Uterine hypertonus and fetal bradycardia occurred after combined spinal-epidural analgesia during induction of labor with oxytocin infusion A case report

Introduction: Pain management is an essential part of good obstetrical care. The rapid onset of pain relief after combined spinal-epidural (CSE) analgesia may cause transient imbalance in maternal catecholamine level, leading to uterine hyperactivity and fetal heart rate (FHR) abnormalities. How to manage the uterine basal tone and FHR abnormalities after labor analgesia still remains controversial. Patient concerns: A 33-year-old nulliparous woman at 40(+5) weeks' gestation underwent induction of labor after premature rupture of membranes. CSE analgesia was provided when the patient described her pain as the top on a scale of 10 during induction of labor with oxytocin infusion. Diagnosis: Uterine hypertonus and fetal bradycardia were diagnosed within 10 minutes after CSE analgesia. Interventions: Oxytocin infusion and CSE analgesia were immediately suspended, and measures of staying in left lateral decubitus position and giving supplemental oxygen were attempted to resuscitating the baby. Because of suspicious fetal distress, the baby was rapidly delivered by emergency cesarean section. Outcomes: The Apgar score of the baby was 8 and 10 at 1 and 5 minutes after birth. Subsequent follow-up confirmed that both mother and baby were in well condition. Conclusion: The loss of tocolytic effect of epinephrine after CSE analgesia and continuous oxytocin infusion may work together to form a totally synergistic function, finally leading to inevitable uterine hypertonus and fetal bradycardia. Both obstetrical provider and anesthesiologist should carefully monitor all patients in the first 15 minutes after CES analgesia induction. Oxytocin administration in this critical period deserves attention. Additionally, intraprofessional collaboration is also necessary to ensure high quality and safe delivery for all childbearing women.