week 3 pain pathways (everything) Flashcards by Amanda D

which labs need to be obtained during the initial visit of the mother (11)

CBC 
Typing,
Rubella antibody, 
Cervical gonorrhea and chlamydia culture. 
VDRL, 
HBsAg (Hep B)
Pap, 
Urine complete, 
PPD (TB)
HIV (with consent)
BG

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15-20 weeks

MATERNAL ALPHA FETOPROTEIN: increase in neural tube defects (NTD) and decrease in Downs syndrome. Triple screening (AFP,HCG, Estriol). If abnormal, do U/S or amniocentesis
Folic acid decrease risk of NTD

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18-20 weeks

U/S for dating. Best time to access fetal development

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24-28 weeks

Glucose test for ALL

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28-30 weeks

RhoGAM to Rh(-ve) mom

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34-38 weeks

CBC

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36-40 weeks

Cervical chlamydia and gonorrhea culture in high risk patients

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does oxytocin level increase during labor

NO!

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so how does labor start if there is not increase to level of oxytocin
(2 answers)

there is increase sensitivity of myometrium to oxytocin

increase synthesis of prostaglandins by fetal membrane and decida helps to start labor

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the physiological presentation of labor:

Increased sensitivity of myometrium to oxytocin
synthesis of prostaglandins by fetal membrane and decida
Lightening
Braxton Hicks contraction
Cervical effacement
Bloody show due to breaking down of mucous plug
Rupture of amniotic membrane
Cervical dilatation

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Maternal physiology at labor there is a 300% increase in

in minute ventilation

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in labor what happens to maternal oxygenation?

60% increase in oxygen consumption

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maternal Hyperventilation in labor results in:

decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and fetal acidosis

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Each contraction pushes what vol of blood into the circulation?

what is this called?

300-500 ml of blood into circulation – auto transfusion

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maternal CO results in (increases by how much)

a 45% increase in cardiac output

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After delivery ,involution of uterus relieves inferior vena caval obstruction resulting in:

80% increase in cardiac output and stroke volume

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First
Latent
CO?

15% increase

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first
active phase
co

30% increase

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second phase CO

45%

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third phase CO

80%

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First latent phase start/end

events

Regular uterine contractions/ 4 cm dilatation

Cx effaces and slowly dilate

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first active phase start end

events

4 cm/10 cm (complete dilatation)

Regular intense contractions, fetal head descends into pelvis

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second phase start/end

events:

Complete cervical dilatation/delivery of baby

Baby undergoes all stages of cardinal movements (Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion)

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third phase start/end

events:

Delivery of baby/delivery of placenta

Placenta separates and uterus contracts to establish hemostasis

first stage-- pain initial spot- progression. level of spinal anesthesia must cover what sections

Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor. level of spinal anesthesia must cover T10-L1

second stage- pain spot level of spinal anesthesia must cover what sections:

Pain through by pudendal nerve (S2-S4) Somatic pain caused by stretching of vagina and perineum by descent of fetus Level of spinal anesthesia is needed for S2-S4

first stage- cause of pain? what is the pressure ?

1st stage: Cause of pain is uterine contractions and exceeds 25 mmHg pressure and dilate Cx.

level of anesthesia for c section

how is pain and temperature mediated in the genitalia

autonomic nervous system- not lateral spinothalamic tract

Uterus and Cx- pain levels ? pain is carried by what fibers

T10 to L1-2 Pain impulses carried in visceral afferent C fiber

Perineum

S2,S3,S4 Pain impulses carried by somatic nerve fiber; pudendal nerves

Inhalation agents | effects on uterus

Cause uterine relaxation - increase blood loss

Parentral agents effects on labor

Opioids minimally decrease progression of labor

Regional anesthesia is given for:

``` Primigravida Prolong labor High parenteral analgesic requirement Use of oxytocin Large baby Small pelvis Fetal malpresentation ```

Vasopressors | a1 stimulation effects

uterine contraction

Vasopressors | b2 stimulating effects

uterine relaxation

Small dose on phenylephrine effects

increase blood flow increase bp

Oxytocin uses

Used to induce labor and to prevent postpartum blood hemorrhage

oxytocin complications:

Complication: fetal distress, uterine tetany, maternal water retention, hypotension, reflex tachycardia

Ergot alkaloids | uses

to treat uterine atony

What is used to treat PPH?

Prostaglandins

Magnesium | uses

Use to stop premature contraction and to prevent eclamptic seizures

magnesium side effects

Side effects: hypotension, heart block, muscle weakness and sedation. Also INCREASES blockage of non-depolarizing agents. Cardiac and respiratory arrest can occur

treatment for magnesium side effects

Treatment D/C- mag Calcium Lasix

B2 agonist

stop premature labor

Hypotension

Ephedrine, oxygen, left uterine displacement and IV fluids. Small doses of phenylephrine can also be used

Unintentional IV injection (of epidural)

Place supine with left uterine displacement | Thiopental or propofol to stop seizures

Unintentional intrathecal injection

Place supine with left uterine displacement Ephedrine and fluids Intubation and ventilation in high spinal

Postdural puncture headache

Bed rest Hydration Oral analgesic Caffeine

Postdural puncture headache

blood patch

Signs of Fetal Distress (7)

``` Repetitive late deceleration Loss of beat-to-beat variability Fetal heart rate < 80 Fetal scalp pH < 7.20 Meconium stained amniotic fluid Oligohydramnios Intrauterine growth retardation ```

Obesity what % of ideal body weight BMI morbid obesity BMI

>20% of ideal body weight BMI >30 BMI>40

obesity labs

High glucose, cholesterol and TG

obesity PFT results

restrictive lung disease

obesity breathing issues

increase work of breathing decrease ERV (expiratory reserve volume) decrease FRC decrease chest wall compliance

in morbid obesity- closing capacity results in

In morbid obesity, closing capacity exceeds FRC - V/Q mismatch - arterial hypoxemia

obesity distribution of lipid soluble drugs

Increase volume of distribution for lipid-soluble drugs

treatment for pickwickian syndrome

Oropharyngeal appliances Positive pressure nasal mask Surgery

Obesity-hypoventilation syndrome leading to (ten things total listed)

``` Hypercapnia Hypoxemia Somnolence; poor sleep at night Pulmonary HTN Systemic HTN RVH / LVH Dependent edema Cyanosis-induced polycythemia Rales Pulmonary edema ```