Reactions 425 - 31 Oct 1992

Bupivacaine

Fetal bradycardia without maternal hypotensionfollowing epidural analgesia: 3 case reports

Ten to 15 minutes after receiving epidural analgesia duringparturition, the fetuses of 3 women, aged 27-36 years,developed bradycardia of 7-10 minutes’ duration while thewomen remained normotensive throughout. Each woman hadreceived 13-15ml bupivacaine 0.25% via an epidural injectionadministered in the sitting position. When fetal bradycardiadeveloped, the women were moved onto their left side andgiven oxygen. No further episodes of fetal bradycardia wereseen, but in 1 case there was loss of beat-to-beat variationswith some late decelerations. A cesarean section wasperformed on this woman and a healthy newborn wasdelivered. The other 2 women received epidural top-ups with5ml bupivacaine 0.25%, and shortly afterwards also deliveredhealthy babies.

Author comment: In these patients fetal bradycardiaoccurred following epidural analgesia without a concomitantdrop in maternal blood pressure. It seems logical to call thisphenomenon ‘... supine non-hypotensive syndrome post-epidural analgesia.’Eldor J, et al. Supine non-hypotensive syndrome post-epidural analgesia.International Journal of Gynaecology and Obstetrics 38: 236-238, Jul 1992 -Israel 807000216

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Reactions 31 Oct 1992 No. 4250114-9954/10/0425-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved