Obstetrical delivery

The use of atropine became part of routine preoperative medication when anesthetics such as ether were used, because these irritant anesthetics markedly increased airway secretions and were associated with frequent episodes of laryngospasm. Preanesthetic injection of atropine or scopolamine could prevent these hazardous effects. Scopolamine also produces significant amnesia for the events associated with surgery and obstetric delivery, a side effect that was considered desirable. On the other hand, urinary retention and intestinal hypomotility following surgery were often exacerbated by antimuscarinic drugs. Newer inhalational anesthetics are far less irritating to the airways. 

Since local anesthetics are capable of blocking all nerves, their actions are not limited to the desired loss of sensation from sites of noxious (painful) stimuli. Although motor paralysis can be desirable during surgery, it may also limit the ability of the patient to cooperate (ie, push) during obstetric delivery or ambulate without assistance after outpatient surgery. 

Approximately half the cases of cerebral palsy occur in premature pregnancies, which suggests that for these cases more has happened to the fetus than a mere obstetrical delivery problem. 

Malformations of many organ systems apart from the brain are common in cerebral palsy, which suggests damage in early gestation by an environmental or physiological impact rather than an obstetrical delivery problem. 

Ideally, Rh (D) should be administered to an Rh(D)-negative woman within 72 hours after abortion, amniocentesis, obstetric delivery of an Rh-positive child, or transfusion of Rh-positive blood. However, the product may be effective at much greater postexposure intervals and should be given even if more than 72 hours have elapsed. The answer is (B). 

Oxytocin is contraindicated in patients with known hypersensitivity to the drug, cephalopelvic disproportion, unfavorable fetal position or presentation, in obstetric emergencies, situations of fetal distress when delivery is not imminent, severe toxemia (preeclampsia, eclampsia), hypertonic uterus, during pregnancy (intranasal administration), when there is total placenta previa, or to induce labor when vaginal delivery is contraindicated. Oxytocin is not expected to be a risk to the fetus when administered as indicated. When oxytocin is administered with vasopressors, severe hypertension may occur. 

Kaplan and Kelloner estimated that between 1972 and 1982, the number of deliveries with general anesthesia in the U.S., Canada, and Great Britain was 29,31,300. Only four cases of MH were reported in obstetric cases during this time. These statistics support Crawford s view that pregnancy may have a protective effect against MH (Crawford, 1972). 

Mothers of preterm infants were also more likely than mothers of full-term infants to have obstetrical complications at the time of delivery. Eighty percent of mothers of preterm infants had three or more obstetrical complications. Possible complications included premature labor, oremature rupture of membranes, prolonged rupture of membranes, Caesarean section, chorioamnionitis, and marginal placenta abruption. In contrast, only one mother of a full-term infant developed obstetrical complications during the perinatal period. 

For preoperative analgesia, as a supplement to balanced analgesia, to surgical and postsurgical anesthesia and for obstetrical analgesia during labor and delivery. 

Labor and delivery - Misoprostol can induce or augment uterine contractions. A major adverse effect of the obstetrical use of misoprostol is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. 

Obstetric infections include infections which occur during pregnancy, delivery and in the postpartum period, and which affect the uterus or its content. Clinical entities are amnionitis, and post partum or post-caesarean endometritis and infected abortion. Symptoms are lower abdominal pain, fever and eventually foetid amniotic fluid or lochia. 

Obstetric infections can be treated with penicillin-beta-lactamase inhibitors such as amoxicillin-clavulanic acid, with extended spectrum penicillins (with or without beta-lacamase inhibitors if justified by local resistance surveillance data), with a first or second generation cephalosporin combined with metronidazole. In severe cases of streptococcal infection high doses of penicillin in combination with clindamycin is the treatment of choice. In amnionitis, maternal morbidity resolves with delivery. In endometritis, antibiotics should be stopped after the... 

Epidural anesthesia is especially useful in obstetrics. Excellent analgesia occurs and the patient remains awake. Analgesia by the epidural route can be provided for labor and delivery or for cesarean section. Bupivacaine in lower concentrations has the advantage of providing excellent analgesia while minimally reducing motor strength. 

In the caudal form of extradural anesthesia, the agent is introduced through the sacral hiatus above the coccyx. It is particularly applicable to perineal and rectal procedures. Anesthetization of higher anatomical levels is not easily obtained, because the required injection volume can be excessive. Although caudal anesthesia has been used extensively in obstetrics, lumbar epidural blockade is now more commonly used because of the lower dose of drug required in addition, the sacral segments are spared until their anesthesia is required for the delivery. 

Epidural anesthesia—injection of local anesthetic into the space external to the dural sac that encloses the spinal cord, enabling nerves to the pelvis to be selectively anesthetized during obstetrical labor and delivery... 

Obstetrics. While an adequate dose of thiopentone is required to ensure adequate anaesthesia, the barbiturate rapidly crosses the placenta. Cardiorespiratory depression in the fetus may occur if the induction-delivery interval is short. 

Further study has suggested that environmental factors must play a very important role. These factors and their impact are poorly understood at the present time, but they include the possibility of maternal intrauterine viral infections during the gestational period, obstetrical complications during delivery, and perinatal conditions during the early days or months of the patient s life. Essentially, it would appear that schizophrenic patients have a genetic vulnerability to develop the disorder, which is manifested later in life if and when certain environmental conditions occur. 

The attractions of enabling patients to manage their own analgesics rather than be dependent on others are obvious. In mild and moderate pain it is easy to provide tablets for this purpose, but in severe chronic and acute recurrent pain, e.g. terminal illness, postsurgical, obstetric, other routes are needed to provide speedy relief just when it is needed. Drug delivery S5rstems range from inhalation devices... 

Five studies of the prophylactic intravaginal use of chlorhexidine vaginal suppositories before delivery and in obstetrics have been reviewed (7). No severe adverse reactions were reported. 

Maternal hypotension and excessive placental transfer of local anesthetics and other drugs, for example narcotics or sedatives, given to the mother before or during delivery are the main causes of neonatal death related to the use of these agents in obstetrics. However, deaths are very infrequent (155). 

Propofol Propofol has been relatively free of acute side effects other than those associated with its mechanism of action. Continuous infusions lasting greater than 10 days in ICUs have demonstrated no significant apparent toxicities. Propofol is not recommended for obstetrics, including cesarean section deliveries. It crosses the placenta, and as with other general anesthetic agents, may be associated with neonatal depression. Propofol is not recommended for use in nursing mothers because it is excreted in human milk, and the effects of oral absorption of small amounts of propofol in newborn and infants are not known. 

Obstetrics/gynecology. Research pertaining to the care of women during pregnancy and childbirth, as well as to the study of the women s reproductive system in general. Studies in these areas include contraception, hormone-replacement therapy, menopause, menstrual disorders, ovarian cysts, postmenopausal syndrome, pregnancy/labor/delivery, yeast infections, and others. 

A study reported rapid and prolonged analgesia in all of 14 obstetric patients who received a dose of only 1 mg synthetic human P-endorphin intrathecally at time of delivery. Since this peptide does not cross the BBB (or placenta), no fetal respiratory depression accompanied the procedure, nor were CNS or cardiovascular effects observed. 

Inhibition of natural or induced uterine contractions by halothane during parturition may prolong the process of delivery, as well as increase blood loss. Thus, other agents or techniques may be preferred for the relief of obstetrical pain. 

Nalbuphine, a narcotic agonist-antagonist (10 mg in adult administered SC, IM, or IV every 3 to 6 hours) is indicated for the relief of moderate to severe pain, for preoperative analgesia, as a supplement to balanced analgesia and to surgical anesthesia, and for obstetrical analgesia during labor and delivery. 

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