Flashcards in week 3 pain pathways (everything) Deck (59)
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1
which labs need to be obtained during the initial visit of the mother (11)
CBC
Typing,
Rubella antibody,
Cervical gonorrhea and chlamydia culture.
VDRL,
HBsAg (Hep B)
Pap,
Urine complete,
PPD (TB)
HIV (with consent)
BG
2
15-20 weeks
MATERNAL ALPHA FETOPROTEIN: increase in neural tube defects (NTD) and decrease in Downs syndrome. Triple screening (AFP,HCG, Estriol). If abnormal, do U/S or amniocentesis
Folic acid decrease risk of NTD
3
18-20 weeks
U/S for dating. Best time to access fetal development
4
24-28 weeks
Glucose test for ALL
5
28-30 weeks
RhoGAM to Rh(-ve) mom
6
34-38 weeks
CBC
7
36-40 weeks
Cervical chlamydia and gonorrhea culture in high risk patients
8
does oxytocin level increase during labor
NO!
9
so how does labor start if there is not increase to level of oxytocin
(2 answers)
there is increase sensitivity of myometrium to oxytocin
increase synthesis of prostaglandins by fetal membrane and decida helps to start labor
10
the physiological presentation of labor:
- Increased sensitivity of myometrium to oxytocin
- synthesis of prostaglandins by fetal membrane and decida
-Lightening
-Braxton Hicks contraction
-Cervical effacement
-Bloody show due to breaking down of mucous plug
-Rupture of amniotic membrane
-Cervical dilatation
11
Maternal physiology at labor there is a 300% increase in
in minute ventilation
12
in labor what happens to maternal oxygenation?
60% increase in oxygen consumption
13
maternal Hyperventilation in labor results in:
decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and fetal acidosis
14
Each contraction pushes what vol of blood into the circulation?
what is this called?
300-500 ml of blood into circulation – auto transfusion
15
maternal CO results in (increases by how much)
a 45% increase in cardiac output
16
After delivery ,involution of uterus relieves inferior vena caval obstruction resulting in:
80% increase in cardiac output and stroke volume
17
First
Latent
CO?
15% increase
18
first
active phase
co
30% increase
19
second phase CO
45%
20
third phase CO
80%
21
First latent phase start/end
events
Regular uterine contractions/ 4 cm dilatation
Cx effaces and slowly dilate
22
first active phase start end
events
4 cm/10 cm (complete dilatation)
Regular intense contractions, fetal head descends into pelvis
23
second phase start/end
events:
Complete cervical dilatation/delivery of baby
Baby undergoes all stages of cardinal movements (Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion)
24
third phase start/end
events:
Delivery of baby/delivery of placenta
Placenta separates and uterus contracts to establish hemostasis
25
first stage-- pain initial spot- progression.
level of spinal anesthesia must cover what sections
Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor.
level of spinal anesthesia must cover T10-L1
26
second stage- pain spot
level of spinal anesthesia must cover what sections:
Pain through by pudendal nerve (S2-S4)
Somatic pain caused by stretching of vagina and perineum by descent of fetus
Level of spinal anesthesia is needed for S2-S4
27
first stage- cause of pain? what is the pressure ?
1st stage: Cause of pain is uterine contractions and exceeds 25 mmHg pressure and dilate Cx.
28
level of anesthesia for c section
T4
29
how is pain and temperature mediated in the genitalia
autonomic nervous system- not lateral spinothalamic tract
30
