Labour and Delivery 3 Flashcards
What is a partogram?
used to monitor and record progress of labour, progress in dilations of cervix
When is pain relief indicated for the following RFs to minimise need for emergency anaesthesia?
Marked obesity
Obstetric complications with potential for operative devliery (e.g. placenta praevia, high order multiple gestation)
Severe pre-eclampsia
Bleeding disorders (E.g. thrombocytopaenia)
Use of anticoagulants
Severe oedema, trauma, surgery or anatomical abnormalities of face, neck or spine
Abnormal dentition, small mandible or difficulty opening mouth
Extremely short stature, short neck or arthritis of neck
Goitre
Prior history of anaesthesia complications
Cardiovascular, neurological or respiratory disease
What are the non medical pain relief options?
preparation at antenatal classes presence of birth attendant maintaining mobility back rubbing immersion of body in water
What inhalation agent can be used for pain relief
Entonox - equal mix of NO and oxygen
rapid onset
mild analgesic
may be insufficient
causes light headedness and nausea
What systemic opiates can be used?
Pethidine or Meptid are widelty used IM
very easy to administer
What are the disadvantages of using systemic opiates?
analgesic effect small
patients become sedated, confused and feel out of control
antiemetics usually needed
opiates may cause respiratory depression in the newborn
When is spinal anaesthesia used?
used for C-section or mid-cavity instrumental vaginal delivery
rapid, short lasting but effective analgesia
What is a spinal?
LA injected through the dura mater into CSF
How is a pudendal nerve block administered?
LA injected bilaterally around the pudendal nerve where it passes by ischial spine
Suited for low-cavity instrumental vaginal delivery
Describe an epidural analgesia
injection of LA with or without opiates, LA infuses continuously or used to top up
complete sensory and partial motor blockade from upper abdomen downwards
What are the advantages of an epidural?
only method in labour which makes women pain free
useful if labour long, helps reduce BP in HTN, abolishes premature urge to push, analgesia for instrumental delivery
What are the disadvantages of epidural?
increased midwifery supervision need to check BP and pulse regularly
women are bed bound
reduced bladder sensation - urinary retention
maternal fever common
high instrumental delivery rate
hypotension
LA toxicity
spinal tap - inadvertent puncture of the dura mater causing leakage of CSF –> severe headache
What are some of the complications of pain relief?
CV - HTN, tachycardia, arrhythmia, arrest
CNS - dizzy, tinnitus, metallic taste, slurred speech
Pruritis - common with regional opiod administration
N&V, fever, resp depression, fetal bradycardias
What is the significance of meconium stained liquor?
rare in preterm foetuses but common after 41 weeks
insignificant if v diluted but perinatal mortality increased if thick
indication for caution because fetus may aspirate and hypoxia more likely
How often is FHR auscultation used?
auscultated every 15 min in first stage
auscultated every 5 min in second stage
