M1 Labor and Birth Flashcards
1
Q
Infant Mortality Rate in the U.S.
A
6.2/1,000
2
Q
In 2008, the U.S. infant mortality rate was 6.9/1,000 live births. How did we rank worldwide?
A
30th
3
Q
What is a major cause of the U.S. infant mortality rate?
A
preterm birth
4
Q
How much blood is emptied from the uterus into the maternal system during a ctx?
A
400 mL
5
Q
How do ctx affect maternal cardiac OP in 1st and 2nd stages of labor?
A
- ↑ 15% 1st stage
- ↑ 30-50% 2nd stage
6
Q
What happens to maternal BP and pulse during ctx?
A
↑
7
Q
Valsalva maneuver
A
- Pinch your nose closed.
- Close your mouth.
- Try to exhale, as if inflating a balloon.
- Bear down, as if having a bowel movement.
8
Q
effects of the Valsalva maneuver
A
- maternal
- ↑ intrathoracic pressure
- ↑ venous pressure
- ↑ BP
- ↓ pulse
- fetal hypoxia
9
Q
The Valsalva maneuver should not be used in the ____ stage of labor.
A
2nd
10
Q
When should you check VS during active labor?
A
between ctx
11
Q
Blood flow ____ during labor.
A
↓
12
Q
How often do you measure BP during active labor?
A
hourly
13
Q
What position should a pregnant mother not assume?
A
supine
14
Q
CV changes during ctx
A
- maternal
- cardiac OP ↑
- BP ↑
- HR ↑
- +400 mL blood
- fetal
- ↓ blood flow/O2
15
Q
respiratory changes during labor
A
- ↑ physical activity → ↑ 02 consumption
- respiratory rate and depth
- ↑ if anxious
- hyperventilation
16
Q
hyperventilation
A
- → respiratory alkalosis
- blowing off too much CO2
- Sx
- tingling
- numbness
- dizziness
- Tx: breathe into cupped hands
17
Q
maternal GI changes during labor
A
- ↓ motility
- very thirsty/dry mouth
- N/V or belching: common @ full dilation
- interventions
- may need antiemetic (promethazine)
- usually NPO + ice or small sips
18
Q
Mendelson’s syndrome
A
aspiration of food or acidic gastric contents → pneumonia
19
Q
Mendelson’s recommendations
A
- develop clear masks
- only trained people deliver gases
- all laboring women NPO in case GETA needed
20
Q
GETA
A
general endotracheal anesthesia
21
Q
Evidence shows aspiration is very rare, but laboring women are still kept NPO. Why?
A
don’t take a chance that even one woman will die
22
Q
Current research shows withholding food and fluids is unlikely to be _______.
A
beneficial
23
Q
Use of glucose solutions during labor is linked to what neonatal conditions?
A
- fetal hypoglycemia
- transient tachypnea of newborn (TTN)
24
Q
What advances in GETA reduce likelihood of aspiration?
A
- cuffed ET tubes
- meds to ↑ pH (bicitra)
- masks no longer kept on face while sedated
25
What percentage of laboring mothers use an epidural?
70%
26
Regional anesthesia is used in what percentage of emergency C/S?
84%
27
Why are IV fluids without glucose not optimal during labor?
They don't provide energy.
28
What happens to the acidity of gastric contents while fasting?
↑
29
Is the stomach every empty?
no
30
consequences of starvation in labor
ketosis → labor slows
31
Current recommendations for intake during labor
* liberalization of fluids
* water
* fruit juice
* carbonated drinks
* tea
* coffee
* broth
* jell-o
* give antacid before GETA
* IV sedation, then place ET tube
32
GU changes during birth
* spontaneous voiding may be difficult
* proteinuria 1+ is normal r/t breakdown of muscle tissue
33
What factors affect spontaneous voiding during/after childbirth?
* tissue edema
* regional anesthesia
34
interventions for difficulty voiding
* catheter if necessary
* encourage voiding q2h
35
maternal hematologic changes r/t childbirth
* WBC (esp. leukocytes) are ↑↑
* Clotting factors (esp. fibrinogen) are ↑↑
* expected blood loss
* SVD: EBD = 500 cc
* C/S: EBD = 1000 cc
36
What H&H levels will help prevent maternal hematologic complications in childbirth?
* Hgb ≥ 11 g/dL
* Hct ≥ 33%
37
Why do clotting factors increase during pregnancy?
to prevent hemorrhage
38
EBL for spontaneous vaginal delivery
500 cc
39
EBL for c-section
1000 cc
40
EBL
estimated blood loss
41
C/S
caesarean section
42
SVD
spontaneous vaginal delivery
43
nursing implications for blood changes during/after delivery
* know admission H&H and compare with PP
* monitor blood loss
* monitor VS
* **1st sign of hypovolemia: tachycardia**
44
expected FHR findings during labor
* normal baseline: 110-160 bpm
* fetal movement → accels in healthy baby
* early decels expected during ctx and vag exam
45
Most MDs in hospitals use _______ \_\_\_\_\_, but _______ monitoring is just as effective on low-risk pts.
* continuous EFM
* intermittent
46
Stresses to the utero-fetal-placental unit result in characteristic FHR patterns. What two patterns indicate inadequate oxygenation for baby?
* variable decels
* late decels
47
What do variable decels indicate?
cord compression
48
What to late decels indicate?
utero-placental insufficiency
49
UPI
utero-placental insufficiency
50
FHR
fetal heart rate
51
What is the nurse's role in ensuring adequate oxygenation to baby?
ensure ctx don't get too frequent or last too long
52
fetal lung changes
* in utero: lungs filled with amniotic fluid
* during labor
* environment changes stimulate urge to breathe
* squeezing helps expel fluid into upper airway
53
How does fetal oxygenation during labor prepare baby to initiate respiration after birth?
internal and external environment changes stimulate urge to breathe
* Sp02 ↓ + C02 ↑ + pH ↓
* external temp ↓ → body temp change
54
doula
female labor attendant
55
benefits of doulas
* one-on-one physical and emotional care
* advocacy
* present for whole labor process
56
What does a doula not do?
provide medical care
57
What starts birth?
* distension of uterus
* release of oxytocin
* uterine ctx
* more oxytocin
* cervical ripening
* hormone changes
* estrogen
* progesterone
* prostaglandins
58
When do the changes that initiate labor start?
days and weeks before
59
S/Sx preceding labor
* Braxton Hicks ctx
* lightening
* bloody show
* mucous plug lost
* ↑ energy and nesting instinct
* wt loss
* GI S/Sx
60
lightening
baby ↓ into pelvis
61
When does lightening occur?
* primip: 2 wks before
* multip: during labor
62
What causes bloody show?
cx capillaries break, mixing blood w/ mucus
63
When is the mucus plug lost?
≤ 2 wks before labor
64
What causes wt loss just before labor?
* 1-3 lb r/t changing hormone levels → excretion of fluid
* GI S/Sx
65
7 cardinal movements
* engagement
* descent
* flexion
* internal rotation
* extension
* restitution
* expulsion
66
engagement
widest presenting part @ ≤ 0 station
67
descent
* concurrent with other steps
* accelerates after dilation of 5-7 cm
68
flexion
* head is fully flexed
* smallest diameter (crown down) presented to pelvis
69
internal rotation
* fetus enters pelvic inlet transverse
* head reaches 0 station
* fetus rotates toward OA or OP position
70
extension
* fetus must extend neck when passing under symphysis pubis
* head born occiput, face, chin
71
restitution (external rotation)
head turns 45 degrees to LOT or ROT to realign with shoulders
72
expulsion
* anterior, then posterior, shoulders are born
* followed by body
73
5 Ps
passenger
passageway
power
position
psyche
74
factors r/t passenger
* size of head
* presentation
* lie
* attitude
* position
75
fetal presentation
part that enters pelvis first
76
What characteristics of the fetal skull allow for molding?
* fontanels
* bones not fused
77
fontanels
wide spaces where sutures meet
78
Fontanels allow bones to ____ in _____ during childbirth.
* shift
* molding
79
molding
skull bones shift to allow head to conform to birth canal
80
anterior fontanel
* large
* diamond-shaped
81
posterior fontanel
* small
* triangular
82
Skull bones are joined by \_\_\_\_\_\_.
sutures
83
presentation rates by body part
* cephalic: 96%
* breech: 3%
* shoulder: 1%
84
cephalic presentation variations
* vertex
* military
* brow
* face
85
vertex presentation
* head fully flexed
* most favorable
86
military presentation
head in neutral position
87
brow presentation
head partly extended
88
face presentation
89
breech presentation
* buttocks enter pelvis first
* usually r/t problem
* birth usually by C/S
90
problems r/t breech presentation
* preterm birth
* fetal anomaly
* uterine or pelvic abnormalities
91
shoulder presentation
* transverse lie
* will need C/S
92
situations in which shoulder presentation is seen
* preterm birth
* high parity
* PROM
* polyhydramnios
* placenta previa
93
fetal lie
* vertical relationship of fetal spine to maternal spine
* three categories
* longitudinal
* transverse
* oblique
94
longitudinal lie
* 99% of fetuses
* head or buttocks in the pelvis
* long axis of baby's spine is parallel to mom's
95
transverse lie
long axis of baby is at a right angle to mom's spine
96
oblique lie
long axis of baby is at some angle between longitudinal (0°) and transverse (90°)
97
fetal attitude
* relationship of fetal parts to each other
* normal: flexion
* extension possible
98
normal fetal attitude
flexion
99
flexed fetal attitude
* head flexed toward chest
* arms and legs flexed over thorax
* back is convex C shape
100
fetal position
* relationship of fetal landmarks to 4 quadrants of maternal pelvis
* 3-letter abbreviation
101
parts of fetal position abbreviation
* presenting part
* right or left of pelvis
* anterior, posterior, or transverse of pelvis
102
fetal positions
* presenting part
* occiput (O)
* sacrum (S)
* mentum (M)
* presenting part side-to-side
* right (R)
* left (L)
* presenting part front-to-back
* anterior (A)
* posterior (P)
* transverse (T)
103
ROA
right occiput anterior
104
ROT
right occiput transverse
105
ROP
right occiput posterior
106
LOA
left occiput anterior
107
LOT
left occiput transverse
108
LOP
left occiput posterior
109
RMA
right mentum anterior
110
RMP
right mentum posterior
111
LMA
left mentum anterior
112
LSA
left sacrum anterior
113
LSP
left sacrum posterior
114
passage components
* bony pelvis
* soft tissues
* vagina
* cervix
* pelvic floor muscles
* introitus
115
pelvic shapes
* most women have a mixture
* gynecoid
* android
* anthropoid
* platypelloid
116
gynecoid pelvis
* classic female type
* 50%
117
android pelvis
* Resembles male pelvis
* Inlet: heart-shaped
* Outlet: narrow
118
anthropoid pelvis
* Resembles ape pelvis
* Inlet: oval
* Diameter: wider A-P
119
platypelloid pelvis
* Inlet: flattened
* Diameter: wider transverse
120
problems with passage
* soft tissue obstruction
* cephalopelvic disproportion
121
most common soft tissue obstruction
full bladder
122
effects of soft tissue obstruction
* decreased space for baby
* intensified maternal discomfort
123
interventions for soft tissue obstruction
* void q 1-2 hrs
* cath PRN
124
powers of labor
* primary: ctx
* secondary: pushing
125
primary power of labor
* ctx
* effect
* effacement
* dilation
* descent
126
secondary power of labor
* pushing
* effect: descent
127
ctx frequency
time from start of one ctx to start of the next
128
ctx duration
time from start of ctx to end of same ctx
129
ctx intensity
* strength of ctx
* palpate at fundus
* mild: tip of nose
* moderate: chin
* strong: forehead
130
characteristics and purpose of uterine contractions during labor
* characteristics
* coordinated
* involuntary
* intermittent
* involves upper 2/3 of uterus
* purpose
* aids fetal descent
* puts pressure on cx to cause dilation and effacement
131
stages of labor
* 1st stage
* latent phase
* active phase
* transition
* 2nd stage
* 3rd stage
132
effacement
* thinning and shortening of cervix during 1st stage
133
dilation
* cervix opening during labor
* estimate of width of cervical os
134
How long is the cx before labor?
about 2-3 cm
135
How is an estimate of effacement written?
% reduction of original length
136
timing of effacement
* primips: before dilation
* multipls: after dilation
137
How is dilation documented?
* in cm
* full dilation: 10 cm (about 4 in)
138
fetal station
* measure of fetal descent
* relation of presenting part to mom's ischial spines
139
landmarks involved in fetal station
* presenting part
* mom's ischial spines
140
How is fetal station measured?
* in cm
* 0 station = level of mom's ischial spines
* –5 (superior) to +5 (inferior)
141
0 station timing
* primips
* 2-3 wks before birth
* "baby has dropped"
* multips: occurs during labor
142
What triggers the secondary power (pushing)?
baby's head reaching pelvic floor
143
station of pelvic floor/Ferguson reflex
+1 or lower
144
Ferguson reflex
* involuntary urge to push and bear down
* bearing down
* ↑ intra-abd pressure
* compresses uterus
* aids fetal descent
145
position
* position of woman
* position of baby inside uterus
* both affect
* ease of labor process
* oxygenation of baby
* comfort of mom
146
Frequent position changes help with ...
* fatigue
* circulation
* comfort
147
nursing role: mom's position
* encourage and assist mom to
* change positions frequently
* find comfortable positions
148
upright maternal positions during labor
* gravity aids and shortens labor
* positions
* walking
* sitting
* kneeling
* squatting
* better cardiac OP → ↑ blood to placenta
149
mom squatting during labor helps with
pushing
150
Why is the supine position contraindicated in PG and labor?
* causes vena cava syndrome
* can result in fetal distress and acidosis
151
vena cava syndrome
* compression of aorta and vena cava by gravid uterus
* → hypotension in mom, less blood to uterus
* can → fetal distress, acidosis
152
psyche
concerns mom's state of mine during labor and mental adaptation to any adverse or unplanned events
153
birth plan not realized →
* anxiety
* fear
* grief
* loss of control
154
What previous experience affects mom's psyche during labor?
* positive
* negative
* Hx of abuse
155
Does knowledge of birth horror stories affect mom's psyche during labor?
YES
156
Name some aspects of culture that affect mom's psyche during labor.
* modesty
* gender of attendant
* stoic
* loud
157
What else can negatively affect mom's psyche during labor?
no support person
158
When should a primip go to the hospital for SVD?
ctx regular, painful, q 5 min x 1-2 hrs
159
When should a multip go to the hospital for SVD?
ctx regular, painful, q 5-10 min x 1 hr
160
Signs for any pregnant woman to go to the hospital.
* vaginal bleeding bright red and like a period
* ROM
* ↓ FM
161
normal FM count
4-6/hr
162
true vs. false labor: ctx
* **true:** regular, painful
* **false:** irregular, may or may not be painful
163
true vs. false labor: walking
* **true:** walking ↑ regularity, pain
* **false:** walking stops ctx
164
true vs. false labor: pain location
* **true:** begins in low back, wraps around front
* **false:** mainly in low back, menstrual-like
165
What is the most significant difference between true and false labor?
True labor is accompanied by progressive cervical change.
166
tests for determining ROM
* **definitive:** fern test
* pooling of amniotic fluid in vagina
* nitrazine tape or pH paper
167
What is the only definitive test for ROM?
fern test
168
fern test
* only definitive test for ROM
* sample gathered with sterile speculum exam observed under microscope
* fern leaf-like structures = amniotic fluid
169
nitrazine tape/pH paper
* can be used to test for ROM
* drawback is false postivies
* blood, semen, and soaps are also alkaline
170
things to document about amniotic fluid
* color
* viscosity
* odor
* amount
* **time of ROM**
171
normal color for amniotic fluid
pale with white vernix
172
normal viscosity of amniotic fluid
watery
173
normal odor of amniotic fluid
mild/no odor
174
normal amount of amniotic fluid at ROM
1000 mL
175
What does yellow or cloudy, thick, and foul-smelling amniotic fluid indicate?
infection
176
What are the implications of green or brown amniotic fluid?
* fetal hypoxia
* breech presentation
* meconium aspiration
* \> 40 wks GA
177
What does amniotic fluid \< 500 mL indicate?
lower GI problems
178
What does amniotic fluid \> 2000 mL indicate?
upper GI problems
179
characteristics of pain in childbirth
* normal (not r/t injury or illness
* woman has prep time
* self-limiting
* intermittent
* there's a prize at the end
180
physiologic component of pain
reception of stimuli by sensory nerves and transmission of impulses to CNS
181
psychological component of pain
* recognizing sensation
* interpreting as pain
* reacting to pain
182
GCT
Gate Control Theory
183
Gate Control Theory
by sending alternative signals to CNS, pain signals can be blocked
184
physiologic effect of unrelieved pain
fight or flight response
185
How does the fight-or-flight response work in labor?
stimulation of SNS
↓
↑ catecholamines
↓
vasoconstriction
↓
↓ blood flow to uterus
↓
↓02 to fetus
↓
fetal distress
186
psychological effects of pain during childbirth
* poor bonding
* unpleasant memories
* poor sexual
187
How does unrelieved pain affect bonding?
When physical needs are unmet, psychological needs cannot be addressed. (Maslow's Hierarchy)
188
How does unrelieved pain affect future childbearing?
* creates unpleasant memories, which can
* affect desire for more children
* cause anxiety in subsequent labor experiences
189
How does unrelieved pain affect a woman's sexual life?
creates fear of PG or perineal pain
190
causes of pain in labor
* visceral
* cervical dilation
* contractions
* somatic
* fetal descent
191
visceral labor pain
* during 1st stage of labor
* causes
* cervical dilation
* contractions
192
cervical dilation pain
* slow, deep pain
* visceral
* "it hurts everywhere
193
contraction pain
* pulls on pelvic structures
* referred to back and legs
* "my back hurts"
194
somatic labor pain
* descent of fetal head
* localized, intense, sharp
* splitting, tearing pain (perineal)
* "it's burning"
195
Differences in pain perception can be caused by
* previous experience
* preparation
* support system
* anxiety and fear → tensing → ↑ pain
196
What preparation can help mom's perception of labor pain?
* childbirth classes
* coping skills
197
nursing role in pain relief during labor
* look for ways to ↓ anxiety and fear
* pharmcological interventions as prescribed
198
Studies in sheep show ____ ↑ catecholamine release and significantly ↓ ______ \_\_\_\_\_\_ to the \_\_\_\_\_\_.
* pain
* blood flow
* uterus
199
nonpharm pain relief in labor
* cutaneous stimulation
* mental stimulation
* breathing and relaxation
200
physiologic response to relaxation techniques in labor
* ↑ uterine blood flow
* →
* ↑ 02 to fetus and ctx effiency
* ↓ pain perception and tension
* → fetal descent
201
psychological effects of relaxation techniques during labor
* ↑ maternal comfort
* ↓ anxiety/fear
* empowers mom
202
cutaneous stimulation physiological effect
↑ circulation → ↓ muscle tension
203
types of cutaneous stimulation
* self-massage
* counterpressure (sacral)
* thermal
* heat or cold
* shower or tub
* washcloth
* hydrotherapy: tub
* acupressure
* acupuncture (by licensed specialist)
* transcutaneous electrical nerve stimulation (TENS)
* frequent position changes
204
effleurage
massage using circular motion with the palm of the hand
205
hydrotherapy effects
* ↓ catecholamines
* triggers oxytocin release
* releases endorphins
206
The cervix can dilate ____ cm in 30 min.
2-3
207
TENS
transcutaneous electrical nerve stimulation
208
purpose of mental stimulation
* occupy mind to compete with pain
* promote tranquil environment
209
aspects of mental stimulation
* focal point: eyes open or closed
* imagery to promote warmth and security
210
quality of environment can
influence a woman's ability to cope with pain
211
effects of breathing techniques
* alters focus
* interferes with pain transmission
* ↑ O2 to mom and baby
212
basics of breathing techniques
* patterned from simple to complex
* all incorporate cleansing breath, pattern, cleansing breath
213
Slow-paced breathing is used in what stage of labor?
1st
214
using slow-paced breathing
* focus on relaxation
* slow and deep breaths
* in through nose, out through mouth
* use as long as possible in labor
215
modified-paced breathing
* shallow and faster chest breathing
* focus on relaxation
* can combine patterns
216
patterned-paced breathing
* pant-blow ("hee hee hee hoo")
* focus on pattern
* can alter pattern to **prevent pushing in transition**
217
problems with breathing during labor
* hyperventilation → respiratory alkalosis
* dry mouth: breathing + NPO
218
S/Sx of respiratory alkalosis
* dizziness
* lightheadedness
* tingling of fingers
219
dry mouth interventions
* ice
* mouth wash
* hard candy
* washcloth
220
effects of support in labor
* significantly relieves pain
* improved outcomes
* ↓ interventions and complications
* enhanced satisfaction
221
How do drugs enhance labor?
* allow relaxation of tense muscles
* stimulate contractions
222
When do drugs slow labor?
* given too early
* prevent effective pushing
223
drugs with direct effects on fetus
* those that cross placenta
* example: ↓ FHR variability from
* meperidine (demerol)
* MgSO4
* admin
* give slowly IVP over 1-2 ctx
* ↓ blood flow in ctx → ↓ drug to baby
224
indirect drug effects on baby
* drug affects mother, causing side effect for baby
* example
* epidural → vasodilation
* if mom's BP ↓ too much → fetal hypoxia/acidosis
* admin
* give 500-1000 cc fluid bolus before epidural admin
* will ↑ intravascular volume, keep BP ↑
225
major method of labor pain relief if epidural is not possible
opioid analgesics
226
benefits of opioid analgesics for labor pain
* good pain control
* fast-acting
* no LOC
227
adverse effects of opioid analgesics for labor pain relief
* **No. 1 side effect is respiratory depression in baby**
* neurologic and behavioral depression in baby x 2-4 days
* depression in attention and social response in baby for 6 wks
228
meperidine (Demerol) in labor
* timing
* rapid onset
* long duration (2-4 hrs)
* peak: 30-60 min
* side effects
* N/V
* sedation
* delirium
229
fentanyl (Sublimaze) for labor pain
* timing
* rapid onset
* short duration (1 hr)
* SE: less N and sedation than meperidine (Demerol)
230
opioid analgesics for labor pain
* meperidine (Demerol)
* fentanyl (Sublimaze)
231
opioid agonist-antagonists for labor pain
* drugs
* butorphanol (Stadol)
* nalbuphine (Nubain)
* rapid onset
* no respiratory depression in mom or baby
* less N/V than agonists
* **risk: withdrawal Sx in drug-addicted moms**
232
butorphanol for labor pain
* onset: rapid
* duration: 3 hrs
* peak: 30-60 min
* **don't give to pt who previously had agonist**
* reverses analgesic effect of opioid agonist
233
nalbuphine for labor pain
* timing
* onset: rapid
* duration: 1 hr
* **don't give to pt who previously had agonist**
* reverses analgesic effect of opioid agonist
234
naloxone (Narcan) in labor
* **reverses opioid-induced respiratory depression**
* timing
* duration: short
* may need \> 1 dose
* dosage
* 0.1-0.2 mg IV q 2-3 min
* 0.01 mg/kg IV, IM, SQ q 2-3 min
235
antiemetic/tranquilizing drugs used during childbirth
* promethazine (Phenergan)
* hydroxyzine (Vistaril)
236
promethazine during labor
* use
* ↓ anxiety
* potentiate opioids
* ↓ N/V
* admin
* IV or IM
* 50 mg meperidine + 12.5 mg promethazine
237
hydroxyzine (Vistaril) during labor
* use
* ↓ N/V
* sedation/promote rest
* admin: IM only (Z-track)
238
giving narcotics during labor
* give at beginning of ctx to ↓ amt to baby
* time dose so baby's not born at peak of drug action
* if baby born within 60 min, prep for resuscitation
* monitor resp status of baby
239
regional pain management in labor
* use: temporary loss of sensation
* method: anesthetic injected in direct contact with nerves
* types
* epidural
* subarachnoid (spinal) block
* local infiltration
240
regional anesthesia benefits
* no LOC
* discomfort greatly ↓
* fetal effects based on maternal rxn, not direct
241
AE of regional anesthesia
* **hypotention r/t vasodilation (most common)**
* bladder distention r/t ↓ sensation
* prolonged 2nd stage r/t pelvic relaxation; interferes with internal rotation
* catheter migration: leaves half of body numb
* ↑ C/S rate
* fever r/t longer labor
* pruritis of face and neck
242
nursing care: epidurals
* **monitor BP, HR and FHR during and after procedure**
* give pre-epidural IV fluid bolus (500-1000 cc LR)
* help pt into position and help her maintain it
* palpate bladder q 2 hr (may need Foley)
* monitor anesthesia level
* help with position changes q 30 min (to distribute med evenly)
* encourage to push when baby's @ +1/+2 station
* keep side rails up
243
spinal block during labor
* quicker than epidural for C/S (onset in 1-2 min)
* med injected deeper than epidural
* done just before birth or C/S
* hypotention likely
* shorter-acting (1-3 hr)
* transfer and ambulation precautions (motor involvement)
* lay flat x 8-12 hrs to prevent spinal HA
244
spinal block vs epidural
* spinal block
* injected deeper
* quicker onset
* shorter duration
* affects motor fxn
* epidural
* given during labor, not just for delivery
* longer duration
* slower onset
* motor fxn largely intact
245
spinal HA
* AE of spinal block
* prevention: lay flat x 8-12 hrs after
* S/Sx
* severe when upright
* often disappears when flat
* begins within 2 days and can last wks
* Tx
* bedrest
* hydration
* caffeine
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local anesthesia use in L&D
* injected into perineum before episiotomy or sutures for laceration
* doesn't provide pain relief of ctx or birth
* rapid onset
* drug burns during injection
* AE rare except if toxic
* most common: 1% lidocaine
247
general anesthesia in L&D
* GETA: general endotracheal anesthesia
* involves LOC
* rarely used except in absolute emergencies
248
What type of anesthesia is used in 84% of emergency C/S?
regional
249
AE of GETA
acid aspiration syndrome (AAS): rare
250
AAS
acid aspiration syndrome
251
What does acid aspiration syndrome (AAS) lead to?
chemical pneumonia
252
chemical pneumonia
* caused by aspiration of noxious chemical
* e.g. stomach acid aspiration
253
prevention of AAS
* NPO if
* surgery planned, or
* high risk and in labor
* before surgery
* ↑ gastric pH
* non-particulate antacid: Bicitra
* H2 blocker: Pepcid, Zantac, etc.
* speed gastric emptying: Reglan
* block esophagus upon intubation: cricoid pressure
254
What meds to we give to prevent AAS?
* non-particulate antacid: sodium citrate/citric acid (Bicitra)
* H2 blocker
* famotidine (Pepcid)
* ranitidine (Zantac)
* etc.
* GI stimulant/antiemetic: metoclopramide (Reglan)
255
What pH can cause chemical pneumonia?
\< 2.5
256
AE of GETA
* respiratory depression for mom or baby
* uterine relaxation
257
What can uterine relaxation 2/2 GETA cause?
PPH
258
PPH
postpartum hemorrhage
259
Tx for uterine atony
* pitocin or methergine
* fundal massage
* empty bladder if needed
* Tx for PPH if necessary
260
Tx for PPH
* check uterus and bladder
* start fundal massage
* call for help
* attend to family and/or baby
* take over fundal massage
* check lines/catheter
* before you call MD, make sure you know
* VS, LOC
* estimated blood loss
* current meds/flow rates
* as ordered
* pitocin or methergine
* fluids
* blood products
* **simultaneously**
* **communicate with/reassure patient and family**
* **comm with team lead**
