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Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study.
BMC Pregnancy Childbirth. 2023 Mar 16; 23(1):182.BP

Abstract

BACKGROUND

Abnormal cardiotocogram (CTG) tracing may appear after induction of neuraxial labor analgesia. Non-reassuring fetal status (NRFS) indicated by severely abnormal tracings, such as prolonged deceleration (PD) or bradycardia, can necessitate immediate operative delivery. Combined spinal epidural analgesia (CSEA) is known to result in more frequent abnormal tracings than epidural analgesia (EA); however, the corresponding data related to dural puncture epidural (DPE) are unclear. We aimed to evaluate the rates of incidence of severe abnormal CTG after induction of DPE and CSEA.

METHODS

In this study of nulliparous women with full-term pregnancy, data for the DPE intervention group were prospectively collected, while those for the CSEA control group were obtained from medical records. Neuraxial analgesia was performed with cervical dilation ≤ 5 cm, administering initial epidural dosing of 15 mL of 0.125% levobupivacaine with fentanyl 2.5µg/mL for DPE, and intrathecal 0.5% bupivacaine 2.5 mg (0.5ml), fentanyl 10 µg (0.2ml), and 1.3 mL of saline for CSEA. The primary outcome was the incidence of PD, defined as a fetal heart rate reduction ≥ 15 bpm below the baseline and with a lowest value < 80 bpm, and lasting for ≥ 2 min but < 10 min (fetal heart rate < 80 bpm does not have to last for ≥ 2 min), within 90 min after induction of neuraxial labor analgesia.

RESULTS

A total of 302 patients were analyzed, with 151 in each group. The incidence of PD after DPE induction was significantly lower than that after CSEA induction (4.0% vs. 14.6%, P = 0.0015, odds ratio = 0.243, 95% confidence interval = 0.095-0.617).

CONCLUSION

DPE appears to be a safer method compared to CSEA for neuraxial labor analgesia in the early stages of labor for nulliparous women.

TRIAL REGISTRATION

UMIN-CTR: UMIN000035153 . Date registered: 01/01/2019.

Links

Authors+Show Affiliations

Department of Anesthesiology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Department of Anesthesiology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Department of Anesthesiology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Department of Anesthesiology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Department of Anesthesiology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Clinical Research Support Center, Juntendo University, 2-1-1 Hongo Bunkyo-ku Tokyo, 113-8421, Tokyo, Japan.

Department of Obstetrics and Gynecology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Department of Obstetrics and Gynecology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan.

Department of Anesthesiology, Juntendo University Hospital, 3-1-3 Hongo Bunkyo-ku Tokyo, 113-8431, Tokyo, Japan. hiroyuki.sumikura@gmail.com.

MeSH

PregnancyHumansFemalePilot ProjectsHeart Rate, FetalIncidenceDecelerationAnalgesia, ObstetricalSpinal PunctureAnalgesicsFentanylAnalgesia, EpiduralLabor, Induced

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36927405

Citation

Okahara, Shoko, et al. "Comparison of the Incidence of Fetal Prolonged Deceleration After Induction of Labor Analgesia Between Dural Puncture Epidural and Combined Spinal Epidural Technique: a Pilot Study." BMC Pregnancy and Childbirth, vol. 23, no. 1, 2023, p. 182.

Okahara S, Inoue R, Katakura Y, et al. Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study. BMC Pregnancy Childbirth. 2023;23(1):182.

Okahara, S., Inoue, R., Katakura, Y., Nagao, H., Yamamoto, S., Nojiri, S., Takeda, J., Itakura, A., & Sumikura, H. (2023). Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study. BMC Pregnancy and Childbirth, 23(1), 182. https://doi.org/10.1186/s12884-023-05473-0

Okahara S, et al. Comparison of the Incidence of Fetal Prolonged Deceleration After Induction of Labor Analgesia Between Dural Puncture Epidural and Combined Spinal Epidural Technique: a Pilot Study. BMC Pregnancy Childbirth. 2023 Mar 16;23(1):182. PubMed PMID: 36927405.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Comparison of the incidence of fetal prolonged deceleration after induction of labor analgesia between dural puncture epidural and combined spinal epidural technique: a pilot study. AU - Okahara,Shoko, AU - Inoue,Rie, AU - Katakura,Yumi, AU - Nagao,Hitomi, AU - Yamamoto,Saori, AU - Nojiri,Shuko, AU - Takeda,Jun, AU - Itakura,Atsuo, AU - Sumikura,Hiroyuki, Y1 - 2023/03/16/ PY - 2022/4/26/received PY - 2023/2/27/accepted PY - 2023/3/17/entrez PY - 2023/3/18/pubmed PY - 2023/3/21/medline KW - Abnormal cardiotocogram tracing KW - Combined spinal epidural analgesia KW - Dural puncture epidural KW - Labor analgesia KW - Non-reassuring fetal status SP - 182 EP - 182 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 23 IS - 1 N2 - BACKGROUND: Abnormal cardiotocogram (CTG) tracing may appear after induction of neuraxial labor analgesia. Non-reassuring fetal status (NRFS) indicated by severely abnormal tracings, such as prolonged deceleration (PD) or bradycardia, can necessitate immediate operative delivery. Combined spinal epidural analgesia (CSEA) is known to result in more frequent abnormal tracings than epidural analgesia (EA); however, the corresponding data related to dural puncture epidural (DPE) are unclear. We aimed to evaluate the rates of incidence of severe abnormal CTG after induction of DPE and CSEA. METHODS: In this study of nulliparous women with full-term pregnancy, data for the DPE intervention group were prospectively collected, while those for the CSEA control group were obtained from medical records. Neuraxial analgesia was performed with cervical dilation ≤ 5 cm, administering initial epidural dosing of 15 mL of 0.125% levobupivacaine with fentanyl 2.5µg/mL for DPE, and intrathecal 0.5% bupivacaine 2.5 mg (0.5ml), fentanyl 10 µg (0.2ml), and 1.3 mL of saline for CSEA. The primary outcome was the incidence of PD, defined as a fetal heart rate reduction ≥ 15 bpm below the baseline and with a lowest value < 80 bpm, and lasting for ≥ 2 min but < 10 min (fetal heart rate < 80 bpm does not have to last for ≥ 2 min), within 90 min after induction of neuraxial labor analgesia. RESULTS: A total of 302 patients were analyzed, with 151 in each group. The incidence of PD after DPE induction was significantly lower than that after CSEA induction (4.0% vs. 14.6%, P = 0.0015, odds ratio = 0.243, 95% confidence interval = 0.095-0.617). CONCLUSION: DPE appears to be a safer method compared to CSEA for neuraxial labor analgesia in the early stages of labor for nulliparous women. TRIAL REGISTRATION: UMIN-CTR: UMIN000035153 . Date registered: 01/01/2019. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/36927405/Comparison_of_the_incidence_of_fetal_prolonged_deceleration_after_induction_of_labor_analgesia_between_dural_puncture_epidural_and_combined_spinal_epidural_technique:_a_pilot_study_ DB - PRIME DP - Unbound Medicine ER -