Respiratory

As labor pain becomes severe, the unmedicated patient's minute ventilation increases by >75% in first stage and 150-300% during second stage of labor. This results in maternal hypocarbia and alkalosis. These changes lead to uteroplacental and fetoplacental vasoconstriction and a leftward shift of the maternal oxyhemoglobin dissociation curve, potentially resulting in fetal hypoxemia. Effective regional analgesia will markedly diminish maternal hyperventilation. Oxygen consumption increases by 40% in stage 1 and 75% in stage 2. This is attenuated, but not eliminated by regional analgesia. Parenteral opioid administration does not effectively prevent hyperventilation, in contrast to regional anesthesia. Most mothers and fetuses are not adversely affected by the respiratory changes occurring with labor. However, in patients with marginal uteroplacental function effective regional analgesia may be advantageous.

Anxiety and Depression 101

Anxiety and Depression 101

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