Obstetrics and gynecology. Pain relief during labor (most important)

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Obstetrics and gynecology. Pain relief during labor (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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14. Labor pain relief

Pain relief during labor is a process that must be effective and necessarily safe for the fetus.

Psychoprophylactic training

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 is the safest method of labor pain relief.

Drug 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. Despite the fact that hydroxidine quickly crosses the placenta, it does not have a depressing effect on the central nervous system of the fetus 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.

Regional anesthesia. There are several methods of regional anesthesia: epidural (lumbar and sacral), spinal, paracervical and pudendal.

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.

Pudendal anesthesia. This type of anesthesia provides a blockade of the pudendal nerve. It is used for pain relief in the second stage of labor when applying exit forceps and episiotomy.

Author: Ivanov A.I.

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