INFLUENCE OF EPIDURAL ANALGESIA ON FETAL AND NEONATAL WELL-BEING

Epidural analgesia is a frequently used method to reduce the pain of c hild-bearing. Concerns regarding the safety and potential hazards stil l persist in the medical community. This review intends to examine how epidural analgesia determines the various factors of fetal and neonat al well-being. Placental drug transfer of opiates like morphine, pethi dine and fentanyl is rapid and can lead to neonatal depression. Sufent anil seems to be the safest opiate to administer epidurally. Local ana esthetics are transferred to the fetus in substantial amounts, but the reported effects are subtle and are probably inconsequential. Utero- and fetoplacental blood flow seems to be improved by epidural analgesi a with local anaesthetics. Even when using stronger solutions for more extensive blockade in patients for caesarean section, no adverse effe cts could be demonstrated using pulsed Doppler technique as long as pr olonged hypotension (>2 min) is avoided. Hypotension is best prevented with 20-25 ml/kg crystalloid preload and prompt treatment with ephedr ine or etilephrine. Addition of adrenaline to local anaesthetics is co nsidered to be safe for the healthy mother and fetus but it should bes t be avoided in mothers with pregnancy induced hypertension. Fetal and neonatal acid-base balance and gas-exchange are not adversely affecte d by epidural analgesia. Many studies show that epidural analgesia can indeed protect the fetus if hypotension is prevented. Neonatal well-b eing evaluated by APGAR, BRAZELTON, SCANLON and NAGS scores is not sig nificantly influenced by local anaesthetics. Neonatal depression can o ccur however with epidural use of morphine, fentanyl and alfentanil. S ufentanil, again in doses up to 30 mu g in association with bupivacain e seems to be devoid of depressive effects on the neonate. In summary, the anaesthetist has good arguments to reassure his obstetrical colle agues that providing epiduraI analgesia for pregnant women in labour i s a justifiable intervention to support the natural process of child-b earing.