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P&P 3 > Ex1 OB2 > Flashcards

Ex1 OB2 Flashcards

1
Q

Pain of labor is mainly d/t

A

dilation of cervix + lower uterine segment

*common source of bleeding

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2
Q

Pain of L&D is mediated by

A

T10-L1
+
S2-S4

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3
Q

Pain travels via

A

visceral afferent fibers via sympathetic nerves

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4
Q

Pain pathway in first stage of labor

A
  • visceral* afferent sensory nerve fibers

- uterine plexus, hypogastric plexus, lumbar + lower thoracic sympathetic chains

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5
Q

Pain in 1st stage of labor - stimuli enter spinal cord at

A

4 Dermatomes: T10, T11, T12, L1 spinal segments

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6
Q

mode of pain in first stage of labor occurs where?

A
  • non-localized cramping at appropriate dermatome level

- umbilicus to inguinal ligament

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7
Q

Back labor occurs when?

A

first stage of labor

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8
Q

Back Labor

A
  • sharp, localized back pain

- d/t referred pain to dermatomes (cutaneous innervation) + sclerotomes (innervation of bone/muscles)

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9
Q

First Stage of labor is divided into

A

Latent phase + Active phase

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10
Q

Pain in Latent phase

A

confined to T11-T12 dermatomes

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11
Q

Pain in Active phase

A

T10 to L1 dermatomes

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12
Q

Second stage of labor

A

onset of perineal pain at end of 1st stage of labor signals beginning of fetal descent + start of second stage

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13
Q

Cause of pain in second stage of labor

A

Distention of vagina + perineum

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14
Q

Sensory innervation during second stage of labor

A

S2-S4

Innervation of perineum is provided via pudendal nerve

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15
Q

Early vs. late second stage pain

A

early: low back + perineum
late: originates in perineum

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16
Q

psychoprophylaxis

A

“natural childbirth”, focuses on attention

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17
Q

natural childbirth

A

Bradley, dick-read, doula, LeBoyer, Lamaze

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18
Q

TENS

A
  • nociceptive inhibition of presynaptic level of nerve in dorsal horn by limiting transmission
  • placement of electrodes over low back (T10-L1)
  • early labor, not proven in studies
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19
Q

PCEA

A
  • patient controlled epidural analgesia

- continuous infusion

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20
Q

epidural analgesia

A

low doses of LA or opioid combos administered by infusion to provide continuous T10-L1 sensory block during 1st stage of labor

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21
Q

Advantages of epidural

A
  • sensory block (not motor)
  • decreased catecholamines
  • access if emergent C/S
22
Q

How to administer 0.125% bupivicaine when only 0.25% available?

A

10mL 0.25% bupivicaine + 10mL saline

23
Q

Which is better for an epidural:

10mL 0.125% or 5mL 0.25%

A

10mL 0.125%

24
Q

Mom is complaining of pain in lower abdomen, but legs from upper thighs down are very heavy. She feels contractions. The attending asks for you to make her level higher (she already has epidural running). How do you achieve this?

A

VOLUME.
Give 10mL 0.125% (brings level up to ~ umbilicus)

Giving 5mL 0.25% would only make the block more dense, not more coverage.

25
Q

Commonly accepted criteria to proceed with epidural analgesia include

A

No fetal distress
Good regular contractions 3-4 minutes apart lasting 1 minute
Adequate cervical dilation (3-4 cm)
Engagement of fetal head
**acceptable as long as the parturient requests it, and the obstetrician approves it.

26
Q

epidurals and length of labor

A

regardless of when you get it, whether it’s very early on before you’re even getting induced or much later in the delivery, there is no statistically significant change in the length of labor

27
Q

PIEB

A

programmed intermittent epidural bolus

28
Q

Normal medication + dose for initial epidural bolus

A

10mL 0.125% Bupivicaine

29
Q

Epidural - ACOG standard

A

Nurse must stay in room for at least 15-20 minutes after placement

30
Q

Tx for HOTN d/t epidural

A
  • IV fluid bolus
  • vasopressors
  • supplemental O2
  • Left uterine displacement
31
Q

Vasopressors used if mom becomes HOTN after epidural

A

-ephedrine 5-15mg
or
-phenylephrine 25-50 mcg

32
Q

What may occur if moms bp drops d/t epidural?

A

Decels (baby heart rate drops)

33
Q

Should the epidural be maintained while in second stage of labor?

A
  • If patient has good motor function, epidural can be maintained
  • if motor block too strong for pt to push, or unable to sense contractions: turn off or titrate down
34
Q

During rounds, pt claims she is uncomfortable despite epidural. What are your next steps?

A
  • determine how dilated + where uncomfortable*
  • 5cm, first baby, severe pain: okay to top off
  • 5cm 3h ago, needs to be rechecked
35
Q

How to determine where moms block is when epidural is infusing?

A

Ice Test

36
Q

How does the ice test work

A

Fill glove with ice. Place on arm, ask if she feels. If yes - go to ankle and progressively move upward to hip, asking if she feels cold.
Normally: feels cold at ankles, knees, thighs, but not at hip.
Hip: if she feels–> top off with volume. Goal is to be numb up to umbilicus

37
Q

“topping off” depends on

A

VOLUME

38
Q

Top off options

A 
\+ 10mL of infusing gtt
\+10mL 1.5% Lido (quick on)
\+10mL .25% Bupi (careful, long)
OR
100mcg Fentanyl for dense analgesia if mom in severe pain/not close to delivery
39
Q

Spinal analgesia is used for

A

-Mostly C/S
-laboring if early on, can give lower concentrations; or if placing epidural + need immediate relief (CSE)
OR forcep delivery w/o epidural

40
Q

Spinal dose for C/S

A

1.5mL 0.75% Bupi

41
Q

Spinal dose for labor

A

1mL 0.25% Bupi

42
Q

What should all opioids be in spinals?

A

preservative free

43
Q

Intrathecal dose: Morphine

A

0.25-0.5mg

44
Q

Intrathecal dose: meperidine

A

10-15mg

45
Q

Intrathecal dose: fentanyl

A

12.5-25mcg

46
Q

Intrathecal dose: Sufentanil

A

3-10mcg

47
Q

When would 0.25% 1-2mL of Bupi be given as a spinal?

A

mom comes from home, 9cm, needs quick, short term relief

48
Q

0.25% 1-2mL of Bupi in spinal provides relief when/for how long?

A

5minutes onset

1.5-2h DOA

49
Q

CSE effect on baby

A

Fetal bradycardia for ~ 5-8min
(d/t acute reduction in catecholamines or imbalance of norepi on uterine tone)
*may need pressors for a few minutes

50
Q

Which blocks (performed by OB) are alternative options to neuraxial anesthesia?

A

Paracervical (Stage 1 labor) block

Pudendal (Stage 2 labor) block

51
Q

Where is a paracervical block injected?

A

LA injected into fornix of vagina (lateral to cervix) - blocks nerve transmission thru paracervical ganglia (posterior to junction of cervix/uterus)

52
Q

When is a pudendal block used?

A

Vaginal delivery w/o epidural

Outlet Forceps delivery

P&P 3 (9 decks)

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