P 54 The identification of high risk LOH under obstetric analgesia

Abstract

Objectives Labor onset hypertension (LOH) has been defined as the hypertension develops for the first time after the onset of labor. We have analyzed the relationship between LOH and the labor pain by controlling the pain by obstetric analgesia. Methods The 775 cases of normal vaginal delivery under combined spinal epidural analgesia (CSEA) for obstetric analgesia at our facility from July 2015 to June 2016 were retrospectively analyzed. We defined the group of women whose systolic and diastolic blood pressure (BP) had become ≥140 or ≥ 90 mmHg respectively for the first time in labor as LOH. BP was checked every 15 min during labor, and the pain was evaluated by visual analogue scale. Results 224 out of 775 case (29%) was found to be LOH. In 30 cases of 224 LOH (13%), the BP did not lowered than either 140 mmHg nor 90 mmHg even after the labor pain was relieved. We have further analyzed whether anti-hypertensive drug was introduced during or after the labor. No one from the BP well-controlled group needed anti-hypertensive drug during or after the labor, although in 14cases (47%) out of 30 cases of uncontrolled group, anti-hypertensive drug was used during or after labor. Conclusion For most of the LOH, the BP had normalized by introducing obstetric analgesia. However, those that BP did not improve even after the pain was relieved had high possibility of introducing anti-hypertensive drug during or after the labor. In order to find such high risk LOH, observation of BP variation under obstetric analgesia is thought to be valuable.