Obstetrics and gynecology. Pain relief during labor (lecture notes)

Lecture notes, cheat sheets
Free library / Directory / Lecture notes, cheat sheets

Obstetrics and gynecology. Pain relief during labor (lecture notes)

Lecture notes, cheat sheets

Table of contents (expand)

Lecture No. 7

To avoid pain and stress during childbirth, as well as to prevent disruption of labor and create comfortable conditions for the woman, pain relief is used during childbirth.

Pain relief during labor is a process that must be effective and necessarily safe for the fetus. Prior to childbirth, psychoprophylactic preparation for childbirth is carried out, during childbirth, narcotic analgesics are administered and regional anesthesia is performed. The choice of methods of anesthesia during childbirth is determined by the obstetrician-gynecologist together with the anesthesiologist, taking into account the individual characteristics of the psyche of the woman in labor, the condition of the fetus, the presence of obstetric and extragenital pathology, the period of the birth act, the nature of the contractile activity of the uterus. The main principles for choosing the method of anesthesia for childbirth are to ensure the rapid onset of analgesia and the absence of inhibition of labor, vasomotor and respiratory centers of the woman in labor and the fetus, the possibility of developing allergic reactions.

1. Psychoprophylactic preparation

It is aimed at eliminating negative emotions, fear of childbirth and pain, and also reduces the number of analgesics used during childbirth. The main goal of psychoprophylactic training is to teach a woman not to be afraid of childbirth, to obey the doctor's instructions during childbirth and switch her attention from pain to something else, to teach different ways of breathing during labor and at the time of birth of the fetal head. This preparation makes it easier to transfer childbirth. This is the safest method of labor pain relief.

2. Medical pain relief

To relieve agitation, reduce nausea and vomiting, tranquilizers and sedatives are used as components of drug anesthesia. When opening the cervix more than 4 cm in the active phase of labor and the occurrence of painful contractions, it is recommended to prescribe sedatives in combination with narcotic analgesics.

Depending on the period of childbirth, various analgesics are prescribed. During the slow opening of the cervix, the use of short-acting barbiturates and tranquilizers (secobarbital, hydroxyzine, pentobarbital) is effective. They reduce pain during preparatory contractions without affecting the process of childbirth. But at present, barbiturates are used less frequently, since they have a depressant effect on the fetus. Despite the fact that hydroxidine quickly crosses the placenta, it does not have a depressing effect on the fetal central nervous system and on the Apgar score of the newborn. Narcotic analgesics in combination with antispasmodics are used only in the phase of rapid cervical dilatation (in primiparous after dilating the cervix by 3-4 cm, and in multiparous - by 5 cm). 2-3 hours before the expulsion of the fetus, it is necessary to stop the administration of narcotic analgesics in order to avoid its narcotic depression.

Narcotic analgesicsare usually administered intravenously and subcutaneously. The most commonly used nalbuphine, pethidine, buttorphanol. When administered intravenously, these drugs have a faster and shorter duration of action than when administered intramuscularly or subcutaneously. The simultaneous use of sedatives makes it possible to greatly reduce the dose of narcotic analgesics. Nalbuphine is prescribed at a dose of 5-10 mg subcutaneously or intravenously every 2-3 hours. Pethidine is prescribed at a dose of 50-100 mg intramuscularly every 3-4 hours. Butorphanol is prescribed at a dose of 2 mg intramuscularly every 3-4 hours. In addition to the analgesic effect, this the drug has a pronounced sedative effect. But narcotic analgesics can cause fetal central nervous system depression (acceleration and heart rate variability) when administered parenterally. A side effect of analgesics is respiratory depression in both the fetus and the mother, therefore, when they are administered, naloxone, an opiate receptor blocker, should be at the ready (adults are administered 0,4 mg, newborns - 0,1 mg / kg intravenously or intramuscularly).

Regional anesthesia. There are several methods of regional anesthesia: epidural (lumbar and sacral), spinal, paracervical and pudendal. Regional anesthesia is considered the best method of pain relief during childbirth. The sources of pain during childbirth are the body and cervix, as well as the perineum.

Epidural anesthesia. Indications include painful contractions, lack of effect from other methods of pain relief, incoordination of labor, arterial hypertension during childbirth, childbirth with gestosis and fetoplacental insufficiency.

Contraindications include dermatitis of the lumbar region, hemostasis disorders, neurological disorders, hypovolemia, sepsis, bleeding during pregnancy and shortly before delivery, volumetric intracranial processes accompanied by increased intracranial pressure, intolerance to local anesthetics.

Complications can be arterial hypotension, respiratory arrest, allergic reactions, neurological disorders.

The course of labor with epidural anesthesia is not disturbed. Immediately after the introduction of the catheter into the epidural space, the frequency and strength of contractions may decrease, but after the onset of anesthesia, the opening of the cervix usually accelerates. The use of epidural anesthesia in the absence of a decrease in pressure and a decrease in placental blood flow does not harm the fetus. Therefore, it is most preferable for operative delivery in pregnant women with preeclampsia and heart disease, with the exception of severe defects (aortic stenosis and stenosis of the pulmonary valve), when even a slight decrease in blood pressure is dangerous. Anesthesia is used only with full disclosure of the cervix and a sufficiently low position of the presenting part of the fetus (when childbirth through the natural birth canal can be completed without attempts).

Manipulation technique. To prevent a decrease in blood pressure, 300-500 ml of liquid is administered through the installed catheter. A small diameter needle is inserted into the subarachnoid space between the vertebrae L4 - L5 or L5 - S1. The anesthetic is administered only after CSF begins to flow from the needle cannula. 1-1,5 minutes after administration of the drug, the woman in labor must be transferred to a vertical position, which allows the anesthetic to spread in the subarachnoid space. Then the woman in labor is placed in the gynecological position. Childbirth is usually completed by applying obstetric forceps.

Paracervical anesthesia is safe for the woman in labor and is easy to perform and effective. However, paracervical anesthesia may be accompanied by fetal bradycardia, the latter may develop due to the toxic effect of a local anesthetic, as well as with narrowing of the uterine vessels or an increase in the contractile activity of the uterus. Almost all local anesthetics cause fetal bradycardia, the most common being bupivacaine. This type of anesthesia is used with great care.

Manipulation technique. Paracervical anesthesia is indicated when other methods of labor anesthesia adversely affect the fetus or are contraindicated for other reasons. The method is based on blocking the uterovaginal plexus by injecting a local anesthetic on both sides of the cervix.

Pudendal anesthesia. This type of anesthesia provides a blockade of the pudendal nerve and does not have a negative effect on the hemodynamics and respiratory system of the mother and fetus. It is used for pain relief in the second stage of labor when applying exit forceps and episiotomy.

Manipulation technique. Using a lumbar puncture needle, a local anesthetic (mepivacaine, lidocaine, or chloroprocaine) is injected through both sacrospinous ligaments medial to and below their insertion into the ischial spines.

Author: Ilyin A.A.

<< Back: Physiological childbirth (Periods of labor. Delivery through the birth canal)

>> Forward: Management of the second stage of labor

We recommend interesting articles Section Lecture notes, cheat sheets:

▪ Commercial law. Crib

▪ Accounting. Lecture notes

▪ Contract law. Crib

See other articles Section Lecture notes, cheat sheets.

Read and write useful comments on this article.

<< Back

Latest news of science and technology, new electronics:

The existence of an entropy rule for quantum entanglement has been proven 09.05.2024

Quantum mechanics continues to amaze us with its mysterious phenomena and unexpected discoveries. Recently, Bartosz Regula from the RIKEN Center for Quantum Computing and Ludovico Lamy from the University of Amsterdam presented a new discovery that concerns quantum entanglement and its relation to entropy. Quantum entanglement plays an important role in modern quantum information science and technology. However, the complexity of its structure makes understanding and managing it challenging. Regulus and Lamy's discovery shows that quantum entanglement follows an entropy rule similar to that for classical systems. This discovery opens new perspectives in the field of quantum information science and technology, deepening our understanding of quantum entanglement and its connection to thermodynamics. The results of the study indicate the possibility of reversibility of entanglement transformations, which could greatly simplify their use in various quantum technologies. Opening a new rule ... >>

Mini air conditioner Sony Reon Pocket 5 09.05.2024

Summer is a time for relaxation and travel, but often the heat can turn this time into an unbearable torment. Meet a new product from Sony - the Reon Pocket 5 mini-air conditioner, which promises to make summer more comfortable for its users. Sony has introduced a unique device - the Reon Pocket 5 mini-conditioner, which provides body cooling on hot days. With it, users can enjoy coolness anytime, anywhere by simply wearing it around their neck. This mini air conditioner is equipped with automatic adjustment of operating modes, as well as temperature and humidity sensors. Thanks to innovative technologies, Reon Pocket 5 adjusts its operation depending on the user's activity and environmental conditions. Users can easily adjust the temperature using a dedicated mobile app connected via Bluetooth. Additionally, specially designed T-shirts and shorts are available for convenience, to which a mini air conditioner can be attached. The device can oh ... >>

Energy from space for Starship 08.05.2024

Producing solar energy in space is becoming more feasible with the advent of new technologies and the development of space programs. The head of the startup Virtus Solis shared his vision of using SpaceX's Starship to create orbital power plants capable of powering the Earth. Startup Virtus Solis has unveiled an ambitious project to create orbital power plants using SpaceX's Starship. This idea could significantly change the field of solar energy production, making it more accessible and cheaper. The core of the startup's plan is to reduce the cost of launching satellites into space using Starship. This technological breakthrough is expected to make solar energy production in space more competitive with traditional energy sources. Virtual Solis plans to build large photovoltaic panels in orbit, using Starship to deliver the necessary equipment. However, one of the key challenges ... >>

Random news from the Archive

Smart air pollution sensor IKEA VINDSTYRKA 16.02.2023

Swedish furniture giant IKEA has unveiled a smart sensor to track indoor air pollution.

"The new VINDSTYRKA air quality sensor measures and monitors indoor pollutant levels, complementing IKEA's existing range of smart solutions for better indoor air quality," the company said.

According to company spokesman Henrik Telander, VINDSTYRKA is committed to creating an affordable, high-performance air quality sensor to help customers become more aware of the quality of the air they breathe in their homes.

"We take it for granted that the air in our homes is clean, but small daily activities like cooking or cleaning can degrade air quality just as much as industry or traffic," he added.

The most harmful pollutants, particulate matter (PM2,5), cannot be seen with the naked eye. VINDSTYRKA has a display showing the level of these parts, humidity, temperature. When connected to DIRIGERA, the smart hub of smart products, the sensor allows you to read the level of indoor air quality in the IKEA Home smart app.

VINDSTYRKA will be available in all IKEA markets from April 2023.

Other interesting news:

▪ Life success does not depend on testosterone

▪ Where to find free chocolate

▪ Photoelectronic memory based on a colony of bacteria

▪ Extreme camcorder Sony Handycam HDR-GWP88 with built-in projector

▪ Robot grower

News feed of science and technology, new electronics

Interesting materials of the Free Technical Library:

▪ section of the site Encyclopedia of radio electronics and electrical engineering. Article selection

▪ article History of modern times. Crib

▪ article A copy of which country with all cities and terrain exists in Minecraft? Detailed answer

▪ article Mechanic skipper. Job description

▪ article IF generator for tuning receivers. Encyclopedia of radio electronics and electrical engineering

▪ article Burning water. Focus Secret

Leave your comment on this article:

All languages of this page

Home page | Library | Articles | Website map | Site Reviews