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Severe: sudden loss of consciousness, cardiac arrestoEpidural blockInjecting an anesthetic into the epidural spaceMost commonly used as a continuous block 61% of women receive epiduralWhen using opioids with epidural, pain is controlled better Check BP every 5-10 min after AdvantagesPain controlPatient is fully awakeAllows for different blocking for each stage of laborDisadvantagesMaternal hypotension (preload IV fluid bolus)Onset takes up to 30 minDecreased sensationContraindicationsLocal or systemic infection
Coagulation disordersMaternal hemorrhagePlatelet count less than 100,000oSpinal blockAnesthetic agent injected directly into the spinal fluid in the subarachnoid spaceAdvantagesImmediate onsetEase of administrationSmaller dosingSafest and fastest anesthesia techniqueDisadvantagesHypotensionShort actingDifficult to maintain coverage for prolonged proceduresoCombined block Used for labor and c/sInserting an epidural needle into the epi space, then a smaller needle is inserted through the epi needle into the spinal fluid AdvantagesFaster onsetAmbulate after it’s placed (not on the birth center) oPudendal blockLocal anesthetic given near the pudendal nerve to relieve perineal painDoes not decrease contraction painAdvantagesNo drop in maternal BPHelps with discomfort when using forceps/vacuumDisadvantagesSacral nerve damageLess urge to push oLocal infiltrationInjected IM, SQ, or intraSQ area of the perineum for episiotomy or repair (lidocaine)AdvantagesUses the least amount of anesthetic agentDisadvantagesBurning sensation oGeneral anesthesiaInduces unconsciousnessc/s or surgical interventionusually a fetal/maternal emergencyreach the fetus in about 2 minSE: aspiration, maternal amnesia, blood loss if uterus is relaxed (no contractions)Nursing care: prophylactic antacid (Bacitra) Pregnancy
ReproductiveoPre pregnancy uterus weighs 2ozoEnd of pregnancy uterus weighs 2.5lbsoCapacity of the uterus increases from 10mL to 1,000mLoUterine walls thicken from estrogen and progesterone CervixoEstrogen stimulates glandular tissue. Glands secrete thick mucus which accumulates andcreates the mucus plugPrevents infection and other substances from entering the uterus OvariesoHuman chorionic gonadotropin (hCG)Maintains the corpus luteum until the placenta can take overoCorpus luteumSecretes progesterone RespiratoryoVolume of air breathed per min increases 30-40%oDiaphragm elevationoChange from abdomen to thoracic breathing CardiovascularoIncreased blood volume until 30 to 34 weeks gestationoAt birth blood volume is 40-50% above pre pregnancy leveloCardiac output peaks at 25-30 weeks (30-50% above pre pregnancy level)o