Epidural analgesia is a frequently used method to reduce the
pain of child-bearing. Concerns regarding the safety and potential hazards still persist in the medical community. This review intends to examine how
epidural analgesia determines the various factors of fetal and neonatal well-being. Placental
drug transfer of
opiates like
morphine,
pethidine and
fentanyl is rapid and can lead to neonatal depression.
Sufentanil seems to be the safest
opiate to administer epidurally. Local anaesthetics are transferred to the fetus in substantial amounts, but the reported effects are subtle and are probably inconsequential. Utero- and fetoplacental blood flow seems to be improved by
epidural analgesia with local anaesthetics. Even when using stronger solutions for more extensive blockade in patients for
caesarean section, no adverse effects could be demonstrated using pulsed Doppler technique as long as prolonged
hypotension (> 2 min) is avoided.
Hypotension is best prevented with 20-25 ml/kg
crystalloid preload and prompt treatment with
ephedrine or etilephrine. Addition of
adrenaline to local anaesthetics is considered to be safe for the healthy mother and fetus but it should best be avoided in mothers with
pregnancy induced hypertension. Fetal and neonatal acid-base balance and gas-exchange are not adversely affected by
epidural analgesia. Many studies show that
epidural analgesia can indeed protect the fetus if
hypotension is prevented. Neonatal well-being evaluated by APGAR, BRAZELTON, SCANLON and NACS scores is not significantly influenced by local anaesthetics. Neonatal depression can occur however with epidural use of
morphine,
fentanyl and
alfentanil.
Sufentanil, again in doses up to 30 micrograms in association with
bupivacaine seems to be devoid of depressive effects on the neonate. In summary, the anaesthetist has good arguments to reassure his obstetrical colleagues that providing
epidural analgesia for pregnant women in labour is a justifiable intervention to support the natural process of child-bearing.