The Evaluation of Frequency of Hypotention in Normal Vaginal Delivery with Epidural Anesthesia in Beheshti and Jorjani Hospitals of Isfahan 2003

Document Type : Original Article

Authors

1 Associat Professor of Gynecology, Infertility, Isfahan University of Medical Sciences, Isfahan, Iran

2 Intern, Infertility, Isfahan University of Medical Sciences, Isfahan, Iran

3 Midwife, Infertility, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Introduction: Delivery pain is one of the most severe known pains that can be considered a critical experience in lifelong for every woman .Different methods has been introduced for reducing delivery pain such as non pharmacological methods (hypnotism, Acupuncture) and pharmacological methods (systemic drugs ,inhalant anesthetics ,regional anesthesia). Now, the most popular methods for pain relief in labor is regional anesthesia. The most common techniques are spinal, epidural, para cervical and pudendal anesthesia. The most effective ways for pain relief in labor is spinal and epidural block that Produces a complete pain relief in most women. The purpose of this study is determining the distribution of hypotention as a most common complication of epidural anesthesia in vaginal delivery that can lead to fetal distress and low APGAR score and cesarean section.
 
Material and Methods: This is a cross sectional (descriptive–analytic) study and 137 cases were studied. Most of them were 21-30 years old. This study was approved by the local committee of medical ethics. Gestational age was 37-42 weeks .This study was established in fall and winter of year 2003 at Beheshti & Jorjani hospitals. All of them were at the same conditions and all epidural blocks were done with the same anesthesiologist.
 
Results: The data analysis of all cases showed that the distribution of hypotention was 16.1%. distribution of vertigo was 20.4% .The neonatal APGAR score of those mothers who had hypotention during delivery was (8+ 1.23) while APGAR score of those ones who didn’t have hypotention was 9 or more (p<0.001).
Discussion: Hypotension is a common side effect of epidural anesthesia and it can cause fetal distress and low APGAR score, but with infusion 500-1000 CC ringer lactate boxter before anesthesia, can reduce rate of hypotension, prevent hypoxia side effects and low score of APGAR . Of curse 1 degree reduction in APGAR score may be resulted from length of stage II of labor.So epidural anesthesia can be considered as a reliable and safe method for advertising vaginal delivery and reducing the number of unnecessary cesarean section.

Keywords

References

1. Ronald W, Melzack R .Text book of pain .Edinburgh: Churchill Livingstone:1999; 664-670 .
2. Chestnut DH , Epidural and spinal analgesia/anesthesia . Chestnut DH. Obstetric Anesthesia :
Albama Mosbey: 1999; 360-386 .
3. Jafari Javid M. Painless delivery and anesthesia in obstetrics. Poursina.Tehran.2001.
4. Watson A, Bowes JR. Clinical aspects of normal and abnormal labor .Creasy RK , Resnik R.
Maternal –fetal medicine .Sunders :1999; 541- 545 .
5. Prestorn R, Grosby ET ,Kotarba D,et al .Maternal position effects fetal heart rate changes after
epidural analgesia for labor .Can J Anesthesia .993 Dec ;40(12):1136-41
6. Cunninggham FG, Leveno KJ,Bloom SL,Hauth JC,Gilstrap III LC,Wenstrom KD. Intrapartum
assessment. Cunninggham FG, Leveno KJ, Bloom SL,Hauth JC,Gilstrap III LC,Wenstrom KD.
Williams obstetrics .Mc Graw Hill. 2005;449.
7. Zamora JE, Rosaeg OP, Lindsay MP, Crossan ML. Haemodynamic consequence and uterine
contraction following 0.5 or 1 litre crystalloid infusion before obstetric epidural analgesia .Can J
Anaesth . 1996;43(4):347-52.
8. Hollmen A, Jouppila R, Pihlajaniemi R, Karvonen P, Sjöstedt E. Selective lumbar epidural
block in labour. A clinical analysis. Acta Anaesthesiol Scand 1977; 21(3):174-81.
9. Missant C, Teunkens A, Vandermeersch E, Van de Velde M. Intrathecal clonidine prolongs
labour analgesia but worsens fetal outcome: a pilot study. Can J Anaesth. 2004 AugSep;51(7):696-701.
 
10. Hill JB, Alexander JM, Sharma SK, McIntire DD, Leveno KJ. A comparison of the effects of
epidural and mepridine analgesia during labore on fetal heart rate. Obstet Gynecol .2003; 102(2):
333-7.
11. Thorp, JA, Hu DH, Albin RM, McNitt J, Meyer BA, Cohen GR, Yeast JD. The effect of
intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial.
Am J Obstet Gynecol 1993; 169(4):851-4.
12. Available on : www.uptodate.com : Prevention and treatment of adverse effects of neuraxial
anesthesia. 2007-01-14 

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