School of Nursing & Midwifery, Division of Health Science, University of South Australia, Adelaide, SA, Australia.
College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
Int J Obstet Anesth. 2020 May;42:34-38. doi: 10.1016/j.ijoa.2020.01.001. Epub 2020 Jan 17.
The effect that the route of maternal fentanyl administration has on placental transfer of drug to the neonate is not well studied. Plasma concentration ratios are an indicator of fetal exposure, relative to the mother.
A cohort study (n=30) was conducted to measure fentanyl concentrations in maternal plasma, and arterial and venous cord blood, among women administered either intranasal or subcutaneous fentanyl for labour pain relief. Maternal and cord blood samples were collected within 30 min of birth to determine the fentanyl plasma concentration and to assess relative neonatal exposure. Neonatal outcomes were assessed by Apgar scores, need for resuscitation and nursery admission.
Thirty paired samples were obtained from healthy parturients with uncomplicated term pregnancies. Highest observed umbilical venous and arterial concentrations were 0.71 ng/mL and 0.56 ng/mL, respectively, and fetal to maternal fentanyl plasma concentration ratios ranged between 0.23 and 0.73, indicating low fetal exposure. While the total intranasal fentanyl dose administered was significantly higher than the subcutaneous fentanyl dose, this did not result in a higher fetal to maternal ratio. All neonates in both groups had 5-min Apgar scores >7, two neonates required short-term stimulation and oxygen (unrelated to fentanyl) and no neonate was admitted to the nursery.
This study is the first to examine fetal and maternal fentanyl concentrations after subcutaneous administration. This research supports the safe use of fentanyl for labour analgesia for women.
母体芬太尼给药途径对新生儿胎盘药物转移的影响尚未得到充分研究。血浆浓度比值是衡量胎儿暴露程度的指标，与母亲相比。
对 30 名接受鼻内或皮下芬太尼分娩镇痛的妇女进行了一项队列研究（n=30），以测量母体血浆、动脉和脐静脉血中的芬太尼浓度。分娩后 30 分钟内采集母血和脐血样本，以确定芬太尼血浆浓度并评估新生儿的相对暴露量。新生儿结局通过阿普加评分、复苏需要和新生儿病房入院来评估。
从健康足月妊娠无并发症的产妇中获得了 30 对样本。观察到的最高脐静脉和脐动脉浓度分别为 0.71ng/mL 和 0.56ng/mL，胎儿与母体芬太尼血浆浓度比值在 0.23 至 0.73 之间，表明胎儿暴露程度较低。虽然鼻内芬太尼总剂量明显高于皮下芬太尼剂量，但这并没有导致胎儿与母体比值更高。两组新生儿的 5 分钟阿普加评分均>7，两名新生儿需要短期刺激和氧气（与芬太尼无关），无新生儿入住新生儿病房。
这项研究首次检查了皮下给予芬太尼后胎儿和母体的芬太尼浓度。这项研究支持芬太尼在产妇分娩镇痛中的安全使用。
