Effect of Epidural Analgesia on Some Maternal and Fetal Parameters in Pre-Eclampsia
M.Yousri Amin, A.Salam, M.Metwally : Alexandria University , EGYPT
continuous Epidural Analgesia (EA) during labor of pre-eclamptic (P-E) patients has been recommended by several authors. Belief in improved renal function via relief of renal vasospasm, control of blood pressure, excellent analgesia and less infant depression form the basis of such recommendation.In opposition, many clinician consider conduction analgesia to be not recommended in P-E because of deceased blood volume might make them more vulnerable to hypotension.In this study we investigated the effect of continuous EA on maternal hemodynamics, renal function, and acid base balance in P-E , also, its effect on fetal heart rate(FHR) during labor.Patients and methods:Twenty P-E parturient were prepared for labor induction. Central venous catheter was placed via subclavian, lumbar epidural catheter was placed. 10 ml of 0.5% bupivacaine were injected to facilitate perineal analgesia. Measurements:1. Pulse rate, BP, CVP by continuous monitor.2. GFR. 3. Renal plasma flow (RPF).4. Urine/Plasma Na & K.5. Blood Urea. 6. Blood gas analysis.Timing: Before EA, 2 hours later, after delivery.7. Continuous external CTG.RESULTS:The mean age was 31.6+/-5.65. Statistical analysis by student “t” test showed that 2 hours after EA there was significant reduction of Pulse rate, mean arterial BP, t (2.37 , 3.17)respectively, and significant increase in CVP, t(9.86).with insignificant changes after delivery. EA produced insignificant decrease of GFR, RPF,U/P Na ,K, however there was significant increase after labor. Maternal blood gas analysis showed significant increase in PO2 and PH . Significant positive correlation between GFR, urine Na and RPF with insignificant correlation with the mean BP. Abnormal CTG (late deceleration) was recorded in 3 cases, returned to normal after position change and oxygen inhalation.Discussion:Progressive maternal metabolic acidosis may occur during labor, which results from accumulation of lactate and pyruvate or lactic acidosis This acidosis significantly improved after EA which can be explained by the improvement in tissue perfusion secondary to sympathetic blockade, proper hydration and treatment of hypertension.Continuous EA is recommended as a useful tool during labor in P-E.