ANESTHESIA FOR LABOR AND DELIVERY

• Nonpharmacologic analgesia choices: Hypnotherapy, hydrotherapy, and transcutaneous electrical nerve stimulation (TENS)

• Pharmacologic analgesia: Inhalation analgesia, parenteral opioid analgesia (fentanyl, nalbuphine), pudendal block, paracervical block, neuraxial analgesia. Of these, epidural & combined spinal-epidural (CSE) analgesia are most effective

POSTDURAL PUNCTURE HEADACHE (PDPH)

Differential dx: Nonspecific headache, migraines, lactation headaches, cortical vein thrombosis, meningitis, subdural hematoma, subarachnoid hemorrhage

H&P and +/- neuroimaging necessary for correct diagnosis

DRUGS USED IN OBSTETRIC SURGERY

INTRAPARTUM FETAL ASSESSMENT AND THERAPY

UTEROPLACENTAL BLOOD FLOW

Factors That Decrease Uterine Blood Flow

PLACENTAL TRANSFER OF MEDICATIONS

Inhalational & IV induction agents, local anesthetics → can cross placenta

• However, bupivacaine highly protein-bound & chloroprocaine highly metabolized (fetal conc. of these drugs lower than when lidocaine is used)

APGAR SCORE

ANTEPARTUM HEMORRAGE

POSTPARTUM HEMORRHAGE

• Incidence: 10% of all deliveries

• Definition: 500 mL EBL in vaginal delivery, 1,000 mL EBL for CS

• Anesthetic management:

→ Assess pt volume status, hemoglobin & coagulation status, IV access

→ Send T&S or type & crossmatch for blood

→ Administer IV fluid, blood, & vasopressors as indicated

HYPERTENSIVE DISORDERS OF PREGNANCY

Preeclampsia

• Definition: Hypertension + proteinuria after 20 wks’ gestation

• Pathophysiology: Exact mechanism unknown, may involve imbalance between prostaglandins (thromboxane A & prostacyclin), abnl sensitivity to catecholamines, or antigen–antibody reactions between fetal & maternal tissues

• Treatment: Only definitive cure for preeclampsia is delivery of the infant