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Three hundred thirty-six consecutive cesarean deliveries performed under epidural
anesthesia were reviewed. Twenty per cent of mothers suffered at least a 20% fall
in blood pressure following administration of epidural anesthesia. An additional 24%
required ephedrine, a vasopressor with predominantly beta activity, when other corrective
measures failed. Thus, 44% of these patients suffered significant hypotension. Forty-one
percent of all elective repeat cesarean sections were treated with ephedrine because
of maternal hypotension. Fifty-one patients delivered by scheduled repeat cesarean
section were divided into ephedrine-treated and untreated groups. There were no differences
in Apgar scores among infants of both groups. Fetal acidosis was proportional to the
severity of hypotension and the ephedrine dose. The metabolic abnormalities were most
pronounced when severe hypotension, requiring over 15 mg of ephedrine, was present. Following restoration of blood pressure with conventional
measures and ephedrine therapy, lactic acidosis persisted until delivery, whereas
Po2 and Pco2 reverted toward normal values. The hypoperfusion of the intervillous space was the
most likely cause of the observed significant umbilical venous and arterial lactic
acidosis. Maternal hypotension remains a significant problem complicating conduction
anesthesia.
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Article Info
Publication History
Accepted:
July 24,
1981
Received in revised form:
July 21,
1981
Received:
February 17,
1981
Identification
Copyright
© 1982 The C. V. Mosby Co. Published by Elsevier Inc. All rights reserved.
