The document discusses pain relief options for labor, including non-pharmacological and pharmacological methods. It describes the etiology and physiology of labor pain, noting that pain in the first stage is visceral while the second stage is somatic. Non-pharmacological options discussed are continuous labor support, relaxation, hydrotherapy, TENS, hypnosis and acupuncture. Pharmacological options include opiates, nitrous oxide, and regional analgesia techniques like epidural and spinal blocks. Epidural analgesia is described as the most effective method of pain relief, but it can prolong labor and restrict movement. Complications of epidurals are also outlined.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
This topic should be known by medical practitioners as well all the pregnant mothers to a certain extend to request for pain relieving modalities.......
This topic includes Introduction for analgesia and anesthesia used in obstetrics, maternal risk factors for anesthesia, anatomical and physiological considerations, analgesia during labour and delivery, sedatives and analgesia, opioid analgesics, combination of narcotics and antiemetics, inhalation methods, commonly used local anesthesia in obstetrics, spinal anesthesia, infiltration anesthesia, patient controlled anesthesia, psychoprophylaxis, general anesthesia for cesarean section, complication of general anesthesia and its management.
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Methods to manage labour pain.
Analgesics and anaesthetic techniques used in labour..
Newer modalities in labour pain reduction.
Coping with labour pain
This topic should be known by medical practitioners as well all the pregnant mothers to a certain extend to request for pain relieving modalities.......
This topic includes Introduction for analgesia and anesthesia used in obstetrics, maternal risk factors for anesthesia, anatomical and physiological considerations, analgesia during labour and delivery, sedatives and analgesia, opioid analgesics, combination of narcotics and antiemetics, inhalation methods, commonly used local anesthesia in obstetrics, spinal anesthesia, infiltration anesthesia, patient controlled anesthesia, psychoprophylaxis, general anesthesia for cesarean section, complication of general anesthesia and its management.
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Methods to manage labour pain.
Analgesics and anaesthetic techniques used in labour..
Newer modalities in labour pain reduction.
Coping with labour pain
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Pain Relief in Labor,
for 4th year Med. Students
Associate Clinical Prof. Dr. Aisha M. El-Bareg, MD, PhD
Senior Consultant in (Obs & Gyn)/ Reproductive Medicine
Faculty of Medicine, Misurata University, LIBYA
2.
3. Etiology of pain during laborBasic factors for pain in childbirth
1. Physical pain in labor is caused by:
Muscle cramps/ uterine contraction.
Stretching of cervix and perineum .
Position of the baby and pressure of presenting
part on tissue like bladder, urethra, back, lower
colon.
Medical tests and procedures (pelvic exams, IVs,
catheterization, etc).
4. Basic factors for pain in childbirth
2. Emotional Factors
Many negative emotions can actually increase your
perception of pain,:
Fear of pain
Fear of the unknown, Anxiety
Self-doubt
Lack of education
Exhaustion
Dehydration, Hunger
5. Endorphins
Inhibitory neuropeptides acts as Natural pain killer
(endogenous narcotics), produced from pituitary
gland.
Released during stressful events or in moment of
grate pain, it is responsible for euphoric feelings
known as “runner’s high” and “adrenaline rush “.
Relieve stress and enhance pleasure & happiness.
6. • It’s secretion triggered by
• Exercise.
• Smiling, gossiping.
• Eating certain food “chocolate, chili peppers” .
• Massage therapy or acupuncture.
Endorphins
7. Unmedicated labor
• Body produces endorphins to cope with pain.
• Baby’s endorphins raise when mom’s endorphins
raise.
• Oxytocin peaks just after unmedicated birth.
• Stimulates the baby’s adrenal glands
8. Unmedicated labor
• Helps to adapt to life outside of the uterus
–Helps baby breathe
–Increases blood flow to baby
–Stimulates immune system (increased WBC’s)
–Baby is more alert – facilitates bonding.
• Medications decrease natural endorphins for
both.
9. Objectives of pain relief:
Why do we give analgesia for child birth?
1. Humanitarian reason
1. Economic benefit
1. Medical reason
10. Medical Effects of Labour Pain
Pain compromises
placental blood flow
leading to fetal
hypoxia and acidosis.
Increase catecholamine
secretion leads to
increased blood
pressure which
adversely effects fetal
circulation
Releases Adrenocortical
hormone which may
effect electrolytes,
carbohydrates and
protein metabolism.
A traumatic labour
may lead to post
traumatic stress
syndrome.
11. Background
It is only in the last 100 years
that effective methods of pain
relief have become available.
Queen Victoria was given
chloroform by John Snow for
the birth of her eight child and
this did much to popularize the
use of pain relief in labor
12. The ideal analgesic in labor
• Should provide excellent rapid onset pain relief
in both first and second stages .
• Easy to administer.
• Safe to the mother and baby.
• Easily reversible if necessary.
• Does NOT interfere with uterine contractions.
• Does NOT affect patient’s mobility.
13. Physiology of labor pain
1st stage of labor- mostly
visceral
•Dilatation of the cervix and
distension of lower uterine seg.
•Dull, aching and poorly
localized.
•Slow conducting, visceral C
fibers, enter spinal cord at level
of T10-L1.
14. Physiology of labor pain
2nd stage of labor- mostly
somatic
•Distension of the pelvic floor,
vagina and perineum
•Sharp, severe and well
localized
•Rapidly conducting A-delta
fibers, enter the spinal cord at
S2 to S4
15. How does pain occur ?
1st Stage is due to ischemia of the
uterine muscle caused by uterine contraction
resulting in obstruction of its own blood supply.
this result in accumulation of pain metabolites.
2nd Stage stretching of perineal tissue by
advancing presenting part of the fetus.
16. Types of pain relief in labor
Non-pharmacological:
• Educate on the process of
labor & pain relief methods.
• Continuous labor support
• Relaxation.
• TENS.
• Hypnosis.
• Acupuncture
• Hydrotherapy (water birth)
Pharmacological:
• Opiates.
• Inhalational.
• Regional analgesia
17. Continuous Labor Support
Continuous labor support
provided by a doula
decreases :
• Operative vaginal deliveries
• Cesarean deliveries
• Request for pain medication
18. Relaxation
“psychoprophylaxis”
• Essential in all cases.
• Antenatal classes to educate the mothers on
what to expect.
• During labor ask the mother to relax, breathe
deeply and slowly.
• Increase the spirit of the mother and Helps to
cope with pain and satisfaction with pain relief.
• Carries no risk to the mother and fetus.
19. Transcutaneous electronic nerve stimulation
(TENS)
• Low grade electronic waves to block
afferent nerve fibers supplying the
uterus
• Via skin electrode applied on (T10-L1).
• Also facilitate release of endorphins.
• Provides good pain relief to 25% of
patients.
• The mother can control the stimulus
• Carries no risk to the mother and fetus.
20. Hypnosis and acupuncture
• Multiple theories of how it works,
including altered neuro-transmitters,
increased endorphins, suppression
of excitatory neurons.
• Reported to be successful.
• Needs special skill and preparation.
• Carries no risk to the mother or
fetus.
• ??? Placebo effect
21. Standing under warm shower or soaking in tube
of warm water, the temperature of water used
should be between 35-37◦c .
No limit to the time women can stay in bath and
often they are encouraged to stay in it as long as
desired.
No increase in chorioamnionitis , post partum
indometritis, neonatal infection or antibiotic use.
Water therapy (hydrotherapy )
22. • Labor may slow if used in early labor
–Less than 5cm dilation.
• No effect on the usage of epidural analgesia
• Short duration of pain relief.
• Only effective while she’s in the bath.
Water therapy (hydrotherapy )
23. Narcotics (Opiates)
• Pethidine and diamorphine are the commonly
used drugs.
• Very simple to give: IM or IV
• Rapid onset of effect.
• Repeated when necessary.
• Can still get an epidural later
24. Disadvantage:
• Limited pain relief.
• Maternal sedation, drowsiness.
• Nausea and vomiting. (antiemetic)
• Delayed gastric emptying
• Restricted movement, inability to urinate.
• Inability to participate in labor
• Increase rate in instrumental and cesarean del.
• Can cross BPB respiratory depression in
the new born. So give antidote (Naloxone) and
breathing assistance
25. Inhalational anesthesia
• The commonest is nitrous oxide.
• Given in a 50-50 mixture with
oxygen (Entonox).
• Self administered to the patient
via face mask.
• It does not interfere with uterine
contraction
26. • Quick onset (1-2min), short duration of effect (2-
8 min). Start inhaling at the onset of contraction.
• Entonox- side effect:
• Nausea
• Vomiting
• Poor recall of labor
Inhalational anesthesia
27. Advantages
• Provides analgesia varying from good to ineffective.
• Under control of the patient.
• Minimal adverse effects to mother and fetus.
• Not adequate for second stage, instrumental
delivery, suturing of perineum or manual
removal of placenta.
• Light headedness and nausea.
• Not suitable for prolonged use.
Disadvantages
28. • Injection of local anesthetics around sensory
nerves of spinal cord to block pain from
larger but still limited part of body.
• Does not block the motor pathway to the
uterus (T7 &T8).
• Types:
• Epidural
• Spinal
• Combined epidural spinal
• Pudendal block
Regional analgesia
30. History of Epidural
•First description of Ep. Analgesia dates back to J,
Leonard. corning, a neurologist who in 1885
inadvertantly injected cocaine in the epidural space.
•1921, Spanish military surgeon –technique of
‘single- shot’ lumber epidural anesthesia.
•1941, Robert Andrew Hingosn – technique
continuous caudal anesthesia with indwelling
needle
•1942- the first use of continuous caudal anesthesia
in laboring women.
32. • Epidural catheter inserted to the epidural space at
the level of L3-L4 interspace.(segmental)
• Patient maintains lateral or sitting position
• Catheter is aspirated to check the position. The
catheter is left in.
•Test dose given to confirm the catheter position.
small volume of diluted local anesthetic.
•After 5mins loading dose of mixture of 0.1%
Bupivacaine with fentanyl 12mcg/ml is given.
Epidural analgesia
34. Important…
• Secure IV access.
• Hydrate with 500-1000cc RL
• Establishment/after each bolus measure BP
every 5min for 15min, provide continuous
EFM for 30 min.
• Every hour; check level of sensory block.
• Continue until completion of the 3rd stage &
any perineal repair.
• Birth should take place within 4 hours.
35. Advantages:
• The most effective pain relief (T10-S5).
• The absence of pain allows enjoyment and
control of labor (alert mom).
• Reduces maternal fatigue and anxiety.
• Compared to narcotics, greatly reduced newborn
resuscitation rates.
• Ideal in high risk pregnancies e.g. breech, MP,
and PET.
36. Disadvantage:
• Prolonged labor 1 hour. (require oxytocin)
• Restriction of movement during labor.
• Requires CTG.
• Requires resident anesthesia, cardio-
respiratory facilities and one to one care.
• ?increase rate of instrumental delivery.
• Beware of urine retention.
• Risk of headache.
37. Absolute Contraindications of Epidural
1) Patient refusal.
2) Blood Coagulopathy
3) Infection at the site of injection
4) Treatment with low-molecular-weight heparin
within 12 hr.
5) Sever hypovolemia
6) Fixed cardiac out put
- Sever aortic stenosis, Sever mitral stenosis
- Hypertrophic obstructive cardiomyopathy
Contraindicated
In pregnancy
38. Relative Contraindications of Epidural
1) Systemic sepsis.
1) Uncooperative patient.
2) Preexisting neurological deficits,
e.g. demyelinating disease, peripheral neuropathy
4) Sever spinal deformity.
Avoid in pregnancy
39. Complications
• Accidental Dural puncture-leak of CSF causing
spinal headache.
• Accidental total spinal anesthesia -severe
hypotension, respiratory failure, unconsciousness
& death.
• Drug toxicity occur with accidental placement of
catheter within a blood vessel.
• Bladder dysfunction, Back pain , paralysis.
• Short term respiratory distress in baby.
40. Analgesia used in second stage and third
stage.
• Nerve blocks.
• Spinal anesthesia.
• General anesthesia.
41. Spinal anesthesia
• Not used for routine analgesia in labor.
Can be used for …
• Instrumental delivery.
• Manual removal of placenta.
• Repair of third degree tear.
• Mainly used for CS.
42. Spinal Anesthesia
• A fine gauge atraumatic spinal needle is inserted
into the subarachnoid space below level of L2.
• Small volume of local anesthetic is injected, after
which the spinal needle is withdrawn.
• Combined spinal- epidural analgesia?
• Block level from 8th thoracic dermatome (xiphoid
process/breast)
• Quick onset, Longer anesthetic effects
43. Pudendal block
•Quick pain relief to the perineum, vulva, and vag.
•Usually given in the second stage of labor, just
before delivery of the baby.
•Also just before episiotomy
•Anesthesia is produced by blocking the pudendal
nerve (S2,3,4) near to ischial spin.
44. C-sec → failed epidural/spinal/allergy.
• NPO for about 8 hours
• Prophylactic antacid, antiemetic
• Pre-O2
• Induced unconsciousness (inhalational or IV
• Endotracheal intubation- cricoid pressure on
trachea- occludes esophagus, prevent aspiration
• Maintain anesthesia for the rest of surgery using
additional medication given via IV or ET tube
General Anesthesia
(total induced unconsciousness)
45. Complications of GA
Pulmonary aspiration of gastric contents
Aspiration pneumonia (Mandelson’s syndrome)
Failed intubation
Neonatal depression.
46. summary
• Labor is a painful experience.
• Pharmacological and non-pharmacological
method are used for pain relief.
• Each method had its advantage and
disadvantage and the choice of method
depends on the stage of labor and maternal
preference.