Key result
Uterine hypertonia (OR 18.3), severe arterial hypotension (OR 5.8), and prior abnormal fetal heart rate (OR 4.3) were strongly associated with abnormal fetal heart rate after labor epidural analgesia.
Why the study?
Fetal heart rate abnormalities after spinal or combined spinal-epidural analgesia are well described, but few studies have evaluated the impact and risk factors of labor epidural analgesia.
What are the risk factors for abnormal fetal heart rate within one hour of labor epidural analgesia in women with singleton cephalic pregnancies?
Cohort (n=320)
No
What are the risk factors for abnormal fetal heart rate within one hour of labor epidural analgesia in women with singleton cephalic pregnancies?
Odds Ratio: 18.3 (95% CI 4.3–77.3)
p-value: p=<0.0001
Uterine hypertonia, severe hypotension, and prior abnormal fetal heart rate are strong predictors of fetal heart rate abnormalities within one hour of labor epidural analgesia.
May aid anticipation of abnormal fetal heart rates after epidural; leaves open prospective validation before practice change.
• This study aimed to evaluate risk factors for abnormal fetal heart rates occurring within one hour of labor epidural analgesia. • Multiples risk factors were found, either beforehand (small for gestational age, abnormal fetal heart rate) ore occurring afterwards (uterine hypertonia, severe hypotension). • Theses findings help us suspect or anticipate situations at risk of abdnormal fetal heart rates after the beginning of labor epidural analgesia. Fetal heart rate abnormalities after spinal analgesia or combined spinal-epidural analgesia are well described. Multiple mechanisms were involved like imbalance of epinephrine or the occurrence of hypotension. Few studies have studied the impact of labor epidural analgesia. Our aim was to evaluate risk factors for abnormal fetal heart rates occurring within one hour of labor epidural analgesia. This was a monocentric retrospective cohort study. Women undergoing labor epidural analgesia for a singleton cephalic pregnancy with at least 37 weeks of amenorrhea and attempted vaginal delivery were included. Fetal heart rates in the hour before and after labor epidural analgesia was analyzed. Two groups were compared according to the occurrence of abnormal fetal heart rate. We included 320 women. The rate of abnormal fetal heart rate after labor epidural analgesia was 22.8% (73/320). After multivariate analysis, the risk factors associated with the occurrence of abnormal fetal heart rate were uterine hypertonia (odds ratio [OR] = 18.3; 95% confidence interval [CI] [4.3-77.3]; p <0.0001), severe arterial hypotension (OR = 5.8; 95% CI [2.3-14. 8]; p <0.001), presence of abnormal fetal heart rate before labor epidural analgesia (OR = 4.3; 95% CI [1.8-9.9]; p =0.0007), small for gestational age (OR = 3.4; 95% CI [1.0-11.4]; p =0.04), vaginal delivery within one hour of labor epidural analgesia (OR = 3.2; 95% CI [1.2-8.4]; p =0.02). Factors known beforehand (small for gestational age, abnormal fetal heart rate) or occurring afterwards (uterine hypertonia, severe hypotension) should be suspected or anticipated.
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Mousson et al. (2026) conducted a cohort in Labor and Delivery (n=320). Risk factors (e.g., uterine hypertonia, severe arterial hypotension) vs. Absence of risk factors was evaluated on Abnormal fetal heart rate within one hour of labor epidural analgesia (OR 18.3, 95% CI 4.3-77.3, p=<0.0001). Uterine hypertonia (OR 18.3), severe arterial hypotension (OR 5.8), and prior abnormal fetal heart rate (OR 4.3) were strongly associated with abnormal fetal heart rate after labor epidural analgesia.
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