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A RANDOMISED DOUBLE BLIND CLINICAL TRIAL TO EVALUATE THE EFFECTS OF INTRATHECAL BUPIVACAINE OR BUPIVACAINE-FENTANYL COMBINATION ON INTERNAL UTERINE TONE AND FETAL HEART RATE DURING LABOUR ANALGESIA
Abstract Number: F-03
Abstract Type: Original Research
BACKGROUND: Literature suggests association between subarachnoid opioids and transient fetal bradycardia. We evaluated the effects of a lower dose of spinal fentanyl -bupivacaine or bupivacaine alone during CSE technique on the uterine basal tone and its association with the occurrence of FHR abnormalities.
METHODS: This randomized double blind trial was conducted in 30 parturients who requested labor analgesia. After written informed consent, Group B received spinal analgesia with 2.5mg (0.5%) hyperbaric bupivacaine ; Group BF received 2 mg (0.5%) hyperbaric bupivacaine with 15 µg fentanyl. A disposable intrauterine pressure catheter system, attached to the cardiotocograph machine, was inserted by a blinded obstetrician after rupture of membranes beyond 3 cm cervical dilatation of active labour, but < 5 cm. Intra uterine pressure recordings and FHR patterns were noted for 15 minutes prior and 30 minutes following spinal analgesia. The primary outcome was an increase in 10mmHg of uterine basal tone. As secondary outcomes, incidence of FHR change, maternal hemodynamics, VAS scores, spinal block characteristics, nausea, vomiting, pruritis and immediate neonatal outcome was observed.
RESULTS: In group B, a significant decrease in basal tone was observed (p=0.022; t-test).Within group BF the tone was higher than baseline but did not reach a value of statistical significance .Three parturients in Group BF showed a hypertonus pattern [>10mmHg elevation (p=0.102; t-test)].Statistical analysis revealed significant difference (p=0.046; χ2test) of non reassuring fetal heart rate (NRFHR) abnormalities in group BF (n=7) when compared to group B (n=2). Further, uterine hypertonus with NRFHR pattern occurred in 2 of 7 (28.5%), parturients in group BF only. NRFHR with associated maternal hypotension was seen in two women each in groups BF & group B (p=1.00; χ2test).Similar VAS scores were recorded following intrathecal drugs during the first 5 minutes in both the groups showing NRFHR pattern(p=0.00; t test). Neonatal outcome was similar in the two groups.
CONCLUSIONS: There was no evidence of significant hypertonus uterus in either group. A higher incidence of FHR abnormalities and pruritis was seen in BF group as compared to bupivacaine alone. None of the women required emergency caesarean delivery due to these FHR changes. Labour outcomes as well as neonatal outcomes were comparable between the groups.
1. Abrao et al: Obstet Gynecol 2009; 113: 41–47.