Severe sudden loss of consciousness cardiac arrest o

Severe: sudden loss of consciousness, cardiac arrest
o Epidural block
 Injecting an anesthetic into the epidural space
 Most commonly used as a continuous block
 61% of women receive epidural
 When using opioids with epidural, pain is controlled better
 Check BP every 5-10 min after
 Advantages
 Pain control
 Patient is fully awake
 Allows for different blocking for each stage of labor
 Disadvantages
 Maternal hypotension (preload IV fluid bolus)
 Onset takes up to 30 min
 Decreased sensation
 Contraindications
 Local or systemic infection

 Coagulation disorders
 Maternal hemorrhage
 Platelet count less than 100,000
o Spinal block
 Anesthetic agent injected directly into the spinal fluid in the subarachnoid space
 Advantages
 Immediate onset
 Ease of administration
 Smaller dosing
 Safest and fastest anesthesia technique
 Disadvantages
 Hypotension
 Short acting
 Difficult to maintain coverage for prolonged procedures
o Combined block
 Used for labor and c/s
 Inserting an epidural needle into the epi space, then a smaller needle is inserted
through the epi needle into the spinal fluid
 Advantages
 Faster onset
 Ambulate after it’s placed (not on the birth center)
o Pudendal block
 Local anesthetic given near the pudendal nerve to relieve perineal pain
 Does not decrease contraction pain
 Advantages
 No drop in maternal BP
 Helps with discomfort when using forceps/vacuum
 Disadvantages
 Sacral nerve damage
 Less urge to push
o Local infiltration
 Injected IM, SQ, or intraSQ area of the perineum for episiotomy or repair
(lidocaine)
 Advantages
 Uses the least amount of anesthetic agent
 Disadvantages
 Burning sensation
o General anesthesia
 Induces unconsciousness
 c/s or surgical intervention
 usually a fetal/maternal emergency
 reach the fetus in about 2 min
 SE: aspiration, maternal amnesia, blood loss if uterus is relaxed (no contractions)
 Nursing care: prophylactic antacid (Bacitra)
Pregnancy

 Reproductive
o Pre pregnancy uterus weighs 2oz
o End of pregnancy uterus weighs 2.5lbs
o Capacity of the uterus increases from 10mL to 1,000mL
o Uterine walls thicken from estrogen and progesterone
 Cervix
o Estrogen stimulates glandular tissue. Glands secrete thick mucus which accumulates and
creates the mucus plug
 Prevents infection and other substances from entering the uterus
 Ovaries
o Human chorionic gonadotropin (hCG)
 Maintains the corpus luteum until the placenta can take over
o Corpus luteum
 Secretes progesterone
 Respiratory
o Volume of air breathed per min increases 30-40%
o Diaphragm elevation
o Change from abdomen to thoracic breathing
 Cardiovascular
o Increased blood volume until 30 to 34 weeks gestation
o At birth blood volume is 40-50% above pre pregnancy level
o Cardiac output peaks at 25-30 weeks (30-50% above pre pregnancy level)
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