Effects of Maternal Analgesia and Anesthesia on the Fetus and Newborn

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Information about Effects of Maternal Analgesia and Anesthesia on the Fetus and Newborn
Health & Medicine

Published on July 10, 2009

Author: King_maged

Source: slideshare.net

Effects ofmaternal analgesia and anesthesia on the fetus and newborn BY MAGED ZAKARIA NICU Resident

PART I:ANALGESIA FOR LABOUR Nonpharmacologic methods Continuous labour support The use of baths, even if membranes were ruptured. Touch/massage Intradermal water blocks Maternal movement and positioning Systemic opioids Nitrous oxide (N2O) Paracervical block Neuraxial analgesia

Potential Adverse Effects of Untreated Maternal Pain on the Fetus Compensatory MA VC of uterine vessels Left shift of oxyhemoglobin dissociation curve with  O2 release to tissues  Placental perfusion Lipolysis Increased FFA  Ketosis

1. Systemic Opioids Mechanism of actionOpioids act on specific opiate receptors (mu, kappa, and sigma).  Of these, the mu appears most important in terms of analgesia and respiratory depression opioid effects.  The mu receptor type consists of the least two subtypes, mu-1 which probably mediates analgesia and mu-2 which probably mediates respiratory depression, bradycardia, and physical dependence. Opioids may affect the fetus directly, as a result of placental transfer, and/or indirectly, by affecting maternal ventilation or uterine tone. These effects are largely dose rather than drug dependent.All opioids have the potential to  baseline FHR and  variability. It has also been documented that parenteral narcotics can be associated with neonatal respiratory depression,  neonatal alertness, inhibition of sucking, and a delay in effective feeding.

Mechanism of actionOpioids act on specific opiate receptors (mu, kappa, and sigma).  Of these, the mu appears most important in terms of analgesia and respiratory depression opioid effects.  The mu receptor type consists of the least two subtypes, mu-1 which probably mediates analgesia and mu-2 which probably mediates respiratory depression, bradycardia, and physical dependence.

Opioids may affect the fetus directly, as a result of placental transfer, and/or indirectly, by affecting maternal ventilation or uterine tone. These effects are largely dose rather than drug dependent.

All opioids have the potential to  baseline FHR and  variability. It has also been documented that parenteral narcotics can be associated with neonatal respiratory depression,  neonatal alertness, inhibition of sucking, and a delay in effective feeding.

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