancy, data for the DPE intervention group were prospectively collected, while those for the CSEA control group were obtained from medical records. Neuraxial analgesia was performed with cervical dilation ≤ 5 cm, administering initial epidural dosing of 15 mL of 0.125% levobupivacaine with fentanyl 2.5µg/mL for DPE, and intrathecal 0.5% bupivacaine 2.5 mg (0.5ml), fentanyl 10 µg (0.2ml), and 1.3 mL of saline for CSEA. The primary outcome was the incidence of PD, defined as a fetal heart rate reduction ≥ 15 bpm below the baseline and with a lowest value < 80 bpm, and lasting for ≥ 2 min but < 10 min (fetal heart rate < 80 bpm does not have to last for ≥ 2 min), within 90 min after induction of neuraxial labor analgesia. Results A total of 302 patients were analyzed, with 151 in each group. The incidence of PD after DPE induction was significantly lower than that after CSEA induction (4.0% vs. 14.6%, P = 0.0015, odds ratio = 0.243, 95% confidence interval = 0.095–0.617). Conclusion DPE appears to be a safer method compared to CSEA for neuraxial labor analgesia in the early stages of labor for nulliparous women. Trial registration UMIN-CTR: UMIN000035153 . Date registered: 01/01/2019.https://doi.org/10.1186/s12884-023-05473-0Abnormal cardiotocogram tracingCombined spinal epidural analgesiaDural puncture epiduralLabor analgesiaNon-reassuring fetal status |
| spellingShingle | Shoko Okahara Rie Inoue Yumi Katakura Hitomi Nagao Saori Yamamoto Shuko Nojiri Jun Takeda Atsuo Itakura Hiroyuki Sumikura Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study BMC Pregnancy and Childbirth Abnormal cardiotocogram tracing Combined spinal epidural analgesia Dural puncture epidural Labor analgesia Non-reassuring fetal status |
| title | Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study |
| title_full | Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study |
| title_fullStr | Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study |
| title_full_unstemmed | Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study |
| title_short | Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study |
| title_sort | comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique a pilot study |
| topic | Abnormal cardiotocogram tracing Combined spinal epidural analgesia Dural puncture epidural Labor analgesia Non-reassuring fetal status |
| url | https://doi.org/10.1186/s12884-023-05473-0 |
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