BLOOD-PRESSURE AND FETAL HEART-RATE CHANGES WITH PATIENT-CONTROLLED COMBINED SPINAL EPIDURAL ANALGESIA WHILE AMBULATING IN LABOR

Objective To determine the effect of patient-controlled combined spina l epidural analgesia (PCEA) on maternal pulse and blood pressure? and fetal heart rate in primigravid women, when adapting different positio ns in labour. Design A prospective study. Setting Queen Charlotte's an d Chelsea hospital, London. Participants Fifty-five primigravid women in labour at greater than or equal to 37 weeks of gestation; 40 women had supervised standing top-ups given by an anaesthetist. A further 15 women had PCEA top-ups given in each of standing, sitting and lying p ositions. Main outcome measures Maternal pulse rate, blood pressure an d fetal heart rate changes following epidural top-ups. Results In the first 40 women there was no clinically significant fall in their blood pressure (< 5 mmHg). The subsequent 15 women who had PCEA top-ups had no fall in blood pressure in the standing and sitting positions, thou gh the average blood pressure fell significantly when a top-up was giv en in the lying position. Maternal heart rate increased significantly at 12 min post top-up when the women were in the standing position (P = 0.0018). In the 15 women who had PCEA top-ups, the CTG showed improv ement in decelerations when women were in the standing position but de terioration when in the lying position (P < 0.01). Conclusion Patient- controlled epidural analgesia top-ups with maternal mobility may be be neficial to the fetus possibly by reducing the hypotension normally as sociated with top-ups in the lying position.