Labor, C-section Flashcards
Beat to beat variability
Best indicator of fetal well being
Decreased variability with acidosis
Meds will diminish: atropine, beta blockers, narcotics
Early deceleration
- Begin with cx
- Rarely drop below 110
- Vagal
- Secondary to head compression
Late deceleration
Begin 20 sec or more after cx onset
Decrease in uterine blood flow
List stages of labor and pain
Stage 1. Cervical dilation: visceral pain, C fibers T10-L1
Stage 2. Delivery: a delta fibers, somatic S2-4 spino-thalmic tract
Stage 3. Placenta
Stage 4. 60 min after delivery: high risk hemorrhage, uterine atony, significant increase in CO
Rx for deceleration
LUD, oxygen, fluid bolus, vasoprssors
Saline amniotransfusion-restores cushion of amniotic fluid for patient with variable decels, also for thick meconium
Goal: optimize placental blood flow and maternal oxygenation
Prenatal assessment
Anasthetic eval, maternal HTN oxytocin use Dysfunctional labor/induced Bleeding Post date: old placenta GDM
Paracervical block
Interrupts transmission of impulses from uterus and cervix during 1st stage of labor
No Bupivicane - cardio toxicity lido 1% 5-10 cc
High incidence of fetal asphyxia and bradycardia
Lumbar epidural block
First stage level
Second stage level
1st stage: T10 - L1
2nd stage: S2 - S4
Prehydrate, platelet > 100,000, proper equipment
How much bolus is needed to achieve sensory level of T10-L2, epidural
8-10 cc to achieve sensory level of T10-L2
What concentration not to be used in OB pt in epidural
> 0.5% NEVER
Toxic systemic reaction with epidural happen when
Large volumes increase the risk
1/5000 risk
No concentration >.5% in OB pts
Treatment for toxic systemic reaction with epidural
O2, secure airway, BZDP, propofol, hypotension- vasopressors, fluids
What is the elimination half life for LA aside
2-3 hrs
What is the dose of meds for combined spinal epidural
S/S
10-25 mcq fentanyl
1.25-2.5 mg Bupivicane
S/S: pruritis, n/v, urinary retention
Drugs used for uterine atony
- Pitocin: after placental delivery, keep it wide open
- Methergine 0.2 mg IM, not for labor just bleeding
- Prostaglandin: F2aHemabate, 250 mcq IM/IU q 15-90 min
- bronchospasm, tachycardia - Tocolytics: B2 agonists (terbutaline) to stop labor
- MgSO4: replaces Ca in myometrial receptor site
Which med- Ergot poisoning
What are the signs of ergot poisoning
Methergine
S/S: HA, N/V, diarrhea
Example Tocolytic
Terbutaline: beta 2 agonist
Example of prostaglandin
F2aHemabate 250 mcq IM or IU
Misoprostol (Cytotec) 400-1000 mcq PR
Prevention of spinal HoTN
What is the% and treatment
- Co loading with crystalloids
- Zofran 5 min b4 block
- Lateral position
45-100%: neo ( improved fetal acid-base status) and ephedrine
Interrupts the transmission of nerve impulses from the uterus and cervix during the first stage of labor
Paracervical block
How often do u need to assess motor mobility r/t catheter migration
Every 1 hr
What can u use for forceps delivery
Saddle block
Top off epidural : forceps and vacuum extractor
Potential Complications of spinal
- High or total: hoarseness, tingling fingers, diff breathing
- Inadequate spinal: 30-40% N2O, Ketamine .1-.2mg/kg
- Anxiety
- Hypotension: IVF, vasopressors, LUD, brady after SAB
Prevention of aspiration
Bacitra 10 min b4 surgery
Reglan 15-30 min prior
Pepcid 20 mg
RSI
