EBE in 1st stage of labour Obstetrics and gynaecology

1. “EVIDENCE BASED
STUDIES”
AND
“ANALGESIA
ANAESTHESIA IN
OBSTETRICS”
PRESENTED BY-
PREETI KULSHRESTHA
M.SC.NURSING PREVIOUS YEAR

2. EVIDENCE BASED
STUDIES

3. INTRODUCTION
Evidence-based studies means that the
information you use to make decisions
about patient care is based on sound
research, not opinion.

4. EVIDENCE USED IN
PREGNANCY AND LABOUR
There are some evidence which is used in pregnancy and
labour -
1. Use of birthing ball for comfort in pregnancy and labour.
2. Ambulation during labour.
3. Vaginal examination.
4. Support during labour.
5. Use of enemas.

5. 1. Use of birthing ball for comfort in
pregnancy & labour
This will help to keep the deep
muscles of the spine in good working
conditions.
The ball has many uses in late
pregnancy when sitting can become so
uncomfortable. The ball support
perineal muscles without a lot of
pressure and keep the fetus aligned in
the pelvis.

6. 2.Ambulation (walking) during
labour
Ambulation in women during labour
is very necessary during the labour.
 It should be free to adopt any
position unless there is any medical or
obstetrical contraindication.
 It helps to reduce the time period
means shorter the labour with less
labour pain.

7. 3. Vaginal examination
It should be performed by trained
personnel only.
It should be done every 4 hourly
not more frequently and should be
carried out under strict asepsis
during labour.

8. 4. Support during labour
According to evidence based studies
the presence of second person of the
women own choice during the labour.
The second should be an experienced
women who has some understanding of
the birthing process.

9. 5. Use of enemas
There is no evidence that enemas will shorter the length
of labour and also reduce in infection rate in post delivery.
It should be given when there is clear indication and
women has to wish to take it

10. ANALGESIA AND
ANAESTHESIA IN
OBSTETRICS

11. ANALGESIA
Analgesia are the drugs which relieve
pain in labour.

12. METHODS OF PAIN RELIEF
1. Psychoprophylaxis
2. Sedatives and analgesics
3. Inhalation agent
4. Patient controlled analgesia (PCA)
5. Transcutaneous electric nerve stimulation (TENS)
6. Regional anesthesia
7. General anesthesia

13. 1. Psychoprophylaxis
Natural childbirth by psychological support to
prevent or minimize pain and difficulty during
labour

14. 2. Sedatives and analgesics
PETHIDINE –
- used in 1st phase of labour.
- indicated when labour merges into regular, frequent, and painful contraction.
- initial dose is 100mg I.M.
- side effect = nausea.
=vomiting.
= depress respiration of newborn when administered before
delivery.

15. Contd.
Fentanyl –
- powerful opioid used as a pain medication.
- less neonatal effects
- less maternal nausea and vomiting.
Promethazine (phenargan) –
- does not cause major neonatal depression.

16. Contd.
Narcotic antagonist (naloxone) –
- given to the mother 0.4mg iv in labour
- given to the newborn 10 microgram / kg IM or IV

17. 3. Inhalation methods
 Entonox –
- contains 50% nitrous oxide and 50% oxygen mixture.
- used in the 2nd phase.
- side effects – hyperventilation,
- dizziness
- hypocapnia (decrease level of carbon dioxide in blood).

18. 4.Patient controlled analgesia
(PCA)
Effective method of pain relief
Indications – moderate to severe pain
Drugs – pethidine, morphine, fentanyl.

19. 5. Transcutaneous electric
nerve stimulation ( TENS )
Non invasive procedure
Involve the use of mild electric current
Electrodes are placed over the level of T10 – L1 and S 2 – 4.
Usually for 30-60 mins up to 4 times daily
Indication – arthritis, knee pain, neck pain, sports injuries.

20. THANK YOU