Obstetrics

Another clinical consideration is the abiUty of local anesthetic agents to effect differential blockade of sensory and motor fibers. In surgical procedures such as obstetrics or postoperative pain rehef, an agent which produces profound sensory block accompanied by minimal motor block is desirable. On the other hand some procedures such as limb surgery require both deep sensory and motor blockade. In clinical practice, bupivacaine ( 22,... 

R = / -C H ), in low doses, exhibits the former behavior and is used primarily as an extradural agent in obstetrics. The lowest effective extradural concentration of etidocaine (21, X = CH, R = R = 2H, R = / -C H ), however, shows both adequate sensory and profound motor blockade so that it is useful in surgical situations where maximum neuromuscular blockade is necessary. In an isolated nerve preparation, bupivacaine blocks unmyelinated C fibers which are mainly responsible for pain perception at a much greater extent than the myelinated A fibers which carry motor impulses. It is postulated that absorption of bupivacaine by the vasculature at the site of injection, combined with the slow diffusion of this agent, results in an insufficient amount of the drug penetrating the large A fibers to cause motor conduction blockade. Clinically, motor block can be observed in some procedures. 

Prilocaine hydrochloride [1786-81-8] is also similar in profile to Hdocaine, although prilocaine has significantly less vasodilator activity. Prilocaine is the least toxic of the amino amide local anesthetics. However, its tendency to cause methemoglobinemia, especially in newborns, has eliminated its use in obstetric surgery. 

Chlorhexidine has found other medical appHcations, eg, in urology in preventing urinary tract infections (217), in obstetrics and gynecology (218), in controlling infection in bums and wounds (219), and in the prevention of oral disease (220). Hypersensitivity to chlorhexidine has been reported in Japan (221) but 0.05% concentration is considered to be safe. 

Another subclass of proteases attacks internal peptide bonds and Hberates large peptide fragments. Bromelain, a plant protease derived from the stem of the pineapple plant, can even produce detectable semm proteolysis after oral adrninistration (180). Oral therapy with bromelain significantly reduces bmising that stems from obstetrical manipulations (181). Bromelain—pancreatin combinations have been more effective in digestive insufficiency compared to either pancreatin or placebo (182,183). Bromelain may also enhance the activity of antibiotics, especially tetracycline, when adrninistered concurrently (184). 

H.D., abbrev. (Hochdruck) high pressure, heb tlich, a. obstetric. 

Woche,/. week (pi.) lying-in, confinement. Wochen-. weekly lying-in, obstetric, puerperal, maternity, -bett, n. childbed, -binde, /. sanitary napkin, -fluss, m. lochia, wochenlang, adv. for weeks. 

A conduction block is a type of regional anesthesia produced by injection of a local anesthetic drug into or near a nerve trunk. Examples of a conduction block include an epidural block (injection of a local anesthetic into the space surrounding the dura of the spinal cord) a trails sacral (caudal) block (injection of a local anesthetic into the epidural space at the level of the sacrococcygeal notch) and brachial plexus block (injection of a local anesdietic into the brachial plexus). Epidural, especially, and trailssacral blocks are often used in obstetrics. A brachial plexus block may be used for surgery of the arm or hand. 

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. 

Before starting an IV infusion of oxytocin for the induction of labor, the nurse obtains an obstetric history (parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, live birth infant abnormalities)... 

When oxytocin is prescribed, the primary health care provider orders the type and amount of IV fluid, the number of units of oxytocin added to the IV solution, and the IV infusion rate An electronic infusion device is used to control the infusion rate. The primary health care provider establishes guidelines for the administration of the oxytocin solution and for increasing or decreasing the flow rate or discontinuing the administration of oxytocin based on standards established by the Association of Women s Health, Obstetric, and Neonatal Nurses (AWHONN). Usually, the flow rate is increased every 20 to 30 minutes, but this may vary according to the patient s response. The strength, frequency, and duration of contractions and the FHR are monitored closely. 

Develop a nursing care plan for Ms. Morris, a 28-year-old, woman who is admitted to the obstetric unit with premature labor during her third trimester. This is her second child, and die has had two miscarriages. She is prescribed ritodrine for preterm labor. Analyze what nursing diagnoses would have the highest priority. Discuss how you would explore and plan to meet her emotional needs. 

Judith Watson, aged 28 years, is admitted to the obstetric unit and is to receive oxytocin to induce labor. This is her first child, and she is extremely anxious. Analyze what information would be necessary for her to receive from the nurse before the administration of oxytocin. What assessments would be important for the nurse to make during treatment with oxytocin ... 

Magnesium plays an important role in the transmission of nerve impulses. It is also important in the activity of many enzyme reactions, for example carbohydrate metabolism. Magnesium sulfate is used as replacement therapy in hypomagnesemia Magnesium sulfate (MgS04) is used in die prevention and control of seizures in obstetric patients with pregnancy-induced hypertension (PIH, also referred to as eclampsia and preeclampsia). It may also be added to TPN mixtures. 

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). 

Alvey, J. P. Obstetrical management of Rh incompata-bility based on liquor amnii studies. Amer. J. Obstet. Gynecol. (1964), 90, 769 - 775. 

Prior to 1977, trichloroethylene was used as a general and obstetrical anesthetic grain fumigant skin, wound, and surgical disinfectant pet food additive and extractant of spice oleoresins in food and of caffeine for the... 

Crawford JS, Davies P. 1975. A return to trichloroethylene for obstetrical anaesthesia. BrJAnaesth 47 482-489. 

Thierstein ST, Hanigan JJ, Faaul MD, et al. 1960. Trichloroethylene anesthesia in obstetrics Report of 10,000 cases, with fetal mortality and electrocardiographic data. Obstet Gynecol 15 560-565. 

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. 

TABLE 5. Incidence of maternal perinatal obstetrical and medical... 

Patients receiving LT4 therapy who are not maintained in a euthyroid state are at risk for long-term adverse sequelae. In general, overtreatment and a suppressed TSH is more common than undertreatment27 with an elevated TSH. Patients with long-term overtreatment may be at higher risk for atrial fibrillation and other cardiovascular morbidities, depression, and post-menopausal osteoporosis. Patients who are undertreated are at higher risk for hypercholesterolemia and other cardiovascular problems, depression, and obstetric complications. 

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