Randomized study of intravenous fluid preload before epidural analgesia during labour

We performed a randomized controlled trial of the effect of intravenous flu id preload on maternal hypotension and fetal heart rate (FHR) changes in la bour after the first epidural injection. Group 1 (49 women) received I litr e of crystalloid preload. Group 2 (46 women) received no preload. No statis tically significant difference was shown between the two groups for either of the outcomes. Hypotension was found in three women in group I and five i n group 2 (P=0.4). Deterioration in FHR pattern was found in four women in group I and I I in group 2 (P=0.08). This study has not shown a significant increase in the incidence of hypotension when intravenous preload is omitt ed before epidural analgesia using a low concentration of bupivacaine durin g labour. Because of the clinical importance of the difference in the rate of FHR deterioration between the two groups, we continue to administer prel oad for high-risk cases.