Effect of Neuraxial Blockade on Diastolic Function of Parturients at Term

The progression of an uncomplicated pregnancy is associated with substantial alterations in maternal cardiovascular function, including changes in plasma volume, cardiac output, and systemic vascular resistance [1]. Using serial trans-thoracic echocardiography, maternal diastolic function has been investigated and found repeatedly to deteriorate significantly from early gestation to term [2,3]. Epidural anesthesia has also been shown to improve diastolic function in patients with coronary artery disease undergoing revascularization [4], but its effect on diastolic function in parturients has not been reported. Because epidural and combined spinal-epidural anesthesia are commonly used to provide pain relief during labor, and have been reported to blunt the sympathetic nerve activity in parturients, we hypothesized that epidural and combined spinal-epidural anesthesia could alter diastolic function in parturients at term.