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Which of the following is a potential maternal side effect of intrathecal opiates during labor?
Which of the following is a potential fetal side effect associated with the use of intrathecal opiates during labor?
Which of the following best describes the mechanism of action of intrathecal opiates in labor analgesia?
Which of the following statements about the duration of action of intrathecal opiates is correct?
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Which of the following is a potential advantage of using a combined spinal-epidural (CSE) technique for labor analgesia?
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Which of the following statements about the anatomical location of intrathecal opioid administration is correct?
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Which of the following is a potential advantage of using nitrous oxide for postpartum perineal repair?
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Which of the following statements about the onset of action of intrathecal opiates is correct?
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Which of the following statements about the use of intrathecal opiates during labor is correct?
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What is the primary mechanism of action for intrathecal opioids in labor analgesia?
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Which of the following is a potential maternal side effect associated with the use of systemic opioids during labor?
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What is the primary advantage of using a combined spinal-epidural (CSE) technique for labor analgesia?
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Which of the following is a potential fetal side effect associated with the use of systemic opioids during labor?
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When would the use of neuraxial anesthesia (epidural or spinal) be contraindicated during labor?
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Which of the following is a potential advantage of using nitrous oxide for postpartum perineal repair?
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Where is the anatomical location of intrathecal opioid administration during labor?
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What is the typical onset of action for intrathecal opioids in labor analgesia?
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Which of the following statements about the duration of action of intrathecal opioids is correct?
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Which of the following is a potential neonatal side effect associated with the use of systemic opioids during labor?
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Study Notes
Labor Analgesia and Anesthesia
- Epidural analgesia:
- No increase in duration of labor
- No increase in C-sections and operative deliveries
- No significant increase in maternal temperature
- Spinal anesthesia:
- Intrathecal (subarachnoid) space: CSF, spinal nerves, blood vessels
- Risks/side effects: fetal bradycardia, maternal pruritus, N/V
- Combined spinal/epidural (CSE) anesthesia:
- "Needle-through-needle" technique
- Medicine deposited in subarachnoid space and epidural catheter placed in epidural space
- Rapid onset of analgesia (5-10 minutes)
Pain Pathways and Labor Pain
- First stage of labor:
- Visceral/cramping pain from uterus and cervix, referred to abdominal wall, lumbosacral region, iliac crests, gluteal areas, and thighs
- Pain signal enters spinal cord T10-L1
- Transition:
- Greater nociceptive input beginning somatic pain from vaginal distention
- Second stage of labor:
- Combination of visceral and somatic pain from distention of vaginal and perineal tissue via pudendal nerve S2-S4
Adverse Consequences of Labor Pain
- Hyperventilation
- Lightheadedness
- Tingling
- Decreased placental perfusion
- Elevated catecholamines
- Decreased placental perfusion
- Psychological effects:
- Postpartum psychological trauma
- Increased risk for postpartum depression
Systemic Opiates
- Overview:
- No need for anesthesiologist
- When neuraxial anesthesia is contraindicated/undesired
- Increasing sedation and respiratory depression with repeat doses
- Optimal labor opioid:
- Rapid onset
- Rapid metabolism and elimination
- Minimal maternal/fetal/neonatal side effects
- Side effects common to all opioids:
- Respiratory depression
- Orthostatic hypotension
- Delayed gastric emptying
- Nausea
- Vomiting
Opiate Receptors
- Mu, kappa, delta
- Opiates differ in agonist and/or antagonist effects at receptor sites
- Receptors differ in the extent to which they involve respiratory function
- Sensitivity and effects on individuals vary by:
- Degree of opiate naiveté
- Genomic polymorphisms (poorly understood)
- Sensitivity and response differences may not be predictable; therefore, start with lowest doses
Inhaled Nitrous Oxide in Labor
- Safety: VERY SAFE all stages of labor IF:
- Correct dose
- Self-administered, ONLY
- Do not mix with sedatives/opioids
- Fetal/neonatal side effects:
- Crosses placenta
- No effect on FHR tracing
- Quickly removed from neonatal lungs by breathing
- No neonatal respiratory depression
- No effects on breastfeeding
- Labor effects:
- No effects on contraction frequency and labor progress
Pudendal Block
- Regional anesthesia technique
- Perineal distension in labor
- Perineal repair
- Fast-acting
- Lasts 60-90 minutes
- Used in 2nd and 3rd stage of labor
- Broader coverage than local infiltrations
- No disruption of tissue to be repaired
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Description
This quiz covers the maternal side effects of epidural analgesia during childbirth, including symptoms like increased maternal temperature, altered thermoregulation, and postdural puncture headache. It also explores factors contributing to these side effects and how they can be managed.
