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Chapter-05 Labor Analgesia and Intrapartum Fetal Monitoring

BOOK TITLE: Advances in Obstetrics and Gynecology (Volume 2)

Author
1. Rajaram Shalini
2. Goel Neerja
3. Srivastava Himsweta
ISBN
9788184483048
DOI
10.5005/jp/books/10031_5
Edition
1/e
Publishing Year
2008
Pages
17
Author Affiliations
1. University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, University College of Medical, Sciences and Guru Teg Bahadur Hospital, New Delhi, India, New Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India; Asia Oceania Research Organization on Genital Infections and Neoplasia (AOGIN), India, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India, University College of Medical Sciences and Guru Tegbahadur Hospital, Delhi 110095, India, University College of Medical Sciences and GTB Hospital, Delhi, Guru Teg Bahadur Hospital and University College of Medical Sciences, New Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, shalini_rajaram@rediffmail.com, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi,
2. University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, neerjagoel2002@yahoo.com, University College of Medical Sciences and GTB Hospital, Delhi, India, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
3. University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
Chapter keywords

Abstract

Labor and delivery are the most stressful physiological events in the life of both mother and fetus. Labor pains are severe pains and \'there is no other circumstance which is considered acceptable for a person to experience such severe pains, amenable to safe intervention, while under a physician\'s care\'. Obstetricians should be  aware that agents used for pain relief in labor, be it parenteral narcotic agents such as meperidine (pethidine) or butorphanol or inhalational agents such as entonox or local anesthetic agents like lignocaine or bupivacaine (inadvertent intravenous injection or large doses) can cause reduced fetal heart variability, fewer accelerations, late decelerations, persistent bradycardia, etc. In addition sympathetic blockade is known to occur with both spinal and epidural analgesia leading to hypotension and therefore reduced uteroplacental blood flow and transient hypoxic events. The most challenging aspect of fetal monitoring is the recognition of hypoxia without overdiagnosis. Factors affecting fetal heart rate have been described especially elaborating on the response of fetal heart rate to hypoxia. Both internal and external fetal monitoring systems have been described. The fetal heart rate patterns like variability, accelerations, decelerations, reactivity have been explained with graphics. Other newer intrapartum surveillance techniques like fetal electrocardiography, near infra-red spectroscopy, fetal pulse oximetry have also been mentioned highlighting their advantages and disadvantages.

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