Anaesthesia for labour

Question 1

If the structure is in the pelvis which types of nerves supply it?

Answer 1

Sympathetic
Parasympathetic
Visceral afferent

Question 2

If the structure is in the perineum, which types of nerves supply it?

Answer 2

Somatic sensory

Somatic motor

Question 3

What separates the pelvis from the perineum ?

Answer 3

Levator ani

Question 4

Anything above the elevator ani is pelvis/perineum?

Answer 4

Pelvis

Question 5

Anything below the elevator ani is pelvis/perineum?

Answer 5

Perineum

Question 6

Uterine cramping is controlled by nerves/hormones ?

Answer 6

Hormones

Question 7

Uterine contraction is controlled by nerves/hormones?

Answer 7

Hormones

Question 8

Pelvic floor muscle contraction (e.g. when sneezing) is controlled by nerves/hormones?

Answer 8

Nerves

- somatic motor nerve

Question 9

Pain from the ovaries, fallopian tubes and uterus is controlled by which group of nerves?

Answer 9

Visceral afferents

Question 10

Pain from the vagina is controlled by which group of nerves?

Answer 10

Pelvic part - visceral afferent

Perineum part - somatic sensory

Question 11

Pain from the perineum is controlled by which group of nerves?

Answer 11

Somatic sensory

Question 12

When thinking about pain from the female reproductive system, what are the 2 important SC levels?

Answer 12

T11-L2

S2-S4

Question 13

Superior aspect of pelvic organs which touch the peritoneum - pain enters SC at which levels

Answer 13

T11-L2

Question 14

Superior aspect of pelvic organs which touch the peritoneum - where is pain perceived by the patient?

Answer 14

Suprapubic

Question 15

Give 3 examples of pelvic organs which touch the peritoneum

Answer 15

Uterine tubes
Uterus
Ovaries

Question 16

Inferior aspect of pelvic organs which touch the peritoneum - - pain enters SC at which levels

Answer 16

S2,S3,S4

Question 17

Inferior aspect of pelvic organs which touch the peritoneum - where is pain perceived by the patient?

Answer 17

S2,3,4 dermatome

• S2 = posterior leg pain
• S3,4 = bullseye around the anus

Question 18

Give 2 examples of pelvic organs which are inferior to the peritoneum?

Answer 18

Cervix

Superior vagina

Question 19

Name 3 types of anaesthesia used in obs and gynae

Answer 19

Spinal anaesthesia
Epidural anaesthesia
Pudendal nerve block

Question 20

Spinal anaesthesia can be carried out in an emergency situation as it does not require planning. True or false?

Answer 20

False

- needs to be planned

Question 21

Will uterine contractions be affected by spinal anaesthesia ?

Answer 21

No

• they will still occur as they are hormonal
• uterine sensations will be blocked

Question 22

Where is spinal anaesthesia administered ?

Answer 22

L3-L4 region

Question 23

Spinal anaesthesia - what does the needle pass through

Answer 23

Supraspinous ligament 
Interspinous ligament 
Ligamentum flavum 
Epidural space 
Dura mater
Arachnoid mater 
Reach the subarachnoid space

Question 24

Spinal anaesthesia - if the patient is lying flat how can this be a problem?

Answer 24

Anasthesia fluid can move up the spine and patient will get headaches

Question 25

Spinal anaesthesia causes blockage to ______ tone and results in ______ in the lower limbs

Answer 25

Blockage to sympathetic tone and therefore results in vasodilation

Question 26

Epidural anaesthesia - definition

Answer 26

Numbs everything below the pelvic pain line

Question 27

Epidural anaesthesia - will you be able to feel contractions?

Answer 27

Yes, they are hormonal

Question 28

Epidural anaesthesia - where is it administered?

Answer 28

L3-L4 region

Question 29

Epidural anaesthesia - what does the needle pass through

Answer 29

Supraspinous ligament Interspinous ligament Ligamentum glavum Epidural space

Question 30

Epidural anaesthesia passes through the dura. True or false?

Answer 30

False

Question 31

What is more safe - epidural anaesthesia or spinal anaesthesia and why?

Answer 31

Epidural is more safe | - no need to directly involve the SC

Question 32

Epidural anaesthesia can be used during normal vaginal labour. True or false?

Answer 32

True

Question 33

What is the downside of administering epidural during normal vaginal labour?

Answer 33

May inhibit progress during stage 2 of labour as the patient won't want to actively push the baby out

Question 34

Complications of epidural?

Answer 34

``` Hypotension Dural puncture Headache High block Atonic bladder ```

Question 35

Pudendal nerve block definition

Answer 35

Anaesthetises the area innervated by the pudendal nerve

Question 36

What area is innervated by the pudendal nerve?

Answer 36

Majority of the perineum

Question 37

Give examples of when a pudendal nerve block is used?

Answer 37

Episiotomy incision Repairing tears Painful vaginal delivery Forceps use

Question 38

Where is the pudendal nerve located - exits the pelvis via which foramen?

Answer 38

Greater sciatic foramen

Question 39

What does the pudendal nerve wrap round?

Answer 39

Ischial spine

Question 40

Where is the ischial spine located?

Answer 40

At 4 and 8 o'clock positions

Question 41

What is used as a landmark to administer pudendal nerve block?

Answer 41

Ischial spine

Question 42

If the pudendal nerve exits the pelvis via the greater sciatic foramen, where does it re-enter the pelvis?

Answer 42

Lesser sciatic foramen

Question 43

What does the pudendal nerve travel in to keep it contained?

Answer 43

Pudendal canal

Question 44

What does the pudendal nerve supply?

Answer 44

Majority of the perineum

Question 45

Function of pudendal nerve

Answer 45

Role in motor control of external anal and urethral sphincters

Question 46

How can the pudendal nerve be damaged during labour?

Answer 46

Can be stretched

Question 47

If there is pudendal nerve damage, what may result?

Answer 47

Weakened pelvic floor | Faecal incontinence

Question 48

Episiotomy - why is it done

Answer 48

To prevent a nasty tear during labour

Question 49

Episiotomy - which kind of incision should be made?

Answer 49

Mediolateral incision from the posterior fortieth to the fat filled ischia anal fossa

Question 50

Episiotomy - What does it reduce the risk of

Answer 50

Faecal incontinence