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Summary Pain Relief in Labour

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A 1-4 page document written by a final year medical student with distinction grades in the uploaded modules. These notes are concise and of very high quality - using a combination of textbooks, lectures, and current guidelines (NICE and RCOG). These documents are the only resource you should need f...

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  • December 19, 2018
  • 3
  • 2017/2018
  • Summary
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By: Monnie1213 • 4 year ago

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MedStudentUK
Pain Relief in Labour
 Pain during labour is generally severe, with only 2-4% of women reportng minimal pain in labour
 Analgesia during normal labour is not mandatory but all women should be aware of the optons available
to them.
 Indicatons:
Recommended -
- Cardiac disorders
- Suspected difcult intubaton
- Breech
- Multple pregnancy
Mandatory -
- Assisted vaginal delivery
- Perineal repair
- Manual removal of placenta
- C-secton
 Physiology of pain in labour:
- First stage of labour: Cervical dilaton and uterine contractons  myometrial ischaemia  pain
sensaton travels from uterus via visceral aferents/sympathetc nerves  enter the spinal cord
through the posterior segment of the thoracic spine at T10-T12  Pain perceived by brain
- Second stage of labour: Distenton of the pelvic foor/vagina/perineum due to the presentng part of
the foetus  Pain signals travel from these organs via sensory fbres of the sacral nerve at S2-S4
(pudendal nerve)  Pain perceived by brain

Types/Details Advantages Disadvantages
NON-  Holistc (Acupuncture, No/few side efects Not efectve for severe pain
PHARMACOLOGICA Hypnosis, Aromatherapy) -
L TECHNIQUES Unproven efects
 Relaxaton – e.g. Warm
baths, Massage, Breathing
exercise, Psychoprophylaxis
/Lamaze classes
 TENS – promotes
endogenous encephalin
release within the spinal
cord, where it inhibits pain
transmission.
GENERAL GA which is administered  Very quick delivery  Aspiraton 
ENDOTRACHEAL through EDT. Pt remains (ideal in emergency Pneumonia or
ANAESTHESIA unconscious while gas is being C-secton, or Pneumonits
supplied through the tube. Instrumental) (‘Mendelson
 Relaxes the cervix – syndrome’)
Agents: aids in breech  Hypoxic cerebral injury
 Lidocaine  Low risk of (if EDT obstructed)
 Fentanyl hypovolemia+  Neonatal depression
 Propofol haemorrhage  Upper airway injury
 PPH (Atony)
SYSTEMIC  Opiate agonists Opiate agonists – General
ANALGESIA - Pethidine IV (1mg/kg)  Very effectve  N+V
- Morphine IV  Reversal agent  Resp. depression
- Diamorphine IV available (naloxone)  Over-sedaton
- Remifentanil IV (good Partal opioid  Decreased FHR
alternatve to epidural agonist/antagonist – Opiate agonists –
if contraindicated)  Few S/Es  Delayed gastric

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