Low Concentration Ropivacaine Combined In Labor Epidural Analgesia For PIH-syndrome

PIH-syndrome hurt the lives of the mothers and neonates deeply. When you had PIH-syndrome, most of the obstetricians would choose cesarean delivery. But some scholar think that labor progress for parturients is quickly, when the lying-in women had PIH-syndrome, there's no need to choose cesarean delivery. Labor pain hurt mothers and neonates deeply. The best and popular is epidural labor analgesia. So the aim of this study is to evaluate the effect of low concentration ropivacaine combined with low dosage fentanly in epidural labor analgesia for PIH-syndrome.METHODS: sixty PIH-syndrome primiparas parturients were randomly divided into three groups: Group A (n=20) patients received epidural infusion of 0.075% ropivacaine with 2ug/ml fentanyl 6ml. Group B (n=20) patients received epidural infusion of 0.125% ropivacaine with 2ug/ml fentanyl 6ml. The two groups primiparas persistent dose of 6ml, PCEA (2ml, 30min per time). Blood pressure were marked at diffent time points:before anesthesia, 5min after anesthesia, 10min after anesthesia. All drugs were stopped at the beginning of the second stage (10 cervical dilatation). Group C (n=20) did not receive epidural labor analgesia. Maternal were measured variables include vital signs, fetal heart rate (FHR), delivery mode, birth process,harmful side-effects, the neonate was assessed with Apgar's scores, evaluate the effect on relief of labor pain. RESULTS:1. Blood pressures of both goup A and group B were decreased significantly after epidural labor analgesia. P<0.012. Compared with group C, group A and B's blood pressure were significantly lower at each labor stage, SpO2% and PaCO2 had obvious improvement. P<0.013. Group A and B's labor analgesia provieded excellent labor pain relief without motor block.4. Compared with group C, group A and B's cesarean delivery rate and duration of each labor stage were significantly decreased. P<0.015. Apgar scores and the rate of side effects were not statistically significantly different in the three groups.CONCLUSIONS:1. Epidural infusion of 0.075% ropivacaine or 0.125% ropivaciane with 2ug/ml fentanyl all provided effective analgesia during labor and stable BP, protected safety of the women who had PIH-syndrome and decreased the rate of cesarean delivery.2. Epidural labor analgesia can shorten the duration of the stage of labor, lower the rate of caesarean section and had not motor blockade. Through the rate of using OXY and instrumental delivery were improved, there's no statisticaly difference.3. Epidural infusion low concentration ropivacaine combined with low dose fentanyl has not improve side effects to mothers with PIH-syndrome and neonatates.The paregoric can relieve the lying-in woman's pain that resulted in over-breath, and maintain SpO2% over 98%, avoid hyoxemia and its effect on fetus. The paregoric can lessen the heart burden by decreasing the blood pressure and volume ejection. This is beneficial for the patient of sufferering from pregnancy, heart disease or the pulmonary hypertension. The volume ejection is increasing during the process of parturition. The volume ejection is more 40-50% than that before parturition, and even more 120-130% during uterine contraction with pain. 250-300ml blood are pushed out of uterus to systemic circulation during uterine contraction. On the other hand, pain can make sympathetico- adrenal system excitate, then increase blood pressure. All these things can enhance the heart burden that can bear for the health puerperant, but it is dangerous for pregnancy- induced hypertension syndrome patient. It may lead to the heart cardiac inadequacy, and increase the risk of childbearing from vagina. The availability paregoric can inhibit sympathetic nerve, eliminate uterine contraction infirmness or intensity, and recover normal intensity of uterine contraction. The important thing is that the paregoric can eliminate uterus the hypoperfusion state. It is beneficial for fetus oxygenation and pregnancy-induced hypertension syndrome patient.In this study, we use 0.075%-0.125% ropivacaine combined with low dosage fentanyl in epidural labor analgesia for PIH-syndrome, it was provided excellent labor pain relief without motor block, stable the BP in all birth process, ensure the oxygen supply, releasethe heart burden, increased the blood stream of placent and uterus, be good to fetus oxygenate, decrease intrauterine embarrass, no side-effects to neonates. At the same time, it accelerate the birth process, although the rate of using OXY and instrumental delivery were little improved, but there was no statistically difference.So low concentration ropivacaine combined with low dosage fentanyl in labor epidaral analgesia for PIH-syndrome that is safe and effective for labor analgesia to PIH-syndrome.