As a devil, she can give serious complications if you do not carry out careful monitoring and special preventive actions.
Epidural anesthesia and analgesia in obstetrics requires special caution, due to certain peculiarities of the organism of a pregnant woman.
The compression syndrome of the inferior vena cava, with a sharp decrease in blood flow to the heart and a drop in blood pressure, can develop when the pregnant woman is placed backwards (on her back), especially if the uterus did not enter the tone at the beginning of labor, deviating somewhat ventrally (Fig. 104). With epidural anesthesia, hypotension may be even more significant. Therefore, during epidural pain relief of labor, the woman should lie on her side. If it is necessary to lay it backwards (for example, before a caesarean section), a rolled-up sheet is placed under the right buttock, for example, so that the uterus deviates to the left and not just the vena cava, but the aorta.
The softening of the interstitial ligaments, like other ligaments, always happens at the end of the third semester. Therefore, the needle is passed through the interspinous ligament slowly and carefully so as not to “fall” into the subarachnoid space. It is even possible to mistaken the interspecific ligament as the epidural space (in it the resistance to the introduction of the solution in pregnant women is much smaller than in the supraspastic one). It helps experience, control the depth of insertion of the needle and knowledge of the normal distance from the skin to the epidural space (approximately 5 cm).
The expansion of the veins of the epidural plexus (synonym for the internal venous vertebral plexus [Latin plexus venosus vertebralis intemus ]) occurs at the end of pregnancy, because it becomes like an anastomosis between the inferior vena cava [Lat. vena cava inferior ], squeezed uterus, and unpaired vein of latin. vena azygos]. Therefore, epidural veins dilate, especially when straining.
Therefore, it is better to do epidural puncture in the middle plane (to avoid epidural veins located laterally), not during straining (possible during labor), the dose of a local anesthetic should be somewhat less and should be administered fractionally. Special attention is required for aspiration test and test dose in order to avoid intravasal administration of anesthetic.