Les effets de l’analgésie péridurale sur la contractilité utérine et le rythme cardiaque foetal au cours du travail obstétrical

Abstract : Objectives: the main objective was to study the effects of epidural analgesia on uterine contractility and to evaluate its effects depending on whether the pose was broken or intact membranes. The secondary objective was to analyze the effects of epidural analgesia on the fetal heart rate. Method: unicentric, observational, "before / after" study in a retrospective cohort of 250 women in labor. The study took place over the period from July 4th to August 31st 2018 at Port-Royal maternity hospital (Paris 14th). The collection of data was based on information found in the women's medical file. The target population consisted in women with a healthy uterus, a live fetus, cephalic presentation, estimated to be eutrophic and having used epidural analgesia in spontaneous term labor without administration of oxytocin prior to insertion. ODA. We compared uterine contractility and FHR before and after OA placement, first and then second, based on parity, membrane status and the product used for the "test dose". Results: the number of uterine contractions increased immediately after epidural placement within 10 to 20 minutes after insertion. The duration of the contractions only increased from 50 to 60 minutes after the application of the APD. Contractions ranged from 2/10 min to 3/10 min in frequency and from 60 to 90 seconds in duration. These effects were observed that the membranes are intact or broken during the laying of the APD. The epidural had no effect on the duration of uterine contractions in multiparous women. When the "test dose" used was ropivacaine 2 mg/ml, the effects appeared to be reversed: the contractions decreased in frequency from 3/10 min to 2/10 min within 50 to 60 minutes (p = 0.037) llowing the placement and in duration within 10 to 20 minutes (p = 0.031) after placement. After epidural induction, the number of fetal heart rate slows increased within 2 hours of insertion. The most observed slowdowns were atypical variables and late uniforms. RCF was also less oscillating (p = 0.003) and less reactive (p <0.001) within 30 minutes of APD placement.Conclusion: our study showed a significant increase in the number of uterine contractions within 10 to 20 minutes after APD and in the duration of contractions from 50-60 minutes after the pose that the membranes are intact or broken during the pose of ODA. As for the fetal heart rate, it showed more slowdowns within 2 hours after epidural placement. These being of atypical variable types and late uniforms. RCF was also less oscillating and less responsive within 30 minutes after epidural induction.
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Pauline Charton. Les effets de l’analgésie péridurale sur la contractilité utérine et le rythme cardiaque foetal au cours du travail obstétrical. Gynécologie et obstétrique. 2019. ⟨dumas-02188672⟩

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