文档介绍：LABOR ANALGESIA
LABOR PAIN PATHWAYS
First stage:
-pain is due primarily to uterine contractions that cause stretching and thinning of the uterine cervix.
-pain impulses travel via visceral afferent fibers and enter the spinal cord at the T10 ,T11 and L1spinal segments.
-pain is generally poorly localized and is dull or cramping.
LABOR PAIN PATHWAYS
Second stage:
-Stretching of the perineum produces additional pain,more somatic in nature,is well localized and sharp
- these impulses travel via the pudendal nerves from the S2,S3andS4spinal segments
LABOR PAIN
The amount of pain experienced by a woman during labor and delivery can be influenced by many factors,including participation in childbirth preparation classes,parity,and use of oxytocin
ANALGESIA FOR LABOUR PAIN
Psychologic techniques
-hypnosis
-psychoprophylaxis
-positive conditioning
-patient education
-acupuncture
-trenscutaeous electrical nerve stimulation
Systemic medication
Benzodiazepines
-diazepan
crosses the placenta rapidly,and maternal and fetal blood levels are equal within minutes of an IV dose
if total maternal dosage exceeds 30mg, the drug and its active metabolite persist in pharmacological active concentrations for at least a week in the neonate
Systemic Medication
Diazepam
-the adverse effects in neonate:
.in large dose: hypotonia, lethargy, decreased feeding,and hypothermia
.in small dose:reduced beat-to-beat variability.
Midazolam
-if it is used for induction,problem with genral body tone and body temperature of neonate seen.
Systemic Medication
Meperidine
-peak analgesia effect occurs 40 to 50 minutes after Imand 5 to 10 minutes after IV
-the duration is 3-4hours
-can cause dose-dependent neonateal depression, as evidenced by prolonged time to sustained respiration,decreased Apgar scores,and abnomal results from neurobehavioral examination
Systemic Medication
Fentanyl