Long-term epidural block treatment in patients with early threatening preterm delivery and vaginal fetal engagement

We report on an exceptional therapy with epidural anesthesia and tunnelling of the peridural catheter over a time period of 2-14 days in patients with threatening early preterm labor, intact membranes and vaginal engagement of the infants (4 singleton, 8 twin and 2 triplet pregnancies). A combinatio...

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Bibliographic Details
Published in:	Journal of perinatal medicine Vol. 36; no. 6; p. 543
Main Authors:	Arabin, Birgit, Kuizenga, Karel, van Zoeren, Diny, Zveren, Diny V, Eyck, Jim V
Format:	Journal Article
Language:	English
Published:	Germany 01-11-2008
Subjects:	Adjuvants, Anesthesia - therapeutic use Anesthesia, Epidural - instrumentation Anesthesia, Epidural - methods Anesthesia, Obstetrical - instrumentation Anesthesia, Obstetrical - methods Anesthetics, Local - therapeutic use Apgar Score Bupivacaine - therapeutic use Catheters, Indwelling Female Fentanyl - therapeutic use Humans Infant, Newborn Infant, Premature, Diseases Infant, Very Low Birth Weight Labor Pain - therapy Pregnancy Pregnancy Outcome Premature Birth - mortality Premature Birth - prevention & control Time Factors Triplets Twins
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Summary:	We report on an exceptional therapy with epidural anesthesia and tunnelling of the peridural catheter over a time period of 2-14 days in patients with threatening early preterm labor, intact membranes and vaginal engagement of the infants (4 singleton, 8 twin and 2 triplet pregnancies). A combination of bupivacaine (0.125%) and fentanyl (2 microg/mL) was used up to a maximum of 20 mL/h during the treatment period. Long-term follow-up of the infants was normal in 19/20 infants. The advantages, such as prolongation of pregnancy without maternal pain and disadvantages such as the risk of fetal and maternal infection and of sudden delivery are discussed. The online version of the Journal (see http://dx.doi.org/10.1515/jpm.2008.081_supp-1) allows video illustrations of a triplet pregnancy, in which the first triplet was born after one week of epidural anesthesia and the pregnancy continued under epidural anesthesia for the remaining two triplets staying with intact membranes in the vagina (delayed interval delivery) for six more days. The results of this pilot series suggest that prolongation of these pregnancies under epidural anesthesia might be an option in exceptional cases when viability is questionable or when corticosteroid therapy is desired before final delivery. Further evaluation of this strategy is needed but only in tertiary centers with 24-h presence of qualified obstetric and neonatal care and intensive surveillance.
ISSN:	0300-5577
DOI:	10.1515/JPM.2008.081