[Peridural anesthesia in obstetrics (author's transl)].

In German speaking countries peridural anesthesia in obstetrics has been introduced 25 years ago by Anselmino. Because of the increase of operative delivery and the--however rare--serious complications in the mother the technique has been employed less and less. Now, with the introduction of the catheter technique, which renders lower doses of the anesthetic effective and with improved treatment of complications due to it, the technique has become safer for the mother. Anomalies of the position of the fetal head are not more common than in deliveries without peridural anesthesia. But the more frequent need for low forceps delivery remains, since the strain-reflex is abolished, although motorfunction of lower limbs and abdomen are intact. The safe use of peridural anesthesia requires a considerably increased personnel, since the doctor conducting the delivery is only rarely sufficiently qualified in anesthetics and even then should not have to take the responsibility for both delivery and anesthesia. Since we can consider the technique safe for the mother, its effect on the child is predominant interest. Examination of the acid-base metabolism in the fetal blood from the scalp and umbilical cord post-partum has shown favorable results. The effect of complete painlessness on respiration and blood-gases of the mother is of interest (Strasser, Huch, Huch). Further investigations of the effects on fetal heart frequency and its assessment in supine or constant lateral positioning and of the maternal circulation with modern cardiologic techniques have not yet been concluded. On their results will depend, at least in part, the indication for peridural anesthesia in pregnancies and deliveries at risk. Clinical observations and comparison with deliveries under general anesthesia indicate that catheter peridural anesthesia may be advantageous for the child with diabetes, EPH gestosis and prematurity.