The goal of this study is to learn how often blood pressure drops after an epidural for labor and how these drops may affect the parent and the baby. The study focuses on adults who give birth at term and choose to receive an epidural for pain relief. The main questions the study aims to answer are: How often does maternal blood pressure fall within 30 minutes after the epidural? When blood pressure falls, how often do participants need treatments such as fluids or medicines that raise blood pressure? Do changes in the baby's heart rate happen during this time, and do they need treatment? Are certain parent or labor factors linked to a higher chance of blood pressure drops? How often does an urgent cesarean delivery happen because of maternal low blood pressure or concerning fetal heart rate changes soon after the epidural? Participants will not be asked to do anything different from usual care. Researchers will: Review routine vital signs recorded before and after the epidural Review treatments given, such as IV fluids or blood-pressure-raising medicines Review the baby's heart-rate monitoring Record delivery information, including whether an urgent cesarean was needed This study does not change clinical care in any way. It uses information already collected during standard labor and delivery.
Study Type
OBSERVATIONAL
Enrollment
480
Participants receive epidural analgesia for labor pain relief as part of routine clinical care at Sheba Medical Center. The epidural involves placement of an epidural catheter, a test dose, and a loading dose of local anesthetic according to hospital protocol. The study does not change how the epidural is performed. Researchers only observe maternal blood pressure and fetal heart rate after epidural placement.
Absolute and relative number of patients with any MAP (mean arterial pressure) < 65 mmHg
Hypotension after epidural placement
Time frame: First 30 minutes after epidural placement
Absolute and relative number of patients with any MAP (mean arterial pressure) < 60, 55 mmHg
Hypotension after epidural placement
Time frame: First 30 minutes after epidural placement
Absolute and relative number of patients with any SBP (systolic blood pressure) < 90, 85, 80 mmHg
Hypotension after epidural placement
Time frame: First 30 minutes after epidural placement
Incidence of postepidural hypotension defined as ≥20% MAP (mean arterial pressure) drop
Hypotension after epidural placement
Time frame: First 30 minutes after epidural placement
Absolute and relative number of patients with ≥20% SBP (systolic blood pressure) drop
Hypotension after epidural placement
Time frame: First 30 minutes after epidural placement
Time-to-treatment of Hypotension (minutes)
The time interval between epidural placement and the treatment of hypotension by clinical staff
Time frame: First 30 minutes after epidural placement
Area under a MAP of 65, 60, 55 mmHg [mmHg x min]
Time frame: First 30 minutes after epidural placement
Absolute and relative number of patients with symptoms due to hypotension
Weakness, lightheadedness, fainting, dizziness, nausea, vomiting
Time frame: First 30 minutes after epidural placement
Absolute and relative number of patients with NRFHR (Non-reassuring fetal heart rate)
Time frame: First 30 minutes after epidural placement
Absolute and relative number of patients who received fluid bolus
Time frame: First 30 minutes after epidural placement
Absolute and relative number of patients who received vasopressor
Phenylephrine, ephedrine
Time frame: First 30 minutes after epidural placement
Absolute and relative numbers of patients who underwent urgent Cesarean section (Category 1 or 2 urgency) due to hypotension or NRFHR (non-reassuring fetal heart rate)
Time frame: First 30 minutes after epidural placement
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