Epidural Local Anesthetics: A Novel Treatment for Fetal Growth Retardation?
| Autor: | Marco A. E. Marcus, Danja Strümper, H.-F. Gramke, H. Van Aken, Marcel E. Durieux, J Stuessel, D Marcus-Soekarman, F. Louwen |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Anesthesia Epidural Embryology Time Factors Amniotic fluid medicine.drug_class Pilot Projects Oligohydramnios Placental insufficiency Pregnancy medicine.artery medicine Birth Weight Humans Radiology Nuclear Medicine and imaging Anesthetics Local Epidural administration Pulse Uterine artery Bupivacaine Fetal Growth Retardation Cesarean Section Local anesthetic business.industry Uterus Obstetrics and Gynecology Arteries General Medicine Amniotic Fluid medicine.disease Anesthesia Pediatrics Perinatology and Child Health Betamethasone Female business medicine.drug |
| Zdroj: | Fetal Diagnosis and Therapy. 20:208-213 |
| ISSN: | 1421-9964 1015-3837 |
| DOI: | 10.1159/000083907 |
| Popis: | Background: Chronically compromised uterine perfusion may lead to placental insufficiency and subsequent intrauterine growth restriction (IUGR). Various therapeutic approaches (e.g. vasodilators, low-dose aspirin, intravenous glucose infusion, and hemodilution) are often of limited efficacy. Local anesthetics have been shown to improve placental blood flow in pre-eclamptic women. We hypothesized that epidural administration of local anesthetics might improve outcome in IUGR independent of the underlying cause. In preparation for a clinical trial to test this hypothesis, we performed a pilot study in 10 patients. Methods: After approval of the study protocol, 10 pregnant women presenting with oligohydramnios and IUGR were included in the study. In addition to our standard protocol (magnesium, glucose, betamethasone), each patient received an epidural catheter (T10/T12) with continuous infusion of bupivacaine 0.175% at a rate of 5 ml/h. Uteroplacental circulation was monitored by Doppler sonography and the amount of amniotic fluid was estimated daily. Results: Epidural insertion and infusion was performed without complications. Four patients continued to deteriorate rapidly, amniotic fluid volume did not change and uterine artery pulsatility index (PI) tended to increase. In the remaining 6 patients the clinical status stabilized, amniotic fluid volume tended to increase and uterine artery PI tended to decrease during treatment. This improvement was associated with a prolonged interval to cesarean section and increased infant birth weight. Conclusion: Our data suggest that, even if the underlying cause of IUGR is not pre-eclampsia, epidural local anesthetic administration might improve placental blood flow and be beneficial in a subgroup of patients. A clinical trial to test this hypothesis appears warranted. |
| Databáze: | OpenAIRE |
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