Pulse Pressure Variability With Position Before EPIdural Analgesia

Hopital Foch1 enrolled

Overview

Fetal heart rate abnormalities are common. Miller et al. have demonstrated that new onset fetal heart rate abnormalities after initial labor epidural dosing occur more frequently in women with a low admission pulse pressure than those with a normal admission pulse. The aim of the present study is to look for a statistical link between the occurrence of a fetal heart abnormality requiring an intervention and maternal hemodynamic factors (blood pressure, pulse pressure, and cardiac output) measured before epidural analgesia in two positions: dorsal decubitus position and in the left lateral decubitus.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Labor Epidural Analgesia

Interventions

Nicom (TM)DEVICE

Heart rate, arterial pressure and cardiac output measurements (monitor NICOM) performed in the dorsal decubitus position and in the left lateral decubitus

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * pregnant women * gestational age ≥ 36 weeks * single eutrophic fetus * wishing for epidural analgesia * cervical dilatation less than or equal to 5 cm * spontaneous labor * scheduled for a vaginal delivery. Non-inclusion Criteria: * prematurity (\< 36 weeks of amenorrhea) or post-term birth * intention of induction of labour using oxytocin before epidural analgesia or prostaglandin * contraindication to epidural analgesia * history of hypertension or gravidic hypertension or heart disorder * gestational diabetes * foetal malformation or oligohydramnios or fetal growth abnormality * fœtal macrosomia diagnosed by ultrasonic scanning * hematocrit less than 20% Exclusion Criteria * induction of labour using oxytocin before epidural analgesia * newborn weight \> 4kg at birth

Locations (4)

AP-HP Hopital Antoine Beclere

Clamart, France

Institut Hospitalier Franco-Britannique

Levallois-Perret, France

Institut Mutualiste Montsouris

Paris, France

Hopital Foch

Suresnes, France

Outcomes

Primary Outcomes

Fetal heart rate

Fetal heart rate abnormalities occurring during the first hour of epidural analgesia and requiring an intervention. Relationship between maternal hemodynamic factors (heart rate, blood pressure, pulse pressure, and cardiac output) measured before epidural analgesia in two positions (dorsal decubitus position and in the left lateral decubitus) and fetal heart rate abnormalities occurring during the first hour of epidural analgesia and requiring an intervention.

Time frame: 4 days

Secondary Outcomes

Fetal heart rate

Fetal heart rate abnormalities occurring during the labor (\>1 hour) and requiring an intervention. Comparison of the prognostic performance of pulse pressure and cardiac output to detect fetal heart rate abnormalities

Time frame: 4 days

Mode of delivery

Relationship between maternal hemodynamic factors (heart rate, blood pressure, pulse pressure, and cardiac output) measured before epidural analgesia in two positions (dorsal decubitus position and in the left lateral decubitus) and mode of delivery.

Time frame: 4 days

Newborn heart rate, blood pressure, pulse pressure, and cardiac output

Time frame: 4 days

Number of patients with hemodynamic abnormalities

Heart rate, blood pressure, pulse pressure, and cardiac output measured before and after epidural analgesia.

Time frame: 4 days

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.