 While maternal hypotension and FHR changes after neuraxial anesthesia are common occurrences, limited information on maternal and fetal characteristics or risk factors has been published 12-14. A recent retrospective cohort study by Miller et al. reported that a narrow maternal pulse pressure was a risk factor for post-epidural FHR changes 14. In this cohort study, women with an admission pulse pressure 45, compared with pulse pressure 45, had a marked increase in the risk of post-epidural FHR changes 27 vs 6, p 0.001, OR 5.6 2.1-14.3, aOR 28.9 3.8-221.4. Interestingly, the incidence of maternal hypotension was not different between the two pulse pressure groups 21 vs 25, p0.49, suggesting that fetal perfusion is sensitive to the reduced venous return associated with increased venous capacitance related to reduced sympathetic tone. Further supporting this premise, a study by Vricella et al. demonstrated an increased rate of post-epidural maternal hypotension, vasopressor support and FHR changes in women with severe preeclampsia, a clinical state of volume contraction, compared with normotensive controls 15. The authors concluded that the vasoconstriction and intravascular depletion central to the syndrome of severe preeclampsia make this subset of women vulnerable to post-epidural hemodynamic changes and that administration of a standard IV fluid bolus may not adequately compensate for increased venous capacitance. 