OB: Vaginal/C-Section and Complications (Mermigas) Flashcards
Stage 1 Labor:
-lower uterine segment/cervix
-T10-L1
Non-neuraxial = Paracervical
Stage 2 Labor :
-Pelvic Floor
Perineum: S2-S4
Non-neuraxial = Pudendal
Total coverage for labor analgesia =
T10-S4
Steps for Combined Spinal Epidural :
- get loss with epidural needle
- insert spinal needle
- dose spinal
- take needle out
- thread epidural catheter
Which ligament gives us loss?
Ligamentum Flavum
Order of spinal ligaments from superior to deep:
- Supraspinous ligament
- Interspinous ligament
- Ligamentum Flavum
- Posterior Longitudinal ligament
- Anterior Longitudinal ligament
Cranial border:
Foramen Magnum
Caudal Border:
Sacrococcygeal ligament
Anterior:
Posterior longitudinal ligament
Lateral Border:
Vertebral pedicles
Posterior Borders:
Ligamentum flavum and vertebral lamina
Site of Action for Local: Spinal
Subarachnoid space: myelinated preganglionic
Site of Action of Local: Epidural
Must diffuse through the Dural Cuff before –> Nerve Roots
Neuraxial Insertion for Epidural and Spinal:
L3-L4
Safest: below L2-L3
Where does the spinal cord end in adults?
L1-L2
How deep for epidural needle “engagement”?
Around 3cm
Average needle depth for Epidural?
around 5cm
If you get “loss” at 5cm you would add ____ for catheter.
Add another 5cm after loss for catheter
Higher risk of PDPH: Patient Factors
-younger age
-female
-pregnancy
Higher risk of PDPH: Practitioner Factors
-cutting tip needle
-larger diameter needle
-using air for LOR with epidural
-needle perpendicular to long-axis of the neuraxis
Lower Risk of PDPH: Patient factors
-older age
-male
-non-pregnant
Lower Risk of PDPH: Practitioner Factors
-Non-cutting tip needle
-smaller diameter needle
-using fluid for LOR with epidural
-needle parallel to long-axis of neurosis
-Continuous spinal catheter(if placed after wet tap)
No effect on risk of PDPH:
-early ambulation
-continuous spinal catheter (if placed after spinal block)
PDPH Treatment:
-Bed rest
-Caffeine
-NSAIDS
-Epidural Blood Patch
