Fetal Heart Changes Following Neuraxial Analgesia in Uteroplacental Insufficiency Pregnancies [30I

Abstract

INTRODUCTION: Epidural analgesia (EA) and combined spinal epidural (CSE) can cause fetal heart rate changes due to maternal hypotension and uterine tachysystole. Previous studies have focused on CSE or EA in “healthy” pregnancies, excluding uteroplacental insufficiency (UPI) conditions. No studies have discussed the impact of EA and CSE on fetal heart rate in laboring UPI pregnancies. Our objective was to compare the impact of EA versus CSE during labor on fetal heart rate in pregnancies complicated with UPI. METHODS: We conducted a retrospective study of singleton pregnancies complicated with UPI that received EA (n=110) or CSE (n=127) for intrapartum pain relief in a single center from 2012-2015. UPI was defined as pregnancies with chronic hypertension, preeclampsia, and/or fetal growth restriction (IUGR) as per ACOG criteria definitions. Primary outcome was fetal heart rate abnormalities classified as normal, suspicious or pathologic as well as the NICHD criteria. Data collected included maternal demographics, blood pressure, uterine tachysystole, mode of delivery, interventions for FHR abnormalities and neonatal outcomes. Data was analyzed using Student’s t-test, Mann-Whitney U test and Chi-squared or Fisher’s exact test. RESULTS: There was no significant difference among groups in baseline characteristics, rate of maternal hypotension, uterine tachysystole, pregnancy outcome and fetal heart rate categories/abnormalities. When compared to the EA group, CSE had a higher rate of NICU admission (28.3% vs. 16.4%, p-value = 0.031). CONCLUSION: Pregnancies complicated with UPI are neither at higher risk of abnormal fetal heart pattern nor increased rate of fetal intervention.