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Preparing Women for Homebirth
Published in Mary Nolan, Shona Gore, Contemporary Issues in Perinatal Education, 2023
We advise women to think about getting a pool. We are great advocates for the use of water in labour, with 60% of women we care for using water to relieve pain in labour and a home waterbirth rate of 50%. We know that immersion in water can make labour quicker and more straightforward. Women also report high levels of satisfaction with using a pool for labour and/or birth (Cluett & Burns, 2009). When the pool arrives, we advise the couple to practise inflating it and to check that the attachments fit the tap – both things they will not want to struggle with for the first time once in labour! Linked with water for pain relief is the issue of entonox (gas and air). Most multiparous women will have used entonox at some point in their previous labour and are relieved to know that it will be available at home.
Obstetric Analgesia
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Entonox: Consists of oxygen and nitrous oxide in a 50:50 mixture. As nitrous oxide has a low blood-gas solubility coefficient (0.47), the equilibration with blood is very fast and thus has a rapid wash off from the lungs. The patient should be trained regarding the proper and effective usage method. Fifty seconds or ten normal breaths are needed for optimal effect. Entonox can cause nausea, sedation, and even loss of consciousness in some patients. There is an increased risk of diffusion hypoxia and desaturation when Entonox is used in combination with meperidine.
Assessing and managing pain
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Lindsey Pollard, Harriet Barker
Entonox is a 50:50 mixture of nitrous oxide and oxygen delivered through a handheld mask or mouthpiece. If the person becomes drowsy, because of the drug, their hand and therefore the delivery set will fall away. As such, Entonox is another form of PCA. It should not be used by people with Vitamin B12 deficiency and caution should be applied to those at risk of deficiency (Schug et al. 2020). It is effective for mild to moderate, short-lasting pain and is used by paramedics, in emergency care, for procedural pain and during labour. There is no absolute contraindication for the use of Entonox in the first 16 weeks of pregnancy (BOC 2016)
Patient opinion of analgesia during external cephalic version at term in singleton pregnancy
Published in Journal of Obstetrics and Gynaecology, 2020
Leire Rodríguez, Carmen Osuna, José I Pijoan, Patricia Cobos, María M Centeno, Rosa Serna, Antonia Jiménez, Izaskun Artola, Iñigo Melchor, Txantón Martínez-Astorquiza, Juan C Melchor, Jorge Burgos
Clinical Epidemiology Unit staff developed a balanced (1:1) restricted randomisation strategy using permuted blocks of unequal sizes to ensure an appropriate balanced sample size across groups. Each woman was allocated to a group during the inclusion visit by an obstetrician, when she opened a consecutively-numbered opaque sealed envelope containing an aluminium-covered card specifying the group. Study treatments were two commercially available analgesic drugs used as authorised (AEMPS): remifentanil (Ultiva; GlaxoSmithKline SA, Madrid, Spain), 1 mg vials for injectable solution or perfusion, and nitrous oxide (Entonox; AGA Gas AB, Sollentuna, Sweden), a 50:50 mixture of nitrous oxide and oxygen supplied as a gas. Nitrous oxide was administered using a facial mask with a demand or check valve, for 3 min before beginning the ECV. The gas was used continuously during the procedure (2–4 min), and the women were instructed to breathe normally. Remifentanil was administered as a continuous infusion by an infusion pump at a dose of 0.1 mcg/kg/min, for 3 min before beginning the ECV with rescue boluses of 0.1 mcg/kg on demand. In addition, oxygen nasal glasses at a dose of 4 L/min were used. No other analgesics were used in the study. The women were clinically monitored, and in the event of intense sedation, the treatment was removed until they were able to talk. What is more, oxygen saturation and heart rate were monitored constantly by pulse oximetry.
Re-intervention and patient satisfaction rates following office radiofrequency endometrial ablation: a comparative retrospective study of 408 cases
Published in Journal of Obstetrics and Gynaecology, 2022
Ahmed Ghoubara, Seuvandhi Gunasekera, Lavanya Rao, Ayman Ewies
The standard RFEA procedure was performed as described in the literature (Gimpelson 2014). Women received no gonadotropins-releasing hormones analogue or prophylactic antibiotics. The procedures were performed irrespective of the timing of the menstrual cycle. Office procedures were performed in a dedicated unit by three consultants with special interest in hysteroscopy. The standard analgesia protocol in office included ENTONOX® (BOC, Linde Healthcare, Worsley, Manchester, UK; 50: 50 mixture of nitrous oxide and air) delivered via a mouthpiece and four quadrant intracervical block using three ampoules of Lignospan® 2.2 ml each (Septodont, Kent, UK; Lidocaine Hydrochloride 2% with 1:80,000 epinephrine).
Red herring: Acute back pain after combined spinal epidural for labor analgesia
Published in Egyptian Journal of Anaesthesia, 2018
Yoong Chuan Tay, Kian Hian Tan
We present a 40-year old, 152 cm, gestational diabetic primigravid parturient with distressing acute back pain after delivery of a macrosomic baby at 37 + 6 weeks of pregnancy. She had previous history of left ovarian cystectomy 10 years ago with diet-controlled gestational diabetes during her current IVF pregnancy. Fetal growth scans at 21 and 31 weeks were normal but at 36 + 6 weeks showed polyhydramnios and fetal macrosomia (EFW 3.6 kg). Blood investigations were normal. Combined spinal epidural (CSE) analgesia was given to provide rapid onset of analgesia for her labor pain after use of Entonox. CSE insertion (18G Tuohy needle with 27G Whitacre spinal needle, 22G epidural catheter) was inserted uneventfully. Her labor lasted for 4 h with a second stage of 60 min. During delivery, her obstetrician required a Neville-Barnes forceps in a lithotomy position. A baby boy was delivered with caput succedaneum, forceps marks over cheeks. The epidural catheter was removed after delivery. She reported a severe hammer-like pain over her lower back the following morning, worsened by transition from supine to sitting and was unable to stand nor ambulate without assistance by two nurses precluding child care. Urinary incontinence accompanied intense pain episodes. There was no pain at rest. Her pain was noted over the L5 and S1 region on the right, however not radicular in nature. There were no overlying skin changes nor trigger points. An MRI to rule out an epidural hematoma was ordered, but declined by patient citing financial concerns, and upon a review by the Orthopaedics team, a lumbosacral spine X-ray was performed. Her analgesia included oral tramadol, Anarex (paracetamol and orphenadrine citrate) with ketoprofen patch to complement intramuscular pethidine. Physiotherapy was prescribed for mobilization exercises post-partum.