Anatomy of Anaesthesia of Labour

Question 1

what structures make up the adnexae of the female reproductive system?

Answer 1

ovaries

fallopian tubes

Question 2

pelvic structures are supplied by what types of nerves and why?

Answer 2

sympathetic
parasympathetic
visceral afferent
in the body cavity so are “organs”

Question 3

the perineum is supplied by what types of nerves and why?

Answer 3

somatic motor
somatic sensory
is a body wall structure

Question 4

what structure divides the pelvis and perineum?

Answer 4

levator ani muscle

Question 5

what types of nerves carry pain from the vagina?

Answer 5

pelvic part - visceral afferents

perineal part - somatic sensory

Question 6

pain from the superior (peritoneal) pelvic organs will enter the spinal cord at what levels?

Answer 6

T11-L2

Question 7

visceral afferents from the superior aspect of pelvic organs (ie the side touching the peritoneum) run along with what structures?

Answer 7

sympathetic fibres

Question 8

visceral afferents from the inferior aspect of pelvic organs (ie the side touching the peritoneum) run along with what structures?

Answer 8

parasympathetic fibres

Question 9

pain from the inferior pelvic organs will enter the spinal cord at…

Answer 9

S2, 3, 4

Question 10

the vagina and urethra exist in both the pelvis and perineum; where do their nerve fibres enter the spinal cord?

Answer 10

both S2, 3, 4

Question 11

name the sympathetic fibres that supply the pelvis

Answer 11

T11-L2
sacral sympathetic trunks
superior hypogastric plexus

Question 12

name the parasympathetic fibres that supply the pelvis

Answer 12

S2, S3, S4

pelvic splanchnic nerves

Question 13

where in the pelvis do the sympathetic and parasympathetic fibres mix?

Answer 13

inferior hypogastric plexus

Question 14

pain will be felt in what abdominal quadrant if it affects peritoneal pelvic structures?

Answer 14

suprapubic

Question 15

what does the pudental nerve supply?

Answer 15

inferior vagina
perineal muscles
glands
skin

Question 16

spinal and epidural is injected where?

Answer 16

L3-L4 region

Question 17

name the 6 layers a spinal anaesthetic must enter through?

Answer 17

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space (stop here for epidural)
dura mater
arachnoid mater
finally can be injected into the SA space

Question 18

___ fibres supply all arterioles

Answer 18

sympathetic

Question 19

what happens to arterioles when sympathetic tone is blocked

Answer 19

they dilate and cause flushing/warmth/reduced sweating/hypotension

Question 20

what kind of nerve is the pudental nerve?

Answer 20

somatic sensory and motor

Question 21

the pudental nerve passes __rior to the ____ ligament to enter the perineum

Answer 21

posterior

sacrospinous

Question 22

what makes up the pudental canal?

Answer 22

pudental nerve
internal pudental artery and vein
nerve to obturator internus

Question 23

the pudental nerve crosses the ____ aspect of the sacrospinous ligament

Answer 23

lateral

Question 24

what landmark is used for a pudental nerve block?

Answer 24

ischial spines

Question 25

when would you do a pudental nerve block?

Answer 25

episiotomy
forceps delivery
painful vaginal delivery

Question 26

what symptoms indicate damage to the pudental nerve?

Answer 26

weakened pelvic floor

incontinence

Question 27

what kind of incision is made in an episiotomy and why?

Answer 27

posterolateral

prevents the tear extending into the anal sphincter