• R al-Mufti, R Morey, A Shennan, and B Morgan.
• Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London, UK.
• Br J Obstet Gynaecol. 1997 May 1;104(5):554-8.

ObjectiveTo determine the effect of patient-controlled combined spinal epidural analgesia (PCEA) on maternal pulse and blood pressure, and fetal heart rate in primigravid women, when adapting different positions in labour.DesignA prospective study.SettingQueen Charlotte's and Chelsea hospital, London.ParticipantsFifty-five primigravid women in labour at > or = 37 weeks of gestation; 40 women had supervised standing top-ups given by an anaesthetist. A further 15 women had PCEA top-ups given in each of standing, sitting and lying positions.Main Outcome MeasuresMaternal pulse rate, blood pressure and fetal heart rate changes following epidural top-ups.ResultsIn the first 40 women there was no clinically significant fall in their blood pressure (< 5 mmHg). The subsequent 15 women who had PCEA top-ups had no fall in blood pressure in the standing and sitting positions, though the average blood pressure fell significantly when a top-up was given in the lying position. Maternal heart rate increased significantly at 12 min post top-up when the women were in the standing position (P = 0.0018). In the 15 women who had PCEA top-ups, the CTG showed improvement in decelerations when women were in the standing position but deterioration when in the lying position (P < 0.01).ConclusionPatient-controlled epidural analgesia top-ups with maternal mobility may be beneficial to the fetus possibly by reducing the hypotension normally associated with top-ups in the lying position.

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