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PAP Qs Epidural and IOL
Terms in this set (26)
At what spinal level is the epidural commonly given? Why?
Name 3 differences between spinal anaesthesia and epidural analagesia
1. A spinal is a one time dose, with no catheter
2. An epidural uses a catheter and a PCA, you can add doses
3. Spinals are fasting acting, and generally higher doses
What are 4 possible side effects of epidural?
2. Spinal Headache
3. Distrupted Labour
6. Low grade fever
7. Fetal brady
What maternal and fetal monitoring should occur after an epidural is given?
IA can be used after an epidural if normal HR present. Blood pressure needs to be taken Q5 for 20 minutes, empty bladder, assess block
What are the symptoms of a subarachnoid placement of the epidural catheter? What about an intravascular administration of epidural medication?
Why might a spinal headache occur? How is this treated?
Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the tough membrane (dura mater) that surrounds the spinal cord. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache. It can be treated by a blood patch, or just rest.
Describe the epidural space of the spine
The epidural space is past the ligamentum falvum, but before the subarachnoid or dural level. It is the area where the catheter is placed. When getting through the ligamentum flavum, you will have a loss of resistnace and this is how you know you are in the correct place.
Why might an epidural be patchy? How can this be resolved?
Because the medication is pooling on one side of the spine, acting on only those nerves. This can be corrected by changing positions, and may sometimes mean that the epidural needs to be re -done.
What are some contraindications to epidural?
Low blood pressure, low platlets, abnormal anatomy, infection of the spine, History of allergies to local anesthetics, Increased intracranial pressure
Define post dates and post-term?
Early term is 37 weeks to 38+6
Full term is 39-40+6 weeks
Late term is 41 to 41+6 weeks
post-term 42 weeks +
What are the risks of a post-dates pregnancy?
Stillbirth increases between 39 and 41, and 41 and 42. the highest it gets is 1.3 or something.
What are the risks of induction of labour?
uterine tachysystole, rupture of uterus, FHR concerns, adverse reaction to oxytocin, PPH, failed induction
What does the evidence say about the following: stretch and sweep, red raspberry leaf tea, evening primrose oil
S&S is shown to reduce post dates if done regularily after 38 weeks. RRLF and EPO are not as studied. EPO is shown to not be evidence based.
What sort of monitoring is recommended by the AOM for pregnancies after 41+0?
1. Prior to 41+0 weeks' gestation, discuss the risks and benefits of induction of labour between 41 and
42 weeks' gestation and offer induction by 42+0 weeks' gestation.
2. Inform clients that the absolute risk of perinatal death from 40+0 weeks to 41+0 weeks to 42+0
weeks' gestational age changes; currently available research is not of high quality and has not
established an optimal time for induction. Therefore, clients with uncomplicated postdates
pregnancies should be offered full support in choices that will allow them to enter spontaneous
labour. A policy of expectant management to 42+0 weeks following an informed choice
discussion is the most appropriate strategy for clients who wish to maximize their chance of
For clients choosing expectant management beyond 42+0 weeks, discuss the lack of clear evidence
on which to base a recommendation regarding expectant management other than a trend towards
increasing perinatal morbidity and mortality with increasing gestational age (II-2-A)
What is the purpose of the Bishop Score? True or false, the Bishop score measures the following: cervical position, cervical effacement, fetal station, cervical consistency and cervical dilation. What score would indicate the need for cervical ripening?
True and less than 6
What methods may be used for cervical ripening? What are the advantages and disadvantages of each?
Cervical ripening: S&S, intercourse, dates, cervadil, foley.
Is prostaglandin gel contraindicated with PROM? With VBAC?
VBAC yes, PROM yes according to SOGC
True or false: amniotomy alone is an evidence-based method of labour induction
If there is a favourable cervix, but you may need oxytocin
What are the contraindications to amniotomy? What are the risks? What is the method for performing amniotomy?
High presenting part, infection, unfavourable cervix, etc. Insert your right hand to do a VE, find a bulgy spot that is not near the head, insert the hook and sweep with index finger of right hand or use left hand holding the hook to apply pressure while the right hand secures the spot.
What is oxytocin? Describe the low dose protocol. What are the risks associated with oxytocin administration?
Low dose protocol: The low-dose regimen begins
with 1 to 2 mU/min, increased incrementally by 1 to 2 mU
at 30-minute intervals. The benefits of
the low-dose regimen include less risk of tachysystole and
the use of a smaller overall dose. Max dose is 30 mu/min
What contraction pattern is associated with effective oxytocin augmentation? Is EFM recommended with oxytocin induction?
5 in 10 min and EFM to make sure not tachy or FHR concerns
What is the SOGC guideline for cervical dilation per hour?
.5 cm per hour after 5 or 6 cm
At what dilation can a diagnosis of active labour be made?
4 cm SOGC, 6 cm new evidence
What are the 4 "P"s of progress in labour?
Pyche (emotional state)
What are some non pharmacological interventions that can be used to encourage progress in a stalled labour?
ARM, S&S, climbing stairs two at a time, walking, castor oil, nipple stim
What pharmacological interventions can be used to encourage progress in a stalled labour?
Oxytocin or prostaglandin
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