Methods of anesthesia of labor

Thanks to modern medicine and new drugs in our time, it is possible to relieve a woman of suffering, which causes painful pain during labor. Already entering the maternity department, the mother in child can ask to be assigned to her anesthesia during childbirth, which will be carried out in planned or emergency order. Therefore, immediately after the examination by a gynecologist, a woman is prescribed a consultation by an anesthesiologist who will perform anesthesia.

At the interview the doctor should learn about the patient a lot of information is needed:

  • It is necessary to know how many years of labor;

  • What kind of childbirth;

  • Number of pregnancies that resulted in abortion or miscarriage;

  • Term of pregnancy at this stage;

  • Presence of chronic and hereditary diseases;

  • Other factors that are necessary for anesthesia.

  • It is also necessary to conduct a number of laboratory studies. Especially, if in previous laboratory tests there was gestosis, increased liver test, thrombocytopenia, decreased hemoglobin, hemolysis.

    For this purpose, there is a need to prescribe and carry out the following laboratory tests:

  • A blood test of a general nature, with platelet counts, hematocrit and VSC;

  • General urine analysis. The results of this analysis will evaluate proteinuria;

  • Paracoagulation tests should be assigned and a haemostasiogram should be performed;

  • To pass the analysis of a blood on biochemistry. It is important to know the indicators of total protein and its fractions, bilirubin, creatinine, urea, blood plasma and glucose;

  • An electrolyte test will be required. Where will be the level of potassium, sodium, calcium, chlorine, magnesium;

  • Indicators of liver tests of ALT and AST. Also KFK, LDG, APF;

  • It is necessary to know osmolality and RCD for blood;

  • Results of the oxygen index in blood and gases;

  • Indicators of hemoglobin in blood plasma;

  • Carry out an electrocardiogram;

  • Indications: measure intraocular pressure;

  • Blood pressure level;

  • In chronic processes associated with diseases of the nervous system, in particular eclampsia, it is necessary to appoint an additional consultation of the neurologist and ophthalmologist. If possible, then make a computer tomography of the brain, MRI, lumbar puncture, Doppler and MRI.


    Methods of anesthesia during labor

    There are two main criteria for anesthesia during childbirth. It includes the use of medicamental and not medicamental techniques.

    Limitations during anesthesia and anesthesia during labor

    When the doctor does not know what kind of woman can begin to respond to the introduction of the drug or there is an increased chance of developing side effects. In such cases, anesthesia is not applied, and labor takes place in the usual way.

    The doctor, who gives anesthesia, uses the technique of anesthesia or anesthesia, which he most knows and will conduct it impeccably.

    A manual for an anesthesiologist, which consists of five main sections.

  • Conducting anesthesia for the woman in labor with a pelvic presentation and having two or more fetuses;

  • A woman with good health and normal pregnancy;

  • Pregnant woman with gestosis;

  • If there is an anamnesis extragenital pathology;

  • Pregnant with gestosis and extragenital pathology.

  • You need to know that the occurrence of a violation during labor can increase from the first to the last group. Then the number of deliveries that pass through the physiological pathway decreases and the following medical section is formed according to these indications.

    The method of anesthesia, when labor passes through the natural birth canal in pregnant women with the probability of anomalies and complications during labor, which require additional treatment with pelvic presentation and the presence of several fetuses.

    In rare cases, when there is a weak labor activity or there is an insufficient amount of oxygen in the fetus at the second stage of delivery. In this case, caesarean section can not be performed, but only there are indications for the use of obstetric forceps. This stage requires anesthesia.

    Anomalies of labor are most often observed in women with:

  • severe gynecological and obstetric anamnesis;

  • extragenital pathology;

  • the presence of gestosis;

  • can occur with the wrong method of delivery;

  • multiple and uncontrolled use of oxytocin, which can lead to discoordination of the contractile function of the uterus.

  • Increased administration of these drugs can provoke a child's oxygen starvation and even lead to death. It is necessary to know that in the anomaly of labor and discoordination of the contractile function of the uterus, it is contraindicated the introduction of the ganglion blocker to the parturient who can cause a decrease in the tone of the uterus and provoke the fetus of ischemic neuronal pathologies of the brain.

    Anomalies of labor

    There are several indicators when the anomaly of labor is developing:

  • Weak labor activity;

  • Reduction of attempts;

  • Discoordination of the contractile function of the uterus;

  • Increased labor activity;

  • Discoordination;

  • Increased segment tone in the lower part of the uterus;

  • Contractions in the form of cramps;

  • Dystocia of the cervix.

  • If there is a history of obstructed obstetric and gynecological indications, extragenital pathology, gestosis, chronic oxygen deficiency in the fetus, then there is no indication for the treatment of discoordination of labor. It is advisable in this case to conduct a cesarean section. Otherwise, with such symptomatology and conservative treatment there is a great danger for the mother and the fetus. Discoordination of labor is accompanied by severe complications. These include rupture of the uterus, placental abruption, asphyxiation with amniotic fluid. All these moments are shared with hypotonic bleeding, which is virtually impossible to stop. In this case, you can lose not only the fetus, but also the woman in childbirth. Gestosis, which is manifested by pre-eclampsia, eclampsia itself, umbilical cord prolapse with pelvic presentation, all this is considered an immediate indication for the abdominal resolution of labor.

    The technique of conducting anesthesia in a cesarean section in parturient women with an anomaly of labor, which can not be treated, incorrect and pelvic presentation of the fetus, the presence of several fruits.

    There are such vital situations when there is a need for the examination of the uterus with hands, removal of the palms by hand, normalization of the vagina, abortion in late pregnancy, the appointment of curettage of the uterine cavity after miscarriage for a long period. This obstetric section includes small surgeries and anesthesia with them for patients with an abnormality of labor and discoordination with an improper fetal position and multiple pregnancies.

    The fifth section includes anesthesia and analgesia in patients who are not related to pregnancy and labor. This technique is used for surgical interventions for various gynecological diseases, not related to pregnancy. And also in pregnant women with an anomaly of labor, discoordination of the contractile function of the uterus, improper pelvic presentation, the presence of several fruits.

    Anesthesiologist begins to use anesthesia to perform labor activity at the following indications:

  • The presence of severe pain in constant and productive bouts;

  • The opening of the cervix is ​​about 4 cm;

  • Absence of contraindications, which can only tell an obstetrician-gynecologist.

  • There are several criteria by which it is possible to determine the intensity of the pain, which in each patient is determined on an individual basis. Here, the tactics of conducting anesthesia are taken into account, where the ratio of the pain syndrome and the passage of fights is taken. Based on these results, an algorithm of anesthesia is formed:

  • When the pain is at the very top of the pain syndrome and it is not determined during the fights, then anesthesia is not needed;

  • The presence of severe pain, which is determined within 20 seconds at the very top of the bout. The first half shows the administration of analgesics. The second half shows the fractional introduction of oxygen with a mask. Here, the ratio of dinitrogen oxide to oxygen is 1: 1;

  • The pain remains at the normal pain threshold and, in fact, is not determined in the first half of the fights. It lasts 15 seconds. Then there is an increase in the pain syndrome and lasts about 30 seconds. Analgesics are prescribed in the first half of the fights, in the second half, constant inhalation with oxygen and dinitrogen oxide in a ratio of 1: 1;

  • In the presence of low pain syndrome, which lasts 50 seconds, until the fight is over. Epidural anesthesia is prescribed here. In some cases, an alternative method is used. Begin to jointly introduce in the first period of analgesics and tranquilizers. In the second period, continuous oxygenation of the oxide and oxygen dinitrogen in a ratio of 2: 1. It is necessary to carry out this procedure under careful control so as not to cause oxygen starvation in the fetus and its death.

  • In our country, anesthesia with the use of dinitrogen oxide was not widely spread. Therefore, many doctors with accuracy can not assert about its positive and negative aspects. Also, anesthesiologists use analgesics and tranquilizers to eliminate the pain syndrome during childbirth. From the above algorithm, it can be noted that the doctor must himself monitor and determine the threshold of pain between contractions and the physiological course of labor.

    A second part of the algorithm, where the tactic of anesthesia requires more careful improvement, requires several changes. Analgesics of narcotic and non-narcotic composition were used for a long time for anesthesia. They were administered intramuscularly and intravenously. At the present time, many scientists have raised the question of the complete cessation of the introduction of narcotic substances, which were used for anesthesia.

    The most famous drug is the drug Trimeperedin. It begins to be injected intravenously, when the laborer has constant contractions and the cervix is ​​4 cm open. At the initial stage of labor, this drug is not injected, otherwise there may be relief of labor. Completely eliminate the introduction of Trimepedin need 4 hours before the onset of labor. In rare cases, with the permission of the neonatologist and the life indications of the mother in childbirth, the substance is discontinued 1 hour before delivery. Otherwise, the fetus may begin to have CNS damage and respiratory failure.

    Therefore, a more common method of analgesia in childbirth is epidural anesthesia. This method takes pain well, the mother is in the mind, there is an opportunity to communicate with her and give the necessary recommendations.