Lower limbs venous compression reduces the incidence of maternal hypotension following epidural analgesia during term labor

Abstract

Objective(s): Every year in France, 10% to 20% of the 600 000 women given epidural analgesia during labor experience hypotension, which in 15% of cases is associated with fetal heart rate abnormalities. The efficiency of lower limbs venous compression in preventing the occurrence of maternal hypotension after neuraxial anesthesia has already been demonstrated, but only in the context of scheduled cesarean section. We assessed the preventive effect of medical lower limbs venous compression on the incidence of maternal hypotension after epidural analgesia during spontaneous term labor.

Study design: This before/after, single-center study in a university hospital included 93 women in spontaneous labor at term who between 1 January and 31 March 2015 with epidural analgesia plus lower limbs compression and 202 women in spontaneous labor at term who delivered between 1 and 31 December 2014 with epidural analgesia without lower limbs compression (control group). The main outcome was maternal hypotension (systolic blood pressure <90mmHg and/or delta >20%) in the 15min after epidural analgesia.

Results: In the lower limbs compression group the incidence of hypotension 15min after epidural analgesia was significantly lower than in the control group (3.23% versus 23.3%, adjusted odds ratio=0.1 [0.03; 0.35]). The incidence of fetal heart rate abnormalities was unsignificantly lower in the lower limbs compression group than in the control group (10.7% versus 16.34%, p=0.22).

Conclusion: The results suggest that medical lower limbs compression (20-36mmHg) in women in spontaneous labor at term, could significantly reduce the incidence of maternal hypotension following epidural analgesia. A prospective, randomized, open trial would allow confirmation of these preliminary results.

Keywords: Epidural analgesia; Fetal heart rate abnormalities; Hypotension; Lower limbs compression; Term labor.