Labor pain relief of
Anesthesia in labor is aimed at providing comfortable conditions for the giving birth woman, allows to avoid pain and a stress, and also promotes prevention of violations of patrimonial activity.
the Perception of pain the woman in labor depends on such circumstances as a physical condition, disturbing expectation, depression, features of education. In many respects, pain in labor amplifies fear of the unknown and possible danger, and also the previous negative experience. However pain will be weakened or is better to be transferred if the patient has a confidence in a successful completion of childbirth, the correct understanding of process of childbirth. Unfortunately, so far, any of the anesthesia techniques existing now in labor is not absolutely ideal. For achievement of the maximum effect the choice of a method of anesthesia has to be carried out individually. At the same time it is necessary to take a physiological and psychological state of the woman in labor, a condition of a fruit and an obstetric situation into account. Prenatal preparation which purpose is removal of fear of the unknown of the forthcoming childbirth is important for increase of efficiency of anesthesia. In the course of such preparation the pregnant woman needs to be informed on an essence of the processes accompanying pregnancy and childbirth. The patient is trained in the correct relaxations, exercises strengthening muscles of a stomach and a back, raising the general tone, to different ways of breath during fights and at the time of the fruit head birth.by
as one of methods of non-drug labor pain relief acupuncture can be used. Most often when using this method there comes only partial anesthesia, and most of patients need application of additional methods of anesthesia. Other method of non-drug labor pain relief is chreskozhny electroneurostimulation (ChENS) which is applied many years. In the course of childbirth two couples of electrodes impose on a back to the woman in labor. Extent of electrostimulation varies according to need of each specific woman and can be regulated by the patient. This form of an analgeziya is safe, noninvasive, easily available to performance by the nurse or midwife. The main lack of a method is the difficulty at its application of electronic monitoring of a condition of a fruit in spite of the fact that chreskozhny electroneurostimulation does not influence a warm rhythm of a fruit.
However most application of the appropriate medicamentous means is important for labor pain relief. Ways of labor pain relief, can be divided into three types: intravenous or intramuscular administration of medicines for removal of pain and alarm; inhalation labor pain relief; local infiltration application of anesthetics and regional blockade.
Narcotic analgetics are the most effective preparations applied to labor pain relief. However these preparations use more for reduction, than for complete cessation of pain. At the established patrimonial activity in an active phase of the first period of childbirth these preparations promote correction of in-coordinate uterine reductions. The choice of a preparation usually is based on degree of expressiveness of potential side effects and desirable duration of action. Intravenous administration of preparations in comparison with intramuscular as the effective dose decreases on 1/3 - 1/2 is preferable, and action begins much quicker. Tranquilizers and sedative preparations apply in labor as components of medicamentous anesthesia to excitement removal, and also to reduction of nausea and vomiting. In an active phase of childbirth, when opening a neck of a uterus more than 3 - 4 cm and emergence of painful contractions appoint sedatives with narcotic analgetics in a combination to spazmolitichesky means (But - a shpa intramuscularly). Use of narcotic analgetics should be stopped in 2 - 3 hours prior to the estimated moment of exile of a fruit, for prevention of his possible narcotic depression.Inhalation labor pain relief
Inhalation labor pain relief by inhalation of anesthetics are also widely applied by
in obstetric practice. Inhalation anesthetics are used in an active phase of childbirth when opening a neck of a uterus not less than on 3 - 4 cm and with the expressed morbidity of fights. The most widespread is use of nitrous oxide (N2O) with oxygen, trichlorethylene (trilen) and a metoksiflurana (pentwounds). Nitrous oxide represents colourless gas with a light sweetish smell which is the most harmless inhalation anesthetic for mother and a fruit. The most standard ratios of nitrous oxide with oxygen are: 1:1, 2:1 and 3:1, allowing to achieve the most optimum and steady analgeziya. In the course of inhalation anesthesia control from medical personnel of a condition of the woman in labor is necessary. Efficiency of anesthesia in many respects depends on the correct technology of inhalation and rationally picked up ratios of components of gas-narcotic mix. Three options of achievement of analgesic effect can be used.
Options of equipment of labor pain relief by means of inhalation anesthetics
- Inhalation of gas-narcotic mix happens constantly to periodic breaks in 30 - 40 min.
- Inhalation is carried out from the beginning of fight and comes to the end with its termination.
- Inhalation happens only in pauses between fights, so that by the time of their beginning necessary extent of anesthesia was reached.
in labor by means of nitrous oxide it can be carried out throughout all active phase of the first period of childbirth before full opening of a neck of a uterus. Because nitrous oxide is removed from an organism through airways, it provides big controllability of process of anesthesia. At anesthesia in labor after the termination of inhalation of nitrous oxide within 1 - 2 min. the consciousness and orientation in a surrounding situation is restored. The similar analgeziya in labor renders as well spazmolitichesky action, providing coordinate patrimonial activity, preventing anomalies of sokratitelny activity of a uterus and a hypoxia of a fruit Use of gas-narcotic mix of nitrous oxide with oxygen is the most acceptable in obstetric practice for labor pain relief. Except nitrous oxide, for inhalation anesthesia also such preparations as trichlorethylene can be used (has more expressed analgetic effect in comparison by nitrous oxide); metoksifluran (application has less operated character in comparison with use of nitrous oxide and trichlorethylene).the analgeziya
can successfully be applied by
of Epiduralnaya To labor pain relief also a regionarny analgeziya. Reductions of muscles of a uterus, stretching of a neck of a uterus and a tension of the copular device of a uterus are the reason of pain in the first period of childbirth. In the second period of childbirth owing to stretching and a pulling of pelvic structures at advance of a fruit there is additional pain which is transferred on sacral and coccygeal nerves. Therefore, for achievement of anesthesia at the time of delivery it is necessary to block transfer of painful impulses on the corresponding nervous bunches. It can be reached by blockade of a shameless nerve, the kaudalny block, the spinal block or expanded epiduralny.
of Epiduralnaya the analgeziya, is one of popular methods of labor pain relief. Performance of an epiduralny analgeziya consists in blockade of painful impulses from a uterus on the nervous ways entering a spinal cord at the certain level by introduction of local anesthetic to epiduralny space. Indications for an epiduralny analgeziya are: the expressed morbidity of fights in the absence of effect of other methods of anesthesia, a diskoordination of patrimonial activity, arterial hypertension in labor, childbirth at a gestoza and fetoplatsentarny insufficiency.
of Contraindication to labor pain relief by means of an epiduralny analgeziya
- Bleeding during pregnancy and shortly before childbirth.
- Use of anticoagulants or the lowered activity of the curtailing system of blood.
- Existence of the center of an infection in a zone of an estimated puncture.
- the Tumour in the place of an estimated puncture is also contraindication to an epiduralny analgeziya.
- the Volume intra cranial processes which are followed by the increased intra cranial pressure.
Relative contraindications to performance of an epiduralny analgeziya
- Extensive surgical interventions on a back which carried out earlier.
- the Extreme degree of obesity and anatomic features making impossible identification of topographical reference points.
- the Postponed or available diseases of the central nervous system (multiple sclerosis, epilepsy, muscular dystrophy and a myasthenia).
of Epiduralnuyu an analgeziya is carried out at the established regular patrimonial activity and opening of a neck of a uterus not less than on 3 - 4 cm. Has the right to carry out epiduralny anesthesia only the anesthesiologist owning this technique.
treat advantages of epiduralny anesthesia: high efficiency of anesthesia; during an analgeziya the patient is in consciousness; a possibility of long maintenance of the anesthetizing influence throughout childbirth; lack of the oppressing impact on patrimonial activity, a condition of mother and a fruit; optimization of blood supply of a uterus and kidneys against sympathetic blockade. In need of performance of the emergency Cesarean section the epiduralny block can be strengthened that allows to provide the due level of anesthesia during operation.by
as anesthesia in an active phase of the first period of childbirth at disclosure of a neck from 4 to 6 cm also the paratservikalny block at which painful impulses from a body of a uterus and its neck can be blocked by introduction of local anesthetic from two sides of a neck of a uterus can be used.
If in the second period of childbirth has to keep sensitivity of a crotch that allows the woman in labor to make an effort, then an additional analgeziya, to that which is carried out in the first period of childbirth, it is not required. If it is necessary to continue anesthesia or there was a need for surgery (imposing of obstetric nippers), then methods of the choice are the epiduralny block of a shameless nerve or an inhalation analgeziya.
the Block of a shameless nerve is carried out in 10 - 20 min. prior to the moment when anesthesia of a crotch is required. Anesthesia is reached in the way by introduction of local anesthetic to the shameless channel on both sides of a basin. The combination of the block of a shameless nerve with an inhalation analgeziya is expedient when conducting childbirth in natural patrimonial ways at patients of high risk as the block does not exert negative impact on nature of haemo dynamics and system of breath of the woman in labor, or on a condition of a fruit.
Should consider certain advantages of different types of anesthesia at these or those obstetric complications in labor. So, in particular, at a gestoza use of an epiduralny analgeziya is expedient. Advantages of use of this method of anesthesia in this case are: possibility of control of level of arterial pressure; optimization matochno - a placentary blood-groove; improvement of function of kidneys; decrease in need of additional use of the depressants exerting negative impact on a condition of a fruit. If there is a need for the emergency rodorazresheniye by Cesarean section, then already installed block allows to execute this surgery immediately even if it is necessary to increase block level.
If childbirth at a gestoza develops very quickly, or the epiduralny analgeziya is contraindicated for some reasons, then for labor pain relief with success the inhalation analgeziya with use of nitrous oxide can be used. Such analgeziya can be strengthened by small doses of narcotic analgetics, and in the second period of childbirth is added with the block of a shameless nerve.
Anesthesia at violations of patrimonial activity
Deserve attention and violation of patrimonial activity. Adequate timely treatment of a diskoordination of patrimonial activity, as a rule, contributes to its normalization. The choice of the corresponding therapy is carried out taking into account age of women, the obstetric and somatic anamnesis, the course of pregnancy, an objective assessment of a condition of a fruit. At this type of abnormal patrimonial activity the most reasonable method of therapy is carrying out a long epiduralny analgeziya. Frequent anomaly of patrimonial activity is weakness which is korrigirut by intravenous administration of the means strengthening sokratitelny activity of a uterus. Before purpose of rodostimuliruyushchy preparations at exhaustion of the patient it is necessary to provide to the woman rest in the form of a pharmacological dream. The correct and timely providing rest leads to restoration of the broken functions of the central nervous system. In these situations rest promotes restoration of a normal metabolism in a uterus. The wide arsenal of medicamentous preparations which are appointed by the doctor in an individual order depending on the developed obstetric situation and a condition of the woman in labor is for this purpose used. In obstetric practice also the method of an elektroanalgeziya which application allows to reach resistant vegetative balance, to avoid allergic reactions which can arise when using pharmacological preparations is used (neuroleptics, ataraktik, analgetics). Unlike pharmacological preparations use of pulse current allows to receive the so-called “fixed“ stage of a medical analgeziya that gives the chance during the patrimonial act to keep consciousness, verbal contact with the woman in labor without signs of her excitement and transition to a surgical stage of an anesthesia.
Labor pain relief at diabetes
At diabetes at the beginning of an active phase of the first period of childbirth is expedient to avoid use of narcotic analgetics and application of an epiduralny analgeziya is more preferable. It is caused by the fact that negative influence of system analgetics and sedative preparations decreases, stressful reaction of the woman in labor to pain is less expressed, more best control of a condition of the woman in labor against safe consciousness is provided. Besides, the epiduralny analgeziya allows to prevent development of fast and prompt childbirth, allows to provide painless controlled completion of childbirth. If necessary against an epiduralny analgeziya perhaps operational rodorazresheniye as in natural patrimonial ways (obstetric nippers, vacuum - extraction), and by emergency Caesarian (after fast strengthening of the block). If there is no opportunity and conditions for performance of the regionarny block, use of an inhalation analgeziya is possible having strengthened it the block of a shameless nerve.Labor pain relief at heart diseases
At rheumatic diseases of heart anesthesia has to be carried out by
up to a rodorazresheniye and proceed in the early postnatal period. In the best way the prolonged lumbar epiduralny block meets these requirements. This technique allows to exclude attempts in the second period of childbirth, and the vacuum - extractions provides necessary conditions for imposing of obstetric nippers and use. In case of need for Cesarean section the prolonged lumbar epiduralny block can be widespread to necessary level. Such way of anesthesia allows to prevent development of sharp heart failure with hypostasis of lungs and decrease in venous return. At the patient with a valve artificial limb, and using heparin, for labor pain relief it is expedient to use tranquilizers and narcotic analgetics or an inhalation analgeziya bez hyperventilations. In the second period of childbirth it is necessary to add with the block of a shameless nerve.
Anesthesia and premature birth
in the course of conducting premature birth should avoid application of narcotic analgetics and sedative preparations throughout childbirth. Carefully executed regionarny anesthesia is the best type of anesthesia at a rodorazresheniye a premature fruit. The prolonged lumbar epiduralny block supported throughout all childbirth is at the same time an ideal form of an analgeziya as allows to control strictly the course of childbirth and to execute a crotch section. In case of need performance of Cesarean section the epiduralny block can be quickly strengthened.