Labor risk factors for fetal heart rate abnormality after combined spinal-epidural analgesia.

Abstract

To explore the association between obstetric factors or outcomes and fetal heart rate (FHR) abnormalities after combined spinal-epidural analgesia (CSEA). Women with singleton term deliveries who received CSEA at our institution between January 1 and December 31, 2017, were analyzed using medical records. We performed a logistic regression analysis to compare factors and outcomes between cases with and without new FHR abnormalities within 1h after CSEA. Of the 393 women, 163 showed the new occurrence of FHR abnormality after CSEA. Rupture of the membrane (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.52-4.09; P< 0.01) and dilatation of the cervix (OR 1.24; 95% CI 1.07-1.44; P< 0.01) were significantly associated with FHR abnormalities. There were significant differences in FHR abnormality rates between women with cervical dilatation of 2cm or less and 3cm or more (OR 2.20; 95% CI 1.01-4.81; P= 0.047) and 6cm or less and 7cm or more (OR 2.46; 95% CI 1.01-6.01; P= 0.048). FHR abnormalities were not significantly associated with cesarean delivery during labor, instrumental delivery, APGAR score below 7 at 1 or 5min, or umbilical arterial blood gas pH less than 7.2. Rupture of the membrane and an advanced dilated cervix were risk factors for FHR abnormality when CSEA was initiated.