Intrapartum epidural analgesia and emergency delivery for presumed fetal compromise: association or causation? Hypothesized mechanism explored.

We regret that extensive data regarding EDA medication regimes and maternal blood pressure before and during EDA were not available in either study. Placental perfusion and hemodynamic changes The concerns regarding hypotension raised by Papazova I et al i . and van den Bosch I et al i . are speculative and conflicting at best; the "large body of evidence" for improved placental flow after EDA and for EDA being a treatment for placental insufficiency is hardly argumentative against the mechanism that we hypothesized. Given the abundant and ever-increasing use of labor EDA worldwide, the lack of knowledge and consensus on this matter is troubling. van den Bosch I et al i . focus on the term '(subclinical) hypotension', arguing that maternal blood pressure is either sufficient or insufficient to oxygenate the fetus effectively and that EDA-induced hypotension occurs in fewer than 15% of women receiving EDA. Systematic reviews van den Bosch I et al i . and Verheggen I et al i . emphasized that the findings of our studies are novel and differ from those of the most recent meta-analysis on this topic[8]. [Extracted from the article]