Prophylactic intravenous preloading for regional analgesia in labour. Hofmeyr, G J Cochrane database of systematic reviews (Online), 2000. doi abstract bibtex BACKGROUND Fetal heart rate changes are common following regional analgesia during labour. Reduced uterine blood flow from maternal hypotension may contribute to this. Intravenous fluid preloading (volume expansion) may help to reduce maternal hypotension. OBJECTIVES The objective of this review was to assess the effects of prophylactic intravenous fluid preloading prior to epidural analgesia during labour on maternal and fetal well-being. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trial register and the Cochrane Controlled Trials Register were searched. Date of last search: December 1997. SELECTION CRITERIA Randomised and quasi-randomised trials comparing prophylactic intravenous preloading before epidural analgesia during labour with a control group (dummy or no preloading). DATA COLLECTION AND ANALYSIS The reviewer assessed trial quality and extracted data. MAIN RESULTS One study involving 102 women was included. There was potential for considerable bias in this trial. Preloading with intravenous fluids was associated with a reduction in hypotension (relative risk 0.07, 95% confidence interval 0.01 to 0.53). It was also associated with a reduction in fetal heart rate abnormalities (relative risk 0.36, 95% confidence interval 0.16 to 0.83). No differences were detected in other perinatal and maternal outcomes. REVIEWER'S CONCLUSIONS There are methodological limitations in the only trial of preloading with intravenous fluids prior to epidural analgesia. However preloading may have beneficial fetal and maternal effects in healthy women. Further investigation of the risks and benefits of intravenous preloading for women with pregnancy complications is required.
@article{hofmeyr_prophylactic_2000,
title = {Prophylactic intravenous preloading for regional analgesia in labour},
issn = {1469-493X},
doi = {10.1002/14651858.CD000175},
abstract = {BACKGROUND
Fetal heart rate changes are common following regional analgesia during labour. Reduced uterine blood flow from maternal hypotension may contribute to this. Intravenous fluid preloading (volume expansion) may help to reduce maternal hypotension.
OBJECTIVES
The objective of this review was to assess the effects of prophylactic intravenous fluid preloading prior to epidural analgesia during labour on maternal and fetal well-being.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trial register and the Cochrane Controlled Trials Register were searched. Date of last search: December 1997.
SELECTION CRITERIA
Randomised and quasi-randomised trials comparing prophylactic intravenous preloading before epidural analgesia during labour with a control group (dummy or no preloading).
DATA COLLECTION AND ANALYSIS
The reviewer assessed trial quality and extracted data.
MAIN RESULTS
One study involving 102 women was included. There was potential for considerable bias in this trial. Preloading with intravenous fluids was associated with a reduction in hypotension (relative risk 0.07, 95\% confidence interval 0.01 to 0.53). It was also associated with a reduction in fetal heart rate abnormalities (relative risk 0.36, 95\% confidence interval 0.16 to 0.83). No differences were detected in other perinatal and maternal outcomes.
REVIEWER'S CONCLUSIONS
There are methodological limitations in the only trial of preloading with intravenous fluids prior to epidural analgesia. However preloading may have beneficial fetal and maternal effects in healthy women. Further investigation of the risks and benefits of intravenous preloading for women with pregnancy complications is required.},
number = {2},
journal = {Cochrane database of systematic reviews (Online)},
author = {Hofmeyr, G J},
year = {2000},
pmid = {10796169},
keywords = {Anesthesia, Epidural, Anesthesia, Obstetrical, Female, Fluid Therapy, Heart Rate, Fetal, Humans, Hypotension, Pregnancy, Pregnancy Complications, Cardiovascular},
pages = {CD000175}
}
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SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trial register and the Cochrane Controlled Trials Register were searched. Date of last search: December 1997. SELECTION CRITERIA Randomised and quasi-randomised trials comparing prophylactic intravenous preloading before epidural analgesia during labour with a control group (dummy or no preloading). DATA COLLECTION AND ANALYSIS The reviewer assessed trial quality and extracted data. MAIN RESULTS One study involving 102 women was included. There was potential for considerable bias in this trial. Preloading with intravenous fluids was associated with a reduction in hypotension (relative risk 0.07, 95% confidence interval 0.01 to 0.53). It was also associated with a reduction in fetal heart rate abnormalities (relative risk 0.36, 95% confidence interval 0.16 to 0.83). No differences were detected in other perinatal and maternal outcomes. REVIEWER'S CONCLUSIONS There are methodological limitations in the only trial of preloading with intravenous fluids prior to epidural analgesia. However preloading may have beneficial fetal and maternal effects in healthy women. Further investigation of the risks and benefits of intravenous preloading for women with pregnancy complications is required.","number":"2","journal":"Cochrane database of systematic reviews (Online)","author":[{"propositions":[],"lastnames":["Hofmeyr"],"firstnames":["G","J"],"suffixes":[]}],"year":"2000","pmid":"10796169","keywords":"Anesthesia, Epidural, Anesthesia, Obstetrical, Female, Fluid Therapy, Heart Rate, Fetal, Humans, Hypotension, Pregnancy, Pregnancy Complications, Cardiovascular","pages":"CD000175","bibtex":"@article{hofmeyr_prophylactic_2000,\n\ttitle = {Prophylactic intravenous preloading for regional analgesia in labour},\n\tissn = {1469-493X},\n\tdoi = {10.1002/14651858.CD000175},\n\tabstract = {BACKGROUND\n\nFetal heart rate changes are common following regional analgesia during labour. Reduced uterine blood flow from maternal hypotension may contribute to this. Intravenous fluid preloading (volume expansion) may help to reduce maternal hypotension.\n\n\nOBJECTIVES\n\nThe objective of this review was to assess the effects of prophylactic intravenous fluid preloading prior to epidural analgesia during labour on maternal and fetal well-being.\n\n\nSEARCH STRATEGY\n\nThe Cochrane Pregnancy and Childbirth Group trial register and the Cochrane Controlled Trials Register were searched. Date of last search: December 1997.\n\n\nSELECTION CRITERIA\n\nRandomised and quasi-randomised trials comparing prophylactic intravenous preloading before epidural analgesia during labour with a control group (dummy or no preloading).\n\n\nDATA COLLECTION AND ANALYSIS\n\nThe reviewer assessed trial quality and extracted data.\n\n\nMAIN RESULTS\n\nOne study involving 102 women was included. There was potential for considerable bias in this trial. Preloading with intravenous fluids was associated with a reduction in hypotension (relative risk 0.07, 95\\% confidence interval 0.01 to 0.53). It was also associated with a reduction in fetal heart rate abnormalities (relative risk 0.36, 95\\% confidence interval 0.16 to 0.83). No differences were detected in other perinatal and maternal outcomes.\n\n\nREVIEWER'S CONCLUSIONS\n\nThere are methodological limitations in the only trial of preloading with intravenous fluids prior to epidural analgesia. However preloading may have beneficial fetal and maternal effects in healthy women. 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