Abstract
Objective(s)
Every year in France, 10% to 20% of the 600 000 women given epidural analgesia during
labor experience hypotension, which in 15% of cases is associated with fetal heart
rate abnormalities. The efficiency of lower limbs venous compression in preventing
the occurrence of maternal hypotension after neuraxial anesthesia has already been
demonstrated, but only in the context of scheduled cesarean section.
We assessed the preventive effect of medical lower limbs venous compression on the
incidence of maternal hypotension after epidural analgesia during spontaneous term
labor.
Study design
This before/after, single-center study in a university hospital included 93 women
in spontaneous labor at term who between 1 January and 31 March 2015 with epidural
analgesia plus lower limbs compression and 202 women in spontaneous labor at term
who delivered between 1 and 31 December 2014 with epidural analgesia without lower
limbs compression (control group). The main outcome was maternal hypotension (systolic
blood pressure <90 mmHg and/or delta >20%) in the 15 min after epidural analgesia.
Results
In the lower limbs compression group the incidence of hypotension 15 min after epidural analgesia was significantly lower than in the control group (3.23%
versus 23.3%, adjusted odds ratio = 0.1 [0.03; 0.35]). The incidence of fetal heart rate abnormalities was unsignificantly
lower in the lower limbs compression group than in the control group (10.7% versus
16.34%, p = 0.22).
Conclusion
The results suggest that medical lower limbs compression (20–36 mmHg) in women in spontaneous labor at term, could significantly reduce the incidence
of maternal hypotension following epidural analgesia. A prospective, randomized, open
trial would allow confirmation of these preliminary results.
Keywords
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Article info
Publication history
Published online: October 16, 2017
Accepted:
October 16,
2017
Received in revised form:
October 12,
2017
Received:
July 20,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
