Evaluation of the utero-placental blood flow by the method of tissue oxymetry at the neuroaxial analgesia of childbirth

The objective was to evaluate the utero-placental blood flow using the method of tissue oximetry, the effectiveness of pain syndrome relief and the influence on the condition of the woman in labor through the natural childbirth when using epidural anesthesia (EA), combined spinal-epidural anesthesia (CSEA) and dural puncture epidural anesthesia (DPEA).

Materials and methods. A prospective study involving 240 patients during emergency deliveries was conducted at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology of the Ministry of Health of Russia. Anesthesia of childbirth was carried out by epidural method (N = 60), combined spinal-epidural (CSEA, N = 60) and DPE technique (N = 60), the control group consisted of female patients with no pain relief (N = 60). On 1, 3, 5, 7, 10, 15, 25, 30, 60, 90 and 120th minutes, data from near-infrared spectroscopy (NIRS), pain on VAS, BP, RR, and blood oxygen saturation were assessed.

Results. We have not seen NIRS decrease below 89% for either EA or CSEA. All three methods (EA, CSEA, DPE) provided effective, fast-onset and long-term anesthesia to the childbirth, manifested by statistically significant reduction of the severity of pain syndrome on VAS from 8 points to 1–3 points. The fastest analgesic effect was observed in the CSEA group (1–3 min), then in the DPE group (3–10 min) and in the EA group (7–15 min). Reduction of pain severity was more significant in DPE (up to 1–2 points on VAS) compared to EA. The reduction of pain syndrome in CSEA was more stable and lasting than in EA. The used anesthesia methods have a high favorable safety profile, as BP, HR and RR, as well as oximetry and blood oxygen saturation during the entire observation period were within normal values.

Conclusions. DPE and CSEA, along with traditional EA, provide a favorable risk-benefit ratio due to the minimal effect on uterine placental blood flow, rapid onset of anesthesia, early bilateral sacral analgesia with low maternal side effects.

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