Fetal bradycardia and uterine hyperactivity following subarachnoid administration of fentanyl during labor: Case report

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Abstract
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 uteroplacental perfusion, may explain the fetal bradycardia following subrachnoid opioid administration. Cases that do not resolve spontaneously may respond to intravenous terbutaline.

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