Anesthesia for breech births

The use of painkillers should begin when regular labor activity is established and the cervical os is 3-4 cm dilated. Epidural analgesia is widely used in a number of foreign clinics. Scientists studied the course of labor in breech presentation under epidural analgesia in 643 women in labor (273 of whom were primiparous and 370 were multiparous) using a large clinical sample. The authors showed that epidural analgesia requires a higher frequency of oxytocin use during labor and also noted a longer labor duration. The frequency of cesarean sections in the first stage of labor did not differ in primiparous and multiparous women, but the use of epidural analgesia contributes to a more frequent use of cesarean sections in the second stage of labor in both cases. Thus, epidural analgesia is associated with a longer labor duration, an increased frequency of oxytocin use during labor, and an increased frequency of cesarean sections 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 by the pelvic end and cesarean section. In cephalic presentation, the use of oxytocin normalizes uterine activity, and the use of oxytocin in breech presentation remains controversial. The frequency of cesarean section in the second stage of labor is higher when using epidural analgesia during labor. Only in the work of Darby et al. was a decrease in the frequency of cesarean section by 50% in breech presentation under the conditions of epidural analgesia was found. Moreover, the use of oxytocin in the second stage of labor does not correct anomalies of the fetal head insertion. Chadhe et al. are of the opinion that the duration of the second stage of labor up to 4 hours does not have an adverse effect on the mother and fetus in cephalic presentation. However, this is unacceptable for women giving birth with a breech presentation of the fetus, since the prolongation of the second stage of labor in this case is an indicator of disproportion, which usually leads to a cesarean section.

For women in labor with a normal course of labor, without pronounced signs of neuropsychiatric reactions, the following medications are recommended:

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

If a pronounced sedative effect is obtained, but the analgesic effect is insufficient, after 2 hours, the following solutions are administered again in one syringe: 2.5% prolazil - 1 ml (0.025 g), 2.5% diprazine - 2 ml (0.05 g), promedol 2% - 1 ml (0.02 g) intramuscularly.

If the analgesic effect from the administration of the above agents is insufficient, these drugs can be administered again in half the dose at intervals of 2-3 hours. For women in labor who experience a pronounced sedative but insufficient analgesic effect from the administration of the above combinations of substances, only a 2% solution of promedol can be administered at the same interval - 1 ml intramuscularly (0.02 g). In the presence of painful contractions, the following can be used: predion for injection (viadril) - a single dose during labor of 15-20 mg / kg of the body weight of the woman in labor. When administered intravenously, predion can cause limited phlebitis, so it is recommended to administer it with 5 ml of the woman's blood - a total of 20 ml.

In cases of severe psychomotor agitation, the following combinations of substances are used:

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

Pain relief scheme for labor with primary weakness of labor activity. Simultaneously with the use of labor stimulating agents, the following antispasmodics are administered: spasmolitin - 0.1 g orally; 1.5% ganglerone solution - 2 ml (0.03 g) intramuscularly or intravenously with 20 ml of 40% glucose solution. Then, when the cervix is opened by 2-4 cm, a droperidol solution is administered - 2 ml (0.005 g) intramuscularly.

To avoid drug depression in the child, the last administration of analgesics to the mother in labor should be done 1-1 1/2 hours before the birth of the child.

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