Pulse Pressure Variability With Position Before EPIdural Analgesia

Predictive Value of a Postural Test on Pulse Pressure Variation During Labor With Epidural Analgesia on Fetal Heart Rate Abnormalities

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.

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