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Ghidini A, Vanasche K, Cacace A, Cacace M, Fumagalli S, Locatelli A. Side effects from epidural analgesia in laboring women and risk of cesarean delivery. AJOG GLOBAL REPORTS 2024; 4:100297. [PMID: 38283322 PMCID: PMC10820310 DOI: 10.1016/j.xagr.2023.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Epidural analgesia may cause maternal hypotension and changes in the fetal heart rate. The implications of such side effects on the course of labor and delivery are incompletely understood. OBJECTIVE This study aimed to assess whether the occurrence of maternal or fetal side effects associated with labor epidural analgesia increased the risk for cesarean delivery. STUDY DESIGN This was a cohort study of all women who underwent epidural analgesia during labor for the period October 1, 2020 to December 31, 2020. Excluded were cases of multiples, fetal death, noncephalic presentation, and gestational age at birth <37.0 weeks. Maternal vital signs and fetal heart rate tracings for the 1 hour before and 1 hour after epidural analgesia was administered were reviewed. The occurrence of maternal hypotension, defined as a continuous variable and dichotomized into a decrease in maternal systolic blood pressure to <90 mm Hg or a drop in systolic blood pressure by >20% below the last value before epidural analgesia was administered, was related to changes in the fetal heart rate category. The principal outcome was cesarean delivery rate; binary logistic regression analysis was used to control for confounders, and mediation model analysis was used to quantify the extent to which significant variables participated in the causation pathway to cesarean delivery (SPSS version 28 was used for the analyses). RESULTS A total of 439 women met the study criteria. Significant adverse reactions owing to epidural occurred in 184 of 439 women (41.9%) and included severe maternal hypotension in 159 of 439 participants (36.2%) and worsening fetal heart rate category in 50 of 439 participants (11.4%). The logistic regression analysis revealed that cervical dilation at epidural (P=.03), the duration of labor after epidural (P<.001), and worsening fetal heart rate category within 60 minutes of epidural administration (P=.01) were independently associated with recourse to cesarean delivery. The mediation analysis showed that both cervical dilatation at epidural administration and worsening fetal heart rate category had significant direct and indirect effects in the pathway to cesarean delivery. CONCLUSION Worsening fetal heart rate category related to labor epidural independently increased the risk for cesarean delivery.
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Affiliation(s)
- Alessandro Ghidini
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Kelly Vanasche
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Alyssa Cacace
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA, USA (Alyssa Cacace)
| | - Marietta Cacace
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli)
- Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli)
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli)
- Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli)
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Ma DD, Shi WJ, Li SY, Zhang JG, Lu ZJ, Long XB, Liu X, Huang CS, Ying GG. Ephedrine and cocaine cause developmental neurotoxicity and abnormal behavior in zebrafish. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2023; 265:106765. [PMID: 37979497 DOI: 10.1016/j.aquatox.2023.106765] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
Ephedrine (EPH) and cocaine (COC) are illegal stimulant drugs, and have been frequently detected in aquatic environments. EPH and COC have negative effects on the nervous system and cause abnormal behaviors in mammals and fish at high concentrations, but their mechanisms of neurotoxicity remain unclear in larvae fish at low concentrations. To address this issue, zebrafish embryos were exposed to EPH and COC for 14 days post-fertilization (dpf) at 10, 100, and 1000 ng L-1. The bioaccumulation, development, behavior, cell neurotransmitter levels and apoptosis were detected to investigate the developmental neurotoxicity (DNT) of EPH and COC. The results showed that EPH decreased heart rate, while COC increased heart rate. EPH caused cell apoptosis in the brain by AO staining. In addition, behavior analysis indicated that EPH and COC affected spontaneous movement, touch-response, swimming activity and anxiety-like behaviors. EPH and COC altered the levels of the neurotransmitters dopamine (DA) and γ-aminobutyric acid (GABA) with changes of the transcription of genes related to the DA and GABA pathways. These findings indicated that EPH and COC had noticeable DNT in the early stage of zebrafish at environmentally relevant concentrations.
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Affiliation(s)
- Dong-Dong Ma
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Wen-Jun Shi
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China; Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China.
| | - Si-Ying Li
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Jin-Ge Zhang
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Zhi-Jie Lu
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Xiao-Bing Long
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China
| | - Xin Liu
- Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China
| | - Chu-Shu Huang
- Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China
| | - Guang-Guo Ying
- SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou 510006, China; School of Environment, South China Normal University, University Town, Guangzhou 510006, China; Anti-Drug Technology Center of Guangdong Province and National Anti-Drug Laboratory Guangdong Regional Center, Guangdong Provincial Key Laboratory of Psychoactive Substances Monitoring and Safety, Guangzhou 510230, China.
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Yamamoto Y, Umehara N, Yamashita Y, Sato M, Takehara K, Sago H. Labor risk factors for fetal heart rate abnormality after combined spinal-epidural analgesia. Int J Gynaecol Obstet 2023; 160:892-899. [PMID: 35986610 DOI: 10.1002/ijgo.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/26/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the association between obstetric factors or outcomes and fetal heart rate (FHR) abnormalities after combined spinal-epidural analgesia (CSEA). METHODS Women with singleton term deliveries who received CSEA at our institution between January 1 and December 31, 2017, were analyzed using medical records. We performed a logistic regression analysis to compare factors and outcomes between cases with and without new FHR abnormalities within 1 h after CSEA. RESULTS Of the 393 women, 163 showed the new occurrence of FHR abnormality after CSEA. Rupture of the membrane (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.52-4.09; P < 0.01) and dilatation of the cervix (OR 1.24; 95% CI 1.07-1.44; P < 0.01) were significantly associated with FHR abnormalities. There were significant differences in FHR abnormality rates between women with cervical dilatation of 2 cm or less and 3 cm or more (OR 2.20; 95% CI 1.01-4.81; P = 0.047) and 6 cm or less and 7 cm or more (OR 2.46; 95% CI 1.01-6.01; P = 0.048). FHR abnormalities were not significantly associated with cesarean delivery during labor, instrumental delivery, APGAR score below 7 at 1 or 5 min, or umbilical arterial blood gas pH less than 7.2. CONCLUSION Rupture of the membrane and an advanced dilated cervix were risk factors for FHR abnormality when CSEA was initiated.
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Affiliation(s)
- Yoshiko Yamamoto
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Nagayoshi Umehara
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yoko Yamashita
- Division of Obstetric Anesthesia, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Masaki Sato
- Division of Obstetric Anesthesia, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Feng S, Gu J. The utilization of transperineal ultrasound following fetal heart deceleration after epidural analgesia: a case report. BMC Pregnancy Childbirth 2022; 22:873. [PMID: 36424553 PMCID: PMC9685891 DOI: 10.1186/s12884-022-05197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We report a case of fetal heart rate decelerations and relaxation of pelvic muscles and fetal descent using transperineal ultrasound after initiation of epidural labor analgesia. CASE PRESENTATION A 32-year-old woman, G1P0 with gestational age of 40 weeks, required epidural analgesia when her cervical dilatation was 2 cm. Baseline transperineal ultrasound examination was performed before epidural puncture. The fetal heart rate tracing was normal before the initiation of analgesia. Approximately 10 min after the epidural administration of the loading dose, the patient reported onset of analgesia and the FHR tracing showed variable-decelerations. There was no hypotension or evidence of uterine tachysystole. Transperineal ultrasound was performed again after epidural analgesia took effect. The anteroposterior diameter of the levator hiatus increased from 5.3 to 6.6 cm and angle of progress increased from 116°to 133°. The relaxation of pelvic muscle and rapid descent of fetal head may have contributed to the FHR deceleration. The midwife elevated the fetal head through the vagina with her hand, and the FHR recovered soon thereafter. CONCLUSIONS Changes in fetal heart rate after initiation of neuraxial analgesia are unpredictable. In addition to FHR and tocodynametric monitoring, performing TPU may helpful in distinguishing the reasons for FHR change and initiating corresponding corrective measures.
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Affiliation(s)
- Shimiao Feng
- grid.461863.e0000 0004 1757 9397Department of Anesthesiology, West China Second University Hospital, Sichuan University, 20#, Section 3 Renmin Nan Road, Chengdu, Sichuan 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, 20#, Section 3 Renmin Nan Road, Chengdu, Sichuan 610041 China
| | - Juan Gu
- grid.461863.e0000 0004 1757 9397Department of Anesthesiology, West China Second University Hospital, Sichuan University, 20#, Section 3 Renmin Nan Road, Chengdu, Sichuan 610041 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, 20#, Section 3 Renmin Nan Road, Chengdu, Sichuan 610041 China
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Sangroula D, Maggard B, Abdelhaleem A, Furmanek S, Clemons V, Marsili B, Stikes R, Hill M, Sigdel A, Clifford SP, Huang J, Akca O, Logsdon MC. Hemodynamic changes associated with neuraxial anesthesia in pregnant women with covid 19 disease: a retrospective case-control study. BMC Anesthesiol 2022; 22:179. [PMID: 35681119 PMCID: PMC9178224 DOI: 10.1186/s12871-022-01719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Neuraxial blocks is the recommended mode of analgesia and anesthesia in parturients with Coronavirus 19 (COVID-19). There is limited data on the hemodynamic responses to neuraxial blocks in COVID-19 patients. We aim to compare the hemodynamic responses to neuraxial blocks in COVID-19 positive and propensity-matched COVID-19 negative parturients. Methods We conducted retrospective, cross-sectional case–control study of hemodynamic changes associated with neuraxial blocks in COVID-19 positive parturients in a Tertiary care academic medical center. Fifty-one COVID-19 positive women confirmed by nasopharyngeal reverse transcription–polymerase chain reaction (RT-PCR), were compared with propensity-matched COVID negative controls (n = 51). Hemodynamic changes after neuraxial block were recorded by electronic medical recording system and analyzed using paired and unpaired T- test and Wilcoxon-Mann–Whitney Rank Sum tests. The primary outcome was ≥ 20% change in MAP and HR after neuraxial block placement. Results In the epidural group, 7% COVID-19 positive parturients had > 20% decrease in mean arterial pressure (MAP) from baseline compared to 15% COVID-19 negative parturients (P = 0.66). In the spinal group, 83% of COVID-19 positive parturients had a decrease in MAP more than 20% from baseline compared to 71% in control (P = 0.49). MAP drop of more than 40% occurred in 29% COVID positive parturients in the spinal group versus 17% in COVID-19 negative parturients (P = 0.5465). In COVID-19 positive spinal group, 54% required vasopressors whereas 38% in COVID-19 negative spinal group required vasopressors (P = 0.387). We found a significant correlation between body mass index (BMI) > 30 and hypotension in COVID ( +) parturient with odds ratio (8.63; 95% CI-1.93 – 37.21) (P = 0.007). Conclusion Incidence and severity of hypotension after neuraxial blocks were similar between COVID-19 positive and COVID-19 negative parturients. BMI > 30 was a significant risk factor for hypotension as described in preexisting literature, this correlation was seen in COVID-19 positive parturients. The likely reason for parturients with BMI > 30 in COVID negative patients not showing similar correlation, is that the sample size was small.
Supplementary information The online version contains supplementary material available at 10.1186/s12871-022-01719-0.
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Affiliation(s)
- D Sangroula
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA. .,Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
| | - B Maggard
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - A Abdelhaleem
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - S Furmanek
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - V Clemons
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - B Marsili
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - R Stikes
- Center for Women, and Infants, University of Louisville Hospital, 530 S. Jackson Street, Louisville, KY, 40202, USA
| | - M Hill
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - A Sigdel
- Department of Surgery, University of Louisville School of Medicine, 530 S. Jackson, Louisville, KY, 40202, USA
| | - S P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - J Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - O Akca
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA.,Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - M C Logsdon
- School of Nursing, University of Louisville, 555 South Floyd Street, Louisville, KY, 40292USA, USA
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