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Pulse Pressure & Risk of Postepidural Complications

Obstet Gynecol; ePub 2017 Nov 3; Lappen, et al

A 1,500-mL intravenous fluid bolus in women with a narrow pulse pressure decreases the risk of postepidural fetal heart rate (FHR) abnormalities, results in less frequent hypotension, and reduces the need for resuscitative interventions, a recent study suggests. Eligible participants in the single-center randomized controlled trial were normotensive with a nonanomalous singleton gestation at or after 35 weeks and with a narrow pulse pressure (<45 mm Hg) on admission. Patients were allocated to a 500-mL or 1,500-mL intravenous fluid bolus at epidural placement from October 2015 to November 2016. The primary outcome was a category 2 or 3 FHR pattern within 60 minutes after the epidural test dose. Researchers found:

  • 276 women were allocated to receive a 500-mL (n=139) or 1,500-mL (n=137) fluid bolus.
  • The 1,500-mL group had significantly fewer postepidural FHR abnormalities (38.0% vs 51.8%).
  • Maternal systolic hypotension and composite postepidural interventions were also less frequent in the 1,500-mL group.

Citation:

Lappen JR, Myers SA, Bolen N, Mercer BM, Chien EK. Maternal pulse pressure and the risk of postepidural complications: A randomized controlled trial. [Published online ahead of print November 3, 2017]. Obstet Gynecol. doi:10.1097/AOG.0000000000002326.

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