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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 01 Apr 2005
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Blood pressure and fetal heart rate changes with patient-controlled combined spinal epidural analgesia while ambulating in labour. Br J Obstet Gynaecol. 1997 May;104(5):554-8.

Author(s) :

al-Mufti R, Morey R, Shennan A, Morgan B.

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

OBJECTIVE: To determine the effect of patient-controlled combined spinal epidural analgesia (PCEA) on maternal pulse and blood pressure, and fetal heart rate in primigravid women, when adapting different positions in labour.

DESIGN: A prospective study.

SETTING: Queen Charlotte’s and Chelsea hospital, London.

PARTICIPANTS: Fifty-five primigravid women in labour at > or = 37 weeks of gestation; 40 women had supervised standing top-ups given by an anaesthetist. A further 15 women had PCEA top-ups given in each of standing, sitting and lying positions.

MAIN OUTCOME MEASURES: Maternal pulse rate, blood pressure and fetal heart rate changes following epidural top-ups.

RESULTS: In the first 40 women there was no clinically significant fall in their blood pressure (< 5 mmHg). The subsequent 15 women who had PCEA top-ups had no fall in blood pressure in the standing and sitting positions, though the average blood pressure fell significantly when a top-up was given in the lying position. Maternal heart rate increased significantly at 12 min post top-up when the women were in the standing position (P = 0.0018). In the 15 women who had PCEA top-ups, the CTG showed improvement in decelerations when women were in the standing position but deterioration when in the lying position (P < 0.01).

CONCLUSION: Patient-controlled epidural analgesia top-ups with maternal mobility may be beneficial to the fetus possibly by reducing the hypotension normally associated with top-ups in the lying position.

Sumário (português)  :

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Argument (français) :

Argument (English):

Argumento (português):

Keywords :

➡ evidence-based medicine/midwifery ; position during labor ; physiology ; fetal distress ; epidural

Author of this record :

Cécile Loup — 01 Apr 2005

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