Flashcards in week 3 pain pathways (everything) Deck (59)
which labs need to be obtained during the initial visit of the mother (11)
Cervical gonorrhea and chlamydia culture.
HBsAg (Hep B)
HIV (with consent)
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
U/S for dating. Best time to access fetal development
Glucose test for ALL
RhoGAM to Rh(-ve) mom
Cervical chlamydia and gonorrhea culture in high risk patients
does oxytocin level increase during labor
so how does labor start if there is not increase to level of oxytocin
there is increase sensitivity of myometrium to oxytocin
increase synthesis of prostaglandins by fetal membrane and decida helps to start labor
the physiological presentation of labor:
- Increased sensitivity of myometrium to oxytocin
- synthesis of prostaglandins by fetal membrane and decida
-Braxton Hicks contraction
-Bloody show due to breaking down of mucous plug
-Rupture of amniotic membrane
Maternal physiology at labor there is a 300% increase in
in minute ventilation
in labor what happens to maternal oxygenation?
60% increase in oxygen consumption
maternal Hyperventilation in labor results in:
decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and fetal acidosis
Each contraction pushes what vol of blood into the circulation?
what is this called?
300-500 ml of blood into circulation – auto transfusion
maternal CO results in (increases by how much)
a 45% increase in cardiac output
After delivery ,involution of uterus relieves inferior vena caval obstruction resulting in:
80% increase in cardiac output and stroke volume
second phase CO
third phase CO
First latent phase start/end
Regular uterine contractions/ 4 cm dilatation
Cx effaces and slowly dilate
first active phase start end
4 cm/10 cm (complete dilatation)
Regular intense contractions, fetal head descends into pelvis
second phase start/end
Complete cervical dilatation/delivery of baby
Baby undergoes all stages of cardinal movements (Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion)
third phase start/end
Delivery of baby/delivery of placenta
Placenta separates and uterus contracts to establish hemostasis
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
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
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.
level of anesthesia for c section
how is pain and temperature mediated in the genitalia
autonomic nervous system- not lateral spinothalamic tract