Analgesia and anaesthesia in obstetrics_1(1).pptx - Analgesia and anaesthesia in obstetrics Introduction Obstetric anesthesia and analgesia refer to any

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Analgesia and anaesthesia in ob- stetrics
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Introduction Obstetric anesthesia and analgesia refer to any of various procedures used to provide pain relief for labor and childbirth . Obstetric anesthesia is an important component in the care of most women during childbirth. A number of women may choose to receive neuraxial analgesia while in labor, and all women who undergo cesarean delivery require some type of anesthesia.
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History The first anesthetic used in obstetrics was chloroform and ether in 1848 1902- Morphine and Scopolamine were used to induce a twilight sleep. 1924 Barbituates were added for sedation 1940 Dr. Lamaze and Read advocated “natural child birth”
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Mechanism of Labor Pain First Stage of Labor Pain Pathway in first stage
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Mechanism of Labor Pain: Second Stage Activation of the same afferents activated dur- ing the first stage of labor plus afferents that in- nervate the vaginal surface of the cervix, the vagina, and the perineum. Afferents course through the pudendal nerve S2-S4, and they are somatic in nature.
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Pain Pathways during Labor
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Pain in labor – location and neural pathways Site of Origin Cause Pathway Site of Pain Uterus and cervix Contraction and distension of uterus and dilatation of cervix Afférent T10 – L1 Post. Rami T10 – L1 Upper abdomen to groin, mid back and inner upper thighs (referred pain) Peri-uterine tis- sue (mainly pos- terior) Pressure often associated with occipito posterior po- sition and flat sacrum Lumbo sacral plexus L5- S1 Mid and lower back and back of thighs (referred pain) Lower birth canal Distension of vagina and perineum in second stage Somatic roots S2- S4 Vulva, Vagina and Perineum Bladder Over distension Sympathetic T11-L2 Parasympathetic S2-S4 Usually suprapubic Myometrium and uterine visceral peritonium Abruption Scar dehiscence T10-L1 Referred Pain to site of pathology
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Effects of labor pain on mother Obstetric Course Neural stimulation through pain pathways results in the release of substances that either drive (oxytocin) or brake (epinephrine) uterine activity and cervical dila- tion; effect of analgesia on the course of labor can vary be- tween individuals .
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Cardiac and Respiratory Effects The intermittent pain of uterine contractions also stim- ulates respiration and results in periods of intermittent hyperventilation. In the absence of supplemental oxy- gen administration, compensatory periods of hypoven- tilation between contractions result in transient peri- ods of maternal hypoxemia and, in some cases, fetal hypoxemia.
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Effects of labor pain on fetus Labor pain affects multiple systems that de- termine utero-placental perfusion: (1) uterine contraction frequency and intensity, by the effect of pain on the release of oxytocin and epi- nephrine; (2) uterine artery vasoconstriction, by the effect of pain on the release of norepinephrine and epineph- rine; and (3) maternal oxyhemoglobin desaturation, which may result from intermittent hyperventilation followed by hypoventilation
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Non Pharmacologic Methods of Labor Analgesia
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