Anesthesia at birth in the pelvic presentation

The use of anesthetics should begin with the establishment of regular labor and the opening of the uterine throat 3-4 cm. In a number of foreign clinics, epidural analgesia is widely used. Scientists on a large clinical material studied the course of labor in the pelvic presentation in the conditions of epidural analgesia in 643 women giving birth (of which 273 are primiparous and 370 are multi-rodent). The authors showed that epidural analgesia requires a higher frequency of oxytocin in labor, and also noted a longer duration of labor. The rate of cesarean section in the first stage of labor did not differ in the first and multi-gene, but the use of epidural analgesia promotes more frequent use of caesarean section in the II stage of labor in both cases. Thus, epidural analgesia is associated with longer duration of labor, an increase in the frequency of oxytocin in labor and an increase in the frequency of cesarean section in the second stage of labor. Some authors have shown that epidural analgesia significantly reduces the intensity of uterine contractions in the active phase of labor and in the second stage of labor, which leads to an increase in the frequency of fetal extraction beyond the pelvic end and cesarean section. At the head presentation oxytocin normalizes the uterine activity, and the use of oxytocin for pelvic presentation of the fetus remains controversial. The frequency of cesarean section in the second stage of labor is higher when epidural analgesia is used in labor. Only in the work of Darby et al. A decrease in the incidence of caesarean section by 50% in breech presentation under conditions of epidural analgesia was revealed. Moreover, the use of oxytocin in the II stage of labor does not correct the anomalies of insertion of the fetal head. Chadhe et al. Adhere to the view that the duration of the II period of labor until 4 hours does not adversely affect the mother and fetus with headache. However, this is unacceptable for parturients with pelvic presentation of the fetus, since the lengthening of the II period of labor in this case is an indicator of a disproportion that usually leads to a caesarean section operation.

In parturient women during the normal course of the birth act, without expressed signs of neuropsychiatric reactions, the following medicines are recommended:

• promedol in a dose of 0.02 g intramuscularly, the maximum permissible single dose of promedol is 0.04 g, also intramuscularly;
• 20% solution of sodium oxybutyrate - 10-20 ml intravenously, has a pronounced sedative and relaxing effect. The drug is contraindicated in case of myasthenia gravis, caution is required when using it in parturient women with hypertensive forms of late toxicosis;
• Combination in one syringe of solutions of droperidol - 2 ml (0.005 g), fentanyl 0.005% - 2 ml (0.1 mg), ganglerone 1.5% - 2 ml (0.03 g) intramuscularly.

In the case of obtaining a pronounced sedative but insufficient analgesic effect, after 2 hours, the solutions of prolazil 2.5% - 1 ml (0.025 g), diprasine 2.5% - 2 ml (0.05 g), promedol 2% - 1 ml (0.02 g) intramuscularly.

In case of insufficient analgesic effect from the administration of these agents, these preparations can be reintroduced in a half dose with an interval of 2-3 hours. The parturients who have a pronounced sedative but insufficient analgesic effect from the administration of the above combinations of substances can enter one only 2% solution of promedol - 1 ml intramuscularly (0.02 g). In the presence of painful contractions can be applied: predion for injection (viadril) - a one-time dose in childbirth of 15-20 mg / kg of the mass of the mother giving birth. With intravenous administration, the predion can cause limited phlebitis, so it is recommended to inject it with 5 ml of the blood of the parturient woman - only 20 ml.

At the expressed psychomotor exaltation the following combinations of substances are used:

• solution of aminazine 2.5% - 1 ml (0.025 g) + solution of diprazine 2.5% - 2 ml (0.05 g) + solution of promedol 2% - 1 ml (20 mg) intramuscularly in one syringe;
• solution of droperidol - 4 ml (0.01 g) + gangleron solution 1.5% - 2 ml (0.03 g) intramuscularly in one syringe.

Scheme of anesthesia of labor with primary weakness of labor. Simultaneously with the application of rhodostimulating agents, the following antispasmodics are introduced: spasmolitin - 0.1 g inine; gangleron solution 1.5% - 2 ml (0.03 g) intramuscularly or intravenously with 20 ml of 40% glucose solution. Then, when the uterine throat is opened for 2-4 cm, a solution of droperidol - 2 ml (0.005 g) is injected intramuscularly.

In order to avoid a drug depression in a child, the last administration of an analgesic woman in labor should be performed 1-1 / 2 h before the birth of the child.

[1], [2], [3]