Continuous Fetal Heart Beat Monitor and Analysis After Spinal Anesthesia
Conditions
Keywords
cesarean section; spinal anesthesia ; fetal heart beat
Brief summary
Spinal anesthesia may cause sympathetic blockade which decrease peripheral vascular resistance and bradycardia and then hypotension. Maternal hypotension could cause immediate fetus heart beat (FHB) deceleration and postpartum acidosis. Both intravenous hydration or vasopressor during hypotension could prevent maternal hypotension efficiently. Although there were many articles discussion about maternal hypotension and fetal heart rate variation during epidural labor analgesia, the studies about FHB variation during spinal anesthesia is not much. In one literature in 1960, if maternal blood pressure below 60-80 mmHg, FHB deceleration could happen in 5 minutes. In modern medical management, FHB change during and after spinal anesthesia is an interesting topic. The most relevant study was published by NTUH in 2015, which transformed EKG signal to possible FHB change. The parturient will have FHB recording for 20 minutes in the day before operation. On the operation day, after proper position by the anesthetic staff (lateral position or sitting position), spinal anesthesia will performed by obstetric anesthesiologist and the lying down for supine position. Before the baby was delivered by cesarean section no FHB will be monitored. The aim of the study is continuous FHB monitor and analysis after spinal anesthesia for 5-10 minutes to improve fetal physiology knowledge and providing basic information for future study.
Interventions
DRUGSpinal anesthesia with heavy bupivacaine
Spinal anesthesia
Sponsors
Taichung Veterans General Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
1. Age above 20 years 2. Singleton 3. Gestational age above 36 weeks 4. Scheduled Cesarean section at VGHTC 5. Eligible for spinal anesthesia 6. Inform consent
Exclusion criteria
1. ASA \> 3 2. Prenatal examination reveal suspect neonatal congenital heart disease, heart failure, arrythymia or hydrops fetalis which could affect fetal heart beat 3. Regular uterine contraction, premature rupture of membrane or vaginal bleeding before scheduled C/S on prenatal clinic 4. Anticipate vaginal delivery initially but shift to C/S for prolong labor, FHB deceleration or other reason 5. Patients cannot make decision for language barrier, education condition or phsycological disease 6. Register in other study already
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fetal heart rate variability | 5 minutes after spinal anesthesia | Fetal heart rate deceleration (normal \> 100 beats per minute) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neonatal outcome | 1 minute and 5 minutes after delivery | APGAR score\_1 minute, APGAR score\_5 minute ( APGAR score: 0-10 points) |
| Neonatal intensive care rate | baseline (admission) | NICU admission rate |
| Umbilical vein analysis | within 5 minutes after delivery | Umbilical vein blood gas analysis, including pH, O2, CO2, HgB, electrolyte |
| Maternal pain score | 0, 8, 24 hours after surgery | Visual analog scale ( VAS score 0-10) |
Countries
Taiwan
Outcome results
None listed