Anesthesia of labor in abnormal labor and delivery

Acupuncture for weak labor. The study showed that when using electroacupuncture to treat weak labor, qualitatively different changes in uterine contractions occur than when using drug-induced labor stimulation. These changes contribute to a more rapid completion of labor without causing deterioration in the condition of the fetus.

Pain relief in case of weak labor. In case of primary weakness of labor and uterine os dilation by 4 cm, the most effective combinations of drugs in the normal psychosomatic state of the woman in labor are pipolfen at a dose of 25-50 mg and promedol at a dose of 20 mg intramuscularly in one syringe and an antispasmodic - gangleron at a dose of 30 mg intramuscularly and spasmolitin at a dose of 100 mg orally. In this case, data on the nature of labor stimulation when using painkillers are of great importance.

If the first round of labor stimulation is not effective enough, a second round of labor stimulation is prescribed at intervals of 2 hours, consisting of 4 quinine powders orally and 5 injections of oxytocin in the same dose and at the same intervals as during the first round of labor stimulation.

Ataralgesia with dipidolor and neuroleptanalgesia. Simultaneously with the appointment of the 1st round of labor stimulation, halidorin is prescribed in a dose of 50-100 mg intramuscularly or intravenously.

Subsequently, with the 2-3 injection of oxytocin (1st round of labor stimulation) in the presence of painful contractions and pronounced psychomotor agitation, ataralgesia is used - 2 ml (15 mg) of dipidolor and 2 ml (10 mg) of seduxen or neuroleptanalgesia - fentanyl 2 ml (0.1 mg) and droperidol 2 ml (5 mg). Both mixtures are administered intramuscularly.

Both ataralgesia and neuroleptanalgesia reduce mental stress in women in labor, and significantly increase the pain threshold. The period of dilation is significantly shortened with a normal duration of the expulsion and afterbirth periods.

Discoordinated labor activity

One of the leading clinical symptoms characterizing discoordination of labor is severe constant pain in the lower abdomen and lumbar region, which does not stop between contractions, which causes inadequate behavior of the woman in labor, since the intensity of pain does not correspond to the strength of contractions. Therefore, when treating this anomaly of labor, it is necessary to use drugs with a pronounced antispasmodic and analgesic effect.

Taking these requirements into account, in the treatment of labor discoordination, both ataralgesia and neuroleptanalgesia can be used, but necessarily against the background of the action of the spasmoanalgesic baralgin.

Methods of treating discoordination of labor activity.

1. Ataralgesia (dipidolor + seduxen). When diagnosing discoordination of labor, regardless of the extent of cervical os dilation, it is recommended to administer 5 ml of the official solution of baralgin mixed with 15 ml of isotonic sodium chloride solution intravenously, and 2-3 ml (15-22.5 mg) of dipidolor and 3-4 ml (15-20 mg) of seduxen intramuscularly (depending on the body weight of the woman in labor). Repeated administration of the drugs is usually not required, since labor becomes coordinated.
2. Neuroleptanalgesia (droperidol + fentanyl). 5 ml of the official baralgin solution is administered intravenously in a mixture with 15 ml of isotonic sodium chloride solution (regardless of the degree of dilation of the cervical os). After 1 hour, 3-4 ml of a 0.25% droperidol solution and 3-4 ml of a 0.005% fentanyl solution are administered intramuscularly. Repeated administration of droperidol is not required, and repeated administration of fentanyl is necessary no earlier than after 1-2 hours, since with discoordination of labor, a shortening of the duration of labor by 2-4 hours is noted compared to women in labor who received other analgesic drugs.

The combination of baralgin with drugs for ataralgesia and drugs for neuroleptanalgesia is advisable to use in case of discoordination of labor even in the presence of a preserved and mature cervix, in the presence of regular contractions. The indicated drugs do not have a negative effect on the body of the woman in labor and the condition of the fetus and newborn.

Excessive labor activity. In order to regulate and relieve labor pain during excessive labor activity, a combination of neurotropic agents (aminazine or propazine in a dose of 25 mg) is recommended in combination with solutions of promedol 20-40 mg and pipolfen 50 mg intramuscularly, and if there is no effect, ether anesthesia is additionally used.

A high regulating effect is achieved by using fluorothane inhalations in a concentration of 1.5-2.0 vol%. In this case, the use of fluorothane leads literally in the first 2-5 minutes to the normalization of labor, with an increase in the concentration of fluorothane to 2 vol% and above, almost complete cessation of labor occurs. At the same time, normalization of the fetal heartbeat is noted. However, it should be noted that the use of fluorothane is not an etiopathogenetic method for treating excessive labor. If the cause of excessive labor is not eliminated, and also if fluorothane inhalations continue for less than 20-30 minutes, excessive labor may recur after cessation of fluorothane inhalations. In recent years, the use of beta-adrenergic agonists such as partusisten, jugopara, ritodrine in the complex treatment of excessive labor has become increasingly widespread.

Long-term epidural analgesia in labor. One of the most promising and most effective methods of pain relief in complicated labor (late toxicosis, cardiovascular diseases, labor abnormalities) is long-term epidural analgesia.

Long-term epidural analgesia is indicated in the presence of sharply painful contractions during complicated labor and established regular labor activity with the opening of the cervix by 3-5 cm.

Puncture and catheterization of the epidural space (performed by an anesthesiologist) is performed on a gurney with the woman in labor lying on her side (right) with her legs drawn up to her stomach. After identifying the epidural space (test of failure and loss of resistance, free insertion of the catheter, no leakage of solution from the needle), a test dose of anesthetic was administered through the needle (2-3 ml of 2% trimecaine solution or equivalent doses of novocaine or lidocaine). Five minutes after establishing the absence of signs of spinal block, a fluoroplastic catheter is inserted through the needle in the cranial direction 2-3 segments above the puncture (T12-L2), the needle is removed and a dose of anesthetic is administered through the catheter (10 ml of 2% trimecaine solution or 15 ml of 1% lidocaine solution or 10 ml of 2% novocaine solution). Repeated administrations of anesthetic through the catheter are performed if pain reoccurs. Typically, the administered dose of anesthetic causes analgesia for 40-60 minutes.

It is technically impossible to ensure truly continuous and uniform infusion of anesthetic throughout the analgesia using the drip method, since only due to atmospheric pressure and the gravity of the anesthetic solution itself, its free outflow into the epidural space through a thin catheter from the drip system is possible only with an open clamp, and the rate exceeds the required rate (on average 10 ml/h). Its stable regulation is possible within 7 drops per 1 min or more, which is 2 times higher than required. Precise change of the infusion rate using the clamp of the system is also not possible, since 1 ml/h corresponds to 0.32 drops per 1 min. The fact that the pressure in the epidural space of women in labor is not only increased, but also changes depending on the contractile activity of the uterus (Messih), and also that the difference in the speed of free outflow of the solution from the system depending on the filling of the bottle is large (12.3 ml/h), complicates not only the establishment and maintenance of the optimal infusion rate, but also its precise determination, as well as the dose of the administered anesthetic - both per unit of time and ultimately.

In conclusion, it should be noted that the combination of physiopsychoprophylaxis and drug pain relief during normal and, especially, complicated labor (late toxicosis of pregnancy, some cardiovascular diseases, abnormal labor) allows for a more pronounced pain-relieving effect, achieving normalization of labor due to direct myotropic, central action, as well as normalization of blood pressure and other vital functions of the body.

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