Lower limb compression using a sequential compression device (SCD) significantly decreased the incidence of maternal hypotension in women receiving epidural anesthesia, researchers reported here at the annual meeting of the American College of Gynecologists and Obstetricians.
Studies find that 30% of patients who choose epidural anesthesia during labor experience hypotension despite the standard prophylaxis of IV hydration, said the lead author, Margaret Steinmetz, MD, of the Department of Obstetrics & Gynecology at State University of New York at Buffalo. The condition can cause dizziness, nausea, and vomiting in the mother, and affect placental blood flow, causing fetal bradycardia possibly requiring a STAT cesarian.
“We hypothesized that by using lower limb compression we could recruit blood from the lower extremities and thereby decrease maternal hypotension,” she said.
While several studies have reported on the use of lower limb compression in women receiving epidural prior to cesarian section, there was no research on its use in women delivering vaginally, she said.
In this multicenter, prospective trial, researchers randomized 71 term, singleton, parturients requesting an epidural into one of 3 arms: control (27), thrombo-embolic deterrent (TED) stockings (21), or SCD (23). As per the hospitals’ protocols, all patients received IV fluid hydration prior to epidural placement and blood pressure checks at 1, 5, 15, 30, 45, and 60 minutes following administration of the epidural bolus. The investigators defined hypotension as a decrease in either systolic or diastolic blood pressure of greater than 20% from baseline, which was the average of the 3 blood pressures obtained prior to the epidural.
Patients using the SCDs received intermittent compression; the TEDs used were knee high. The majority of patients received either form of compression for 1 hour post-epidural, although some women used them longer.
The overall rate of hypotension was 50.7%. Hypotension occurred in 66.7% of patients in the control arm compared to 52.4% of patients in the TED arm and 30.4% in the SCD arm. The P value across groups was 0.038, with the only significant difference between the control and SCD groups (0.022). Controlling for clinical site, delivery method, maternal age, gestational age at delivery, and maternal body mass index did not affect the results.
Two patients in the control arm required a cesarian due to fetal bradycardia, but the study was not powered to determine the effects of the intervention on cesarian rates, Dr. Steinmetz said.
Patients were excluded if they had hypertension, lower leg deformity or wound, or a recent history of a deep vein thromboembolism. However, said Dr. Steinmetz, “I don’t think it would be a problem using SCD in patients with hypertension.”
One interesting finding, she said, is that the incidence of hypotension in the study was higher than previously reported in the literature. “The original data is from the 1980s,” she said. “But we suspect the incidence is closer to 50%.”[Presentation title: Full Lower Limb Compression Prevents Hypotension After Epidural in Labour Patients: a Randomized Controlled Trial. Abstract 70P]