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[Management of labor in fetal cardiac sound changes after paracervical block]
A pain free period during the first stage of labor is made possible by paracervical block anaesthesia. The extent of risks for the fetus using this method of anaesthesia is measured by different means. Changes of the fetal heart rate after paracervical block must be regarded as a complication. During the period of ten years paracervical block anaesthesia was performed in 10.041 cases in our hospital (Landesfraunklinik Wuppertal). The analysis of all cardiotocograms taken shows changes of the fetal heart rate after paracervical block in 11,3%. Carbostesin with adrenalin (0.5%) was used, 5 ml were injected on each side. Motility disturbances of the uterus and the vena cava-syndrome are clinically evident because of the various reasons for bradycardy. ECG analysis detects a suppression of the sinus-atrial node as a stimulator. During the period of bradycardy after paracervical block Caesarian section is not indicated. A conservative attitude is justified with the patient in a lateral position. Disturbances of uterine motility and long periods of bradycardy call for intrauterine resuscitation with the application of Partusisten (Th 1165) under constant control of maternal circulation. If there are other reasons for a Caesarian section an improvement of the fetal heart rate--as shown in the cardiotocogram--should be achieved in any case.
A pain free period during the first stage of labor is made possible by paracervical block anaesthesia. The extent of risks for the fetus using this method of anaesthesia is measured by different means. Changes of the fetal heart rate after paracervical block must be regarded as a complication. During the period of ten years paracervical block anaesthesia was performed in 10.041 cases in our hospital (Landesfraunklinik Wuppertal). The analysis of all cardiotocograms taken shows changes of the fetal heart rate after paracervical block in 11,3%. Carbostesin with adrenalin (0.5%) was used, 5 ml were injected on each side. Motility disturbances of the uterus and the vena cava-syndrome are clinically evident because of the various reasons for bradycardy. ECG analysis detects a suppression of the sinus-atrial node as a stimulator. During the period of bradycardy after paracervical block Caesarian section is not indicated. A conservative attitude is justified with the patient in a lateral position. Disturbances of uterine motility and long periods of bradycardy call for intrauterine resuscitation with the application of Partusisten (Th 1165) under constant control of maternal circulation. If there are other reasons for a Caesarian section an improvement of the fetal heart rate--as shown in the cardiotocogram--should be achieved in any case.