Abstract:
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.
journal_name
Fetal Diagn Therjournal_title
Fetal diagnosis and therapyauthors
Strümper D,Louwen F,Durieux ME,Gramke HF,Stuessel J,Marcus-Soekarman D,Van Aken H,Marcus MAdoi
10.1159/000083907keywords:
subject
Has Abstractpub_date
2005-05-01 00:00:00pages
208-13issue
3eissn
1015-3837issn
1421-9964pii
83907journal_volume
20pub_type
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journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章,评审
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journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000263955
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journal_title:Fetal diagnosis and therapy
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journal_title:Fetal diagnosis and therapy
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journal_title:Fetal diagnosis and therapy
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journal_title:Fetal diagnosis and therapy
pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
doi:10.1159/000097102
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journal_title:Fetal diagnosis and therapy
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journal_title:Fetal diagnosis and therapy
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更新日期:2018-01-01 00:00:00
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journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2012-01-01 00:00:00
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journal_title:Fetal diagnosis and therapy
pub_type: 杂志文章,评审
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更新日期:2005-01-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2009-01-01 00:00:00