Long-term epidural block treatment in patients with early threatening preterm delivery and vaginal fetal engagement : Journal of Perinatal Medicine

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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland


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

Birgit Arabin1 / Karel Kuizenga2 / Diny V. Zveren3 / Jim V. Eyck4

1Department of Perinatology, Isala Kliniken, Zwolle, The Netherlands

2Department of Anaesthesiology, Isala Kliniken, Zwolle, The Netherlands

3Department of Neonatology, Isala Kliniken, Zwolle, The Netherlands

4Department of Perinatology, Isala Kliniken, Zwolle, The Netherlands

Corresponding author: Birgit Arabin, MD Clara Angela Foundation Institute for Research Development A. Herrenhausenstr. 44 58455 Witten/Germany

Citation Information: Journal of Perinatal Medicine. Volume 36, Issue 6, Pages 543–547, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2008.081, July 2008

Publication History

Received:
2008-03-01
Revised:
2008-04-24
Accepted:
2008-05-19
Published Online:
2008-07-29

This article offers supplementary material which is provided at the end of the article.

Abstract

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 μg/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.

Keywords: Epidural anesthesia; outcome of preterm infants; pain during labor; preterm delivery; prolongation of pregnancy

Supplementary Article Materials

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