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• W4200329767 abstract "Epidural anesthesia may causes maternal hypotension, which may manifest with maternal symptoms or changes in fetal heart rate (FHR) thought to be due to transient placental hypoperfusion. Different treatments have been proposed for epidural-related hypotension, including ephedrine or phenylephrine. Ephedrine has been chosen as first line treatment at our center; however, the medication per se may cause fetal acidemia, possibly compounding the effects of maternal hypotension. The possible effect of ephedrine on risk of cesarean delivery (CD) in laboring women has not been studied; we have assessed whether ephedrine administration increases the risk of cesarean delivery (CD). Cohort study of all laboring women who underwent epidural anesthesia during labor for the period October 1, 2020-December 31, 2020. Excluded were cases of elective CD, non-cephalic presentation, twins or multiples, fetal death, and gestational age < 37.0 weeks. Principal outcome was CD rate. Standing orders allowed an initial dose of ephedrine 10 mg I.V. administered in the presence of symptomatic maternal hypotension or decelerations on FHR monitor after epidural; additional doses could be administered by Anesthesia. Binary logistic regression analysis was used to control for confounders (SPSS 28). 32% of laboring women with epidural required ephedrine administration, at a dose of 10 mg in 75% of cases. Univariate analysis revealed that Ephedrine administration was associated with increased rates of CS (36% vs 15%, P=0.002), but not with maternal age, BMI, gestational age, labor induction, cervical dilation at epidural, or birth weight. At logistic regression analysis, only multiparity (OR = 0.31, 95% CI 0.01-0.25), induced labor (OR = 2.86, 95% CI 1.10-7.45) and ephedrine use (OR = 2.66, 95% CI 1.01-7.03) were independently associated with odds of CS. Neonatal outcome was not affected by Ephedrine use in terms of Apgar scores at 5 minutes < 7 or need for NICU admission. Ephedrine use in laboring women is associated with a significant increase in risk of CD." @default.
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• W4200329767 date "2022-01-01" @default.
• W4200329767 modified "2023-09-27" @default.
• W4200329767 title "Ephedrine use in laboring patients with epidural anesthesia and risk of cesarean delivery" @default.
• W4200329767 doi "https://doi.org/10.1016/j.ajog.2021.11.1126" @default.
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