Best Practice & Research Clinical Obstetrics & Gynaecology
Volume 24, Issue 3 , Pages 289-302 , June 2010

The effects of maternal labour analgesia on the fetus

  • Felicity Reynolds, MBBS, MD, FRCA, FRCOG (ad eundem Emeritus Professor of Obstetric Anaesthesia)

      Affiliations

    • Of the on-time United Medical and Dental Schools of Guys and St Thomas’ Hospitals, now no longer in existence and swallowed up by King’s College London.

References 

  1. Huch R. Maternal hyperventilation and the fetus. J Perin Med. 1986;14:3–17
  2. Motoyama EK, Rivard G, Acheson F, Cook CD. Adverse effect of maternal hyperventilation on the foetus. Lancet. 1966;286–288
  3. Thalme B, Belfrage P, Raabe N. Lumbar epidural analgesia in labour. I. Acid-base balance and clinical condition of mother, fetus and newborn child. Acta Obstet Gynecol Scand. 1974;53:27–35
  4. Minnich ME, Brown M, Clark RB, et al. Oxygen desaturation in women in labor. J Reprod Med. 1990;35:693–696
  5. Lederman RP, Lederman E, Work BA, McCann DS. The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol. 1978;132:495–500
  6. Ohno H, Yamashita K, Yahata T, Doi R, Kawamura M, et al. Maternal plasma concentrations of catecholamines and cyclic nucleotides during labor and following delivery. Res Commun Chem Pathol Pharmacol. 1986;51:183–194
  7. Segal S, Wang SY. The effect of maternal catecholamines on the caliber of gravid uterine microvessels. Anesth Analg. 2008;106:888–892
  8. Reynolds F. Placental transfer of drugs. Current Anaesthesia and Critical Care. 1991;2:108–116
  9. Snow J. On administration of chloroform during parturition. Association of Medicine Journal. 1853;1:500–502
  10. Tunstall ME. Obstetric analgesia. The use of a fixed nitrous oxide and oxygen mixture from one cylinder. Lancet. 1961;2(7209):964
  11. Porter J. Inhalational agents. In:  Russell R,  Porter J,  Scrutton M,  Reynolds F editor. Pain relief in labour. London: BMJ Books; 1997;p. 65–85
  12. Holdcroft A, Morgan M. An assessment of the analgesic effect in labour of pethidine and 50 per cent nitrous oxide in oxygen (Entonox). J Obstet Gynaecol Br Commonw. 1974;81:603–607
  13. Shnider SM, Moya F. Effects of meperidine on the newborn infant. Am J Obstet Gynecol. 1964;89:1009–1015
  14. Scrutton M. Systemic opioids. In:  Russell R,  Porter J,  Scrutton M,  Reynolds F editor. Pain relief in labour. London: BMJ Books; 1997;p. 86–112
  15. Belfrage P, Boreus LO, Hartvig P, et al. Neonatal depression after obstetrical. analgesia with pethidine: the role of the injection-delivery time interval and of the plasma concentrations of pethidine and norpethidine. Acta Obstet Gynecol Scand. 1981;60:43–49
  16. Kuhnert BR, Kuhnert PM, Philipson EH, et al. Disposition of meperidine and. normeperidine following multiple doses during labor. II. Fetus and neonate. Am J. Obstet Gynecol. 1985;151:410–415
  17. Hamza J, Benlabed M, Orhant E, Escourrou P, Curzi-Dascalova L, Gaultier C. Neonatal pattern of breathing during active and quiet sleep after maternal administration of meperidine. Pediatr Res. 1992;32:412–416
  18. Sosa CG, Buekens P, Hughes JM, et al. Effect of pethidine administered during the first stage of labor on the acid-base status at birth. Eur J Obstet Gynecol Reprod Biol. 2006;129:135–139
  19. Weiner PC, Hogg MI, Rosen M. Neonatal respiration, feeding and. neurobehavioural state. Anaesthesia. 1979;34:996–1004
  20. Nissen E, Lilja G, Matthiesen AS, et al. Effects of maternal pethidine on infants' developing breast feeding behaviour. Acta Paediatr. 1995;84:140–145
  21. Burnard ED, Cross KW. Rectal temperature in the newborn after birth asphyxia. BMJ. 1958;2:1197–1199
  22. Nissen E, Widström AM, Lilja G. Effects of routinely given pethidine during labour on infants' developing breastfeeding behaviour. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma. Acta Paediatr. 1997;86:201–208
  23. Righard L, Alade MO. Effect of delivery room routines on success of first breast-feed. Lancet. 1990;336:1105–1107
  24. Al Tajir GK, Sulieman H, Badrinath P. Intragroup differences in risk factors for breastfeeding outcomes in a multicultural community. J Hum Lact. 2006;22:39–47
  25. Matthews MK. The relationship between maternal labour analgesia and delay in the initiation of breastfeeding in healthy neonates in the early neonatal period. Midwifery. 1989;5:3–10
  26. Crowell MK, Hill PD, Humerick SS. Relationship between obstetric analgesia and time of effective breast feeding. J Nurse Midwifery. 1994;39:150–156
  27. Weiner PC, Hogg MJ, Rosen M. Effects of naloxone on pethidine induced. neonatal depression. BMJ. 1977;2:228–231
  28. Wahab SA, Askalani AH, Amar RA, et al. Effect of some recent analgesics on labor pain and maternal and fetal blood gases and pH. Int J Gynaecol Obstet. 1988;26:75–80
  29. Hodgkinson R, Huff RW, Hayashi RH, Husain FJ. Double-blind comparison of maternal analgesia and neonatal neurobehavior following intravenous butorphanol and meperidine. J Int Med Res. 1979;7:224–230
  30. Olofsson C, Ekblom A, Ekman-Ordeberg G, et al. Lack of. analgesic effect of systemically administered morphine or pethidine on labour. pain. Br J Obstet Gynaecol. 1996;103:968–972
  31. Fairlie FM, Marshall L, Walker JJ, Elbourne D. Intramuscular opioids for maternal pain relief in labour: a randomized controlled trial comparing pethidine with diamorphine. Br J Obstet Gynaecol. 1999;106:1181–1187
  32. Rawal N, Tomlinson AJ, Gibson GJ, Sheehan TM. Umbilical cord plasma concentrations of free morphine following single-dose diamorphine analgesia and their relationship to dose-delivery time interval, Apgar scores and neonatal respiration. Eur J Obstet Gynecol Reprod Biol. 2007;133:30–33
  33. Rayburn WF, Smith CV, Parriot JE, Woods RE. Randomized comparison of. meperidine and fentanyl during labor. Obstet Gynecol. 1989;74:604–606
  34. Morley-Forster PK, Reid DW, Vandeberghe H. A comparison of patient-controlled analgesia fentanyl and alfentanil for labour analgesia. Can J Anaesth. 2000;47:113–119
  35. Blair JM, Dobson GT, Hill DA, et al. Patient controlled analgesia for labour: a comparison of remifentanil with pethidine. Anaesthesia. 2005;60:22–27
  36. Volikas I, Male D. A comparison of pethidine and remifentanil in patient-controlled analgesia in labour. Int J Obstet Anesth. 2001;10:86–90
  37. Volikas I, Butwick A. Maternal and neonatal side effects of remifentanil PCA. Br J Anaesth. 2005;95:504–509
  38. Viegas OAC, Khaw B, Ratnam SS. Tramadol in labour pain in primiparous patients. A prospective comparative clinical trial. Eur J Obstet Gynecol Reprod. Biol. 1993;49:131–135
  39. Khooshideh M, Shahriari A. A comparison of tramadol and pethidine analgesia on the duration of labour: a randomised clinical trial. Aust N Z J Obstet Gynaecol. 2009;49:59–63
  40. Keskin HL, Keskin EA, Avsar AF, et al. Pethidine versus tramadol for pain relief during labor. Int J Gynaecol Obstet. 2003;82:11–16
  41. Vella L, Francis D, Houlton P, Reynolds F. Comparison of the antiemetics metoclopramide and promethazine in labour. BMJ. 1985;290:1173–1175
  42. Porter JS, Bonello E, Reynolds F. The effect of epidural fentanyl on neonatal respiration. Anesthesiology. 1998;89:79–85
  43. Jordan S, Emery S, Bradshaw C, Watkins A, Friswell W. The impact of intrapartum analgesia on infant feeding. Br J Obstet Gynaecol. 2005;112:927–934
  44. Beilin Y, Bodian CA, Weiser PH, et al. Effect of labor epidural analgesia with and without fentanyl on infant breastfeeding. Anesthesiology. 2005;103:1211–1217
  45. Halpern SH, Leighton BL, Ohlsson A, Barrett JFR, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor. JAMA. 1998;280:2105–2110
  46. Leighton BL, Halpern SH. The effects of epidural analgesia in labor, maternal, and neonatal outcomes: a systematic review. Am J Obstet Gynecol. 2002;186:S69–S77
  47. Shnider SM, Abboud TK, Artal R. Maternal catecholamines decrease during labor after epidural anesthesia. Am J Obstet Gynecol. 1983;147:13–15
  48. Westgren M, Lindahl SGE, Norden NE. Maternal and fetal endocrine stress response at vaginal delivery with and without epidural block. J Perinat Med. 1986;14:235–241
  49. Cascio M, Pygon B, Bernett C, Ramanathan S. Effects of intrathecal fentanyl on plasma catecholamine levels in term laboring parturients. Anesthesiology. 1995;83:A493
  50. Eberle R, Kinsella SM, Arrison E, et al. Maternal plasma catecholamine concentrations after labor analgesia with intrathecal sufentanil. Anesthesiology. 1995;83:A971
  51. Hollmen AI, Jouppila R, Jouppila P, et al. Effect of epidural analgesia using bupivacaine and 2-chloroprocaine on intervillous blood flow during normal labour. Br J Anaesth. 1982;54:837–842
  52. Deckardt R, Fembacher PM, Schneider KTM, Graeff H. Maternal arterial oxygen saturation during labor and delivery: pain-dependent alterations and effects on the newborn. Obstet Gynecol. 1987;70:21–25
  53. Arfeen Z, Armstrong PJ, Whitfield A. the effects of Entonox and epidural analgesia on arterial oxygen saturation of women in labour. Anaesthesia. 1994;49:32–34
  54. Griffin R, Reynolds F. Maternal hypoxaemia during labour and delivery: the influence of analgesia and effect on neonatal outcome. Anaesthesia. 1995;50:151–156
  55. Leighton BL, Halpern SH. Epidural analgesia: effects on labor progress and maternal and neonatal outcome. Seminars in Perinatology. 2002;26:122–135
  56. Russell R, Reynolds F. Epidural infusions of low-dose bupivacaine and opioid in labour: does reducing motor block increase the spontaneous delivery rate?. Anaesthesia. 1996;51:266–273
  57. Mardirosoff C, Dumont L, Boulvain M, Tramer MR. Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review. BJOG. 2002;109:274–281
  58. Gaiser RR, McHugh M, Cheek T, Gutsche BB. Predicting prolonged fetal heart rate decelerations following intrathecal fentanyl/bupivacaine. Int J Obstet Anesth. 2005;14:208–211
  59. Ramos-Santos E, Devoe LD, Wakefield ML, et al. The effects of epidural anesthesia on the doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor. Obstet Gynecol. 1991;77:20–26
  60. Patton DE, Lee W, Miller J, Jones M. Maternal, uteroplacental, and fetoplacental hemodynamic and Doppler velocimetric changes during epidural anesthesia in normal labor. Obstet Gynecol. 1991;77:17–19
  61. Hughes AB, Devoe LD, Wakefield ML, Metheny WP. The effects of epidural anesthesia on the Doppler velocimetry of umbilical and uterine arteries in normal term labor. Obstet Gynecol. 1990;75:809–812
  62. Mires GJ, Dempster J, Patel NB, Taylor DJ. Epidural analgesia and its effect on umbilical artery flow velocity waveform patterns in uncomplicated labour and labour complicated by pregnancy-induced hypertension. Eur J Obstet Gynecol Reprod Biol. 1990;36:35–41
  63. Caracostea G, Stamatian F, Lerintiu M, Herghea D. The influence of maternal epidural analgesia upon intrapartum fetal oxygenation. J Matern Fetal Neonatal Med. 2007;20:161–165
  64. Caliskan E, Ozdamar D, Doger E, et al. Prospective case control comparison of fetal intrapartum oxygen saturations of women during epidural analgesia. Int J Obstet Anesth 2010;19:in press
  65. Halpern SH, Muir H, Breen T, et al. A multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor. Anesth Analg. 2004;99:1532–1538
  66. Amiel Tison C, Barrier G, Shnider SM, et al. A new neurologic and adaptive capacity scoring system for evaluating obstetric medications in full term newborns. Anesthesiology. 1982;56:340–350
  67. Pearson JF, Davies P. The effect of continuous lumbar epidural analgesia upon fetal acid-base status during the second stage of labour. J Obstet Gynaecol Br Commonw. 1974;81:975–979
  68. Zador G, Nilsson BA. Low dose intermittent epidural anaesthesia with lidocaine for vaginal delivery. Acta Obstet Gynecol Scand. 1974;34(Suppl.):17–30
  69. Reynolds F, Sharma S, Seed PT. Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia. Br J Obstet Gynaecol. 2002;109:1344–1353
  70. Schocket M, Garrison R, Wiley J, Sharma S. Epidural analgesia has a favorable effect on funic base excess compared to no analgesia during labor. Anesthesiology. 2005;102:SOAP abstract A-40
  71. Ransjö-Arvisdon AB, Matthlesen A-S, Lilja G, et al. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature and crying. Birth. 2001;28:5–12
  72. Smith LJ. Impact of birthing practices on the breastfeeding dyad. J Midwifery Womens Health. 2007;52:621–630
  73. Torvaldsen S, Roberts CL, Simpson JM, et al. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Avaliable at: Int Breastfeed J. 2006;24(1):www.internationalbreastfeedingjournal.com
  74. Rajan L. The impact of obstetric procedures and analgesia/anaesthesia during labour and delivery on breast feeding. Midwifery. 1994;10:87–103
  75. Halpern SH, Levine T, Wilson DB, et al. Effect of labor analgesia on breastfeeding success. Birth. 1999;26:83–88
  76. Albani A, Addamo P, Renghi A, Voltolin G, Peano L, Ivani G. The effect on breastfeeding rate of regional anesthesia technique for cesarean and vaginal childbirth. Minerva Anestesiol. 1999;65:625–630
  77. Riordan J, Gross A, Angeron J, et al. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact. 2000;16:7–12
  78. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003;32:322–331
  79. Henderson JJ, Dickinson JE, Evans SF, et al. Impact of intrapartum epidural analgesia on breast-feeding duration. Aust N Z J Obstet Gynaecol. 2003;43:372–377
  80. Baumgarder DJ, Muehl P, Fischer M, Pribbenow B. effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally. J Am Board Fam Pract. 2003;16:7–13
  81. Volmanen P, Valanne J, Alahuhta S. Breast-feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices. Int J Obstet Anesth. 2004;13:25–29
  82. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005;21:305–314
  83. Wang BP, Li QL, Hu YF. Impact of epidural anesthesia during delivery on breast feeding. Di Yi Jun Yi Da Xue Xue Bao. 2005;25:114–115
  84. Wiklund I, Norman M, Uvnäs-Moberg K, et al. Epidural analgesia: breast-feeding success and related factors. Midwifery. 2009;25:e31–e38
  85. Wilson MJA, MacArthur C, Shennan A. The effect of epidural analgesia on breast feeding: analysis of a randomized controlled trial. Int J Obstet Anesth. 2009;18:S7
  86. Sezer OA, Gunaydin B. Efficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal-epidural analgesia. Int J Obstet Anesth. 2007;16:226–230
  87. Chen LK, Lin CJ, Huang CH, et al. The effects of continuous epidural analgesia on doppler velocimetry of uterine arteries during different periods of labour analgesia. Br J Anaesth. 2006;96:226–230
  88. Wong CA, McCarthy RJ, Sullivan JT, et al. Early compared with late neuraxial analgesia in nulliparous labor induction: a randomized controlled trial. Obstet Gynecol. 2009;113:1066–1074
  89. Ohel G, Gonen R, Vaida S, et al. Early versus late initiation of epidural analgesia in labor: does it increase the risk of caesarean section? A randomized trial. Am J Obstet Gynecol. 2006;194:600–605
  90. Junttila EK, Karjalainen PK, Ohtonen PP, et al. A comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomized controlled trial. Int J Obstet Anesth. 2009;18:15–21
  91. Reynolds F, Seed PT. Anaesthesia for caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia. 2005;60:636–653
  92. Reynolds F, Russell R, Porter J, Smeeton N. Does the use of low dose bupivacaine infusion increase the normal delivery rate?. Int J Obstet Anesth. 2003;12:156–163
  93. Loftus JR, Hill H, Cohen SE. Placental transfer and neonatal effects of epidural sufentanil and fentanyl administered with bupivacaine during labor. Anesthesiology. 1995;83:300–308
  94. Porter JS, Bonello E, Reynolds F. The effect of epidural opioids on maternal oxygenation during labour and delivery. Anaesthesia. 1996;51:899–903
  95. Siddik-Sayyid SM, Taha SK, Azar MS, et al. Comparison of three doses of epidural fentanyl followed by bupivacaine and fentanyl for labor analgesia. Acta Anaesthesiol Scand. 2008;52:1285–1290
  96. Russell R, Reynolds F. Epidural infusions for nulliparous women in labour. A randomised double-blind comparison of fentanyl/bupivacaine and sufentanil/bupivacaine. Anaesthesia. 1993;48:856–861
  97. Van de Velde M, Teunkens A, Hanssens M, et al. Intrathecal sufentanil and fetal heart rate abnormalities: a double-blind, double placebo-controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labot. Anesth Analg. 2004;98:1153–1159
  98. Nelson KE, Rauch T, Terebuh V, D'Angelo R. A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Anesthesiology. 2002;96:1070–1073
  99. Nakamura G, Ganem EM, Módolo NS, et al. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial. Sao Paulo Med J. 2008;6(126):102–106
  100. Missant C, Teunkens A, Vandermeersch E, Van de Velde M. Intrathecal clonidine prolongs labour analgesia but worsens fetal outcome: a pilot study. Can J Anesth. 2004;51:696–701
  101. Soetens FM, Soetens MA, Vercauteren MP. Levobupivacaine-sufentanil with or without epinephrine during epidural labor analgesia. Anesth Analg. 2006;103:182–186
  102. Okutomi T, Mochizuki J, Amano K, Hoka S. Effect of epidural epinephrine infusion with bupivacaine on labor pain and mother-fetus outcome in humans. Reg Aneth Pain Med. 2000;25:228–234

PII: S1521-6934(09)00141-2

doi: 10.1016/j.bpobgyn.2009.11.003

Best Practice & Research Clinical Obstetrics & Gynaecology
Volume 24, Issue 3 , Pages 289-302 , June 2010

Article Tools

* Image Usage & Resolution