Friedlander J D, Fox H E, Cain C F, Dominguez C L, Smiley R M
Department of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, New York 10032, USA.
Reg Anesth. 1997 Jul-Aug;22(4):378-81. doi: 10.1016/s1098-7339(97)80015-6.
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.
The patient was given intravenous terbutaline, after which contractions ceased for 20-30 minutes and then resumed.
The patient underwent successful cesarean delivery. Retrospective analysis of the data revealed a significant increase in uterine tone and contractions following fentanyl administration.
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.
