week 3 pain pathways (everything) Flashcards Preview

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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

Uterus and Cx- pain levels ?

pain is carried by what fibers

T10 to L1-2

Pain impulses carried in visceral afferent C fiber