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Fetal bradycardia and uterine hyperactivity following subarachnoid administration of fentanyl during labor
J D Friedlander1, H E Fox, C F Cain
1Department of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, New York 10032, USA.
Background And Objectives:
Changes in uterine tone have been postulated as the cause of fetal bradycardia following subarachnoid administration of fentanyl for labor analgesia. Such a case occurred in a 20-year-old parturient with an intrauterine pressure catheter in place.
Methods:
The patient was given intravenous terbutaline, after which contractions ceased for 20-30 minutes and then resumed.
Results:
The patient underwent successful cesarean delivery. Retrospective analysis of the data revealed a significant increase in uterine tone and contractions following fentanyl administration.
Conclusions:
This case supports the view that changes in uterine tone, producing a hyperdynamic contractile state and a resulting decrease in uteroplacental perfusion, may explain the fetal bradycardia following subarachnoid opioid administration. Cases that do not resolve spontaneously may respond to intravenous terbutaline.