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Fetal Bradycardia and Uterine Hyperactivity Following Subarachnoid Administration of Fentanyl During Labor
  1. Jeffrey D. Friedlander, M.D.*,
  2. Harold E. Fox, M.D.,
  3. Charles F. Cain, M.D.*,
  4. Carmen L. Dominguez, M.D.* and
  5. Richard M. Smiley, M.D., Ph.D*
  1. *Department of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, New York
  2. Department of Obstetrics & Gynecology, College of Physicians & Surgeons of Columbia University, New York, New York
  1. Reprint requests: Richard M. Smiley, M.D., Ph.D., Department of Anesthesiology, Columbia University, 630 West 168th Street, PH-5, New York, NY 10032.


Background and Objectives Changes in uterine tone have been postulated as the cause of fetal bradycardia following subarachnoid administration of fentanyl for labor analgesia. Such a case occurred in a 20-year-old parturient with an intrauterine pressure catheter in place.

Methods The patient was given intravenous terbutaline, after which contractions ceased for 20-30 minutes and then resumed.

Results The patient underwent successful cesarean delivery. Retrospective analysis of the data revealed a significant increase in uterine tone and contractions following fentanyl administration.

Conclusions This case supports the view that changes in uterine tone, producing a hyperdynamic contractile state and a resulting decrease in utero-placental perfusion, may explain the fetal bradycardia following subarachnoid opioid administration. Cases that do not resolve spontaneously may respond to intra-venous terbutaline.

  • fetal bradycardia
  • subarachnoid labor analgesia
  • fentanyl
  • terbutaline
  • uterine tone
  • intrauterine pressure catheter

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