Maternal heart rate variability patterns associated with maternal hypotension and non-reassuring fetal heart rate patterns following initiation of combined spinal-epidural labor analgesia: a prospective observational trial
Authors' conclusion
The ANI can predict the propensity for maternal hypotension and non-reassuring FHR patterns following CSE.
Study context
- Population
- Laboring women receiving combined spinal-epidural (CSE) labor analgesia initiated with intrathecal plain bupivacaine 1.0 mg and fentanyl 20 µg
- Participants
- 50 / 31 / 62 / 19
- Exposure
- Baseline maternal heart rate variability (HRV) metrics and Analgesia Nociception Index (ANI) in hypotensive vs normotensive parturients, and in those with fetal heart rate (FHR) abnormalities vs reassuring FHR traces
- Normotensiven = 50reference
- Hypotensiven = 31
- Reassuring FHRn = 62reference
- FHR abnormalitiesn = 19
- Outcome
- Maternal hypotension
Methodological detailsdiagnostic accuracy (ROC analysis)
- Diagnostic accuracy (ROC analysis)
Main finding
As reported in the abstract
Prediction of maternal hypotension (AUC of baseline measures)
| Group | AUC |
|---|---|
| Baseline low-frequency (LF)/high-frequency (HF) ratio | 0.677 (95% CI 0.55 to 0.80) |
| ANI | 0.858 (95% CI 0.78 to 0.94) |
AUC
Baseline low-frequency (LF)/high-frequency (HF) ratio0.677 (95% CI 0.55 to 0.80)
ANI0.858 (95% CI 0.78 to 0.94)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Baseline LF/HF ratio | ANI |
|---|---|---|
| Prediction of non-reassuring FHR patterns within 30 min after CSE (AUC) | ||
| AUC | 0.77 (95% CI 0.65 to 0.89) | 0.833 (95% CI 0.72 to 0.94) |
Prediction of non-reassuring FHR patterns within 30 min after CSE (AUC)
- Several baseline HRV metrics and ANI differed significantly between parturients with FHR abnormalities and those with reassuring FHR traces
Patient characteristics
- No significant intergroup differences
Original publication
Maternal heart rate variability patterns associated with maternal hypotension and non-reassuring fetal heart rate patterns following initiation of combined spinal-epidural labor analgesia: a prospective observational trial. Int J Obstet Anesth. Published 28 February 2023. doi:10.
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