Labor Stage 1: Normal and Abnormal Labor

by Veronica Gillispie, MD, FACOG

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    00:01 Now let's discuss Obstetric Anesthesia.

    00:05 So we have a lot of options for managing pain in labor.

    00:09 Let's take time to talk about each of these.

    00:11 First is inhaled anesthesia.

    00:15 So this is in the form of nitrous oxide also known as Laughing Gas.

    00:19 It's inhaled intermittently in labor.

    00:21 Mom is in control of that.

    00:24 Pain relief however is minimal and is short lasting.

    00:28 The side effects are nausea, dizziness and light headedness.

    00:32 Nitrous oxide can be used for labor but not for cesarean sections.

    00:39 Now let's talk about systemic opoid anesthesia.

    00:44 So basically narcotics are given intravenously.

    00:46 We have to be careful though because if they are given intravenously, that means that they go to the placenta and they can effect the fetus.

    00:54 Pain relief is minimal and short lasting.

    00:57 And they should not be given within 4 hours prior to expected to delivery.

    01:02 Again because it is intravenous it goes to the placenta and the fetus can give the affects of the narcotic.

    01:10 Maternal side effects are nausea, vomiting and drowsiness.

    01:15 Fetal or neonatal side effects are fetal heart rate abnormalities or respiratory depression.

    01:22 Now let's talk about local opoid anesthesia.

    01:28 So this would be in the form of pudental nerve block as demonstrated here.

    01:34 It could be used for operative vaginal delivery or repair of laceration or episiotomy.

    01:39 So it's not typically used during the labor process.

    01:42 And it cannot be used for cesarean sections as it would not provide anesthesia to the area needed.

    01:47 But it can be used when you're using operative vaginal delivery.

    01:51 It provides great pain relief along the nerve distribution.

    01:55 Now you have to be cautious when you're doing a pudental nerve block because you can have potential hemorrhage if the pudental artery is accessed instead of the nerve.

    02:04 Now, let's talk about regional opoid anesthesia.

    02:10 So this is in the form of epidural or spinal.

    02:13 So epidural anesthesia typically used for labor but it can be used for C-section.

    02:19 During epidural placement a catheter is placed in the epidural space to inject medication.

    02:26 It gives great pain relief from T8 to below but it can be spotty.

    02:31 That means that patients can have what they call Hot Spots where they don't feel the pain relief in that area.

    02:38 Now the maternal side effect of an epidural is hypotension.

    02:41 This is particularly important specially for labor in patients.

    02:45 With that hypotension patients can experience utero-placental insufficiency and that can affect the fetus.

    02:52 And the fetus will manifest having that hypotension by having late decelerations.

    02:59 So spinal anesthesia.

    03:00 This is injected into the spinal fluid and it's used for C-sections.

    03:05 It gives great relief from T10 to below.

    03:07 So a little bit higher than an epidural and it last for about 2 to 4 hours.

    03:13 Again the maternal side effect is hypotension and bradycardia.

    03:17 And with that again, the fetus can start to have late decelerations as a manifestation of utero-placental insufficiency.

    03:28 Now let's talk about general anesthesia.

    03:32 So general anesthesia is reserved only for emergency C-sections.

    03:36 Typically with C-section again we use an epidural or we use spinal anesthesia.

    03:41 And even in some emerging cases we can still use epidural or spinal.

    03:46 However, if it is an extreme emergency situation we would need to do a C-section.

    03:52 Now the reason that we reserve the general anesthesia for emergencies are because of the maternal side effects.

    03:59 A lot of times moms can have vomiting and that can result in aspiration pneumonitis.

    04:03 Specially if mom has any food in her stomach or has not been in PO for 8 hours.

    04:10 Fetal side effects of general anesthesia, respiratory depression.

    About the Lecture

    The lecture Labor Stage 1: Normal and Abnormal Labor by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care. It contains the following chapters:

    • First Stage of Labor
    • Stage 1 – Normal Labor
    • Stage 1 – Abnormal Labor

    Included Quiz Questions

    1. An intrauterine pressure catheter should be inserted to measure the power of her contractions.
    2. She should be started on pitocin to increase the frequency of her contractions.
    3. She should be given cervical ripening agents to soften the cervix.
    4. She should be managed expectantly for spontaneous vaginal delivery with no further intervention at this time.
    5. She should be recommended to have a cesarean section.
    1. Evaluate for fetal malpresentation
    2. Start pitocin to increase the strength of her contractions
    3. Start pitocin to increase the frequency of her contractions
    4. Vaccuum assisted delivery to help the baby descend into the pelvis
    5. Administer cervical ripening agents to soften the cervix
    1. Gynecoid pelvis, allowing for occiput anterior rotation
    2. Gynecoid pelvis, allowing for occiput posterior rotation
    3. Anthropoid pelvis, allowing for occiput posterior rotation
    4. Platypelloid pelvis, allowing for transverse rotation
    5. Antho,poid pelvis, allowing for transverse rotation
    1. Android
    2. Anthropoid
    3. Gynecoid
    4. Platypelloid
    5. Mesomorphoid

    Author of lecture Labor Stage 1: Normal and Abnormal Labor

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG

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    By ANDRES R. on 09. February 2017 for Labor Stage 1: Normal and Abnormal Labor

    I Really liked it. The example you gave with the wedding was perfect, I will never forget it.