1 School of Nursing, University of Nevada, Las Vegas, NV, USA.
2 Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Biol Res Nurs. 2019 Oct;21(5):495-499. doi: 10.1177/1099800419858667. Epub 2019 Jun 26.
The first stage of labor is significantly longer with epidural analgesia use, implying an alteration in uterine contractility. Although the pre-epidural fluid bolus is used with every epidural and affects as many as 80% of laboring women, its effects on uterine contraction parameters are unknown.
Using a retrospective descriptive repeated measures design, we compared uterine contraction parameters including frequency, duration, peak intensity, resting tone, and Montevideo units at baseline and during the intravascular pre-epidural fluid bolus (Bolus) epochs for healthy laboring women at term gestation undergoing augmentation or induction.
Contraction parameters were compared using data from fetal monitor strips with intrauterine pressure catheter instrumentation.
No significant differences were found between epochs for women receiving constant Pitocin dosages ( = 10) using Wilcoxon signed rank tests at .05 α level, but all parameters trended in the direction of improved contractility except frequency, which was unchanged.
These pilot study findings do not support the proposal that the pre-epidural fluid bolus is a contributor to decreased uterine contractility in any parameter. It is possible that the bolus improved myometrial perfusion and metabolic function in the contracting and resting states in less hydrated women.
硬膜外镇痛的使用会显著延长第一产程，这意味着子宫收缩力发生了变化。虽然每次硬膜外麻醉都会使用硬膜外预充液，并且多达 80%的分娩妇女都会受到影响，但它对子宫收缩参数的影响尚不清楚。
我们采用回顾性描述性重复测量设计，比较了足月妊娠接受引产或催产的健康产妇在基线和硬膜外预充液（Bolus）期的子宫收缩参数，包括频率、持续时间、峰值强度、静息张力和蒙得维的亚单位。
使用带有宫内压力导管仪器的胎儿监护带数据比较收缩参数。
使用 Wilcoxon 符号秩检验，在.05 α 水平下，接受恒速催产素剂量的妇女在各时期之间没有发现显著差异，但除频率外，所有参数均呈改善收缩力的趋势，而频率不变。
这些初步研究结果不支持硬膜外预充液是任何参数下子宫收缩力下降的原因的说法。在水分不足的妇女中，预充液可能改善了收缩和静息状态下的子宫灌注和代谢功能。
