Question

Mrs. Main. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated that she had been having contractions 7 to 10 minutes apart since 4 p.m. They last 30 seconds. She also stated that she had been having "a lot of false labor" and hoped that this was "the real thing". Her membranes are intact. Mrs. Main's temperature, pulse and respirations are normal, and her blood pressure is 124/80. The fetal heart tones are 134 and regular. Mrs. Main vaginal assessment is 4/ 80%/ +1 She reported her findings to the doctor and he ordered Fentanyl 50 mcg every hour as needed for pain.

4. When would it be appropriate to give her the Fentanyl the doctor ordered? What safety measures should be taken at the time the medication is given? Also, at what point is it unsafe to give the medication to her and why?

Answer 1

The ideal opioid for labor would provide quick onset and lasting pain relief, and would have no unwanted side effects for the mother and newborn. Unfortunately, none of the opioids we have right now meet this criteria. All opioids cross the placenta and can cause side effects in the fetus, or newborn. The potential side effects are more common and more severe when you’re giving injectable opioids; side effects are less likley when these opioids are given through an epidural.

Because of these side effects, IV opioids during labor are typically not given towards the second stage of labor. This is because they might slow down and effect the baby’s breathing, and may harm the baby’s ability to breastfeed right after birth.

So epidural anesthesia is the best way to give opioid but it case if iv opioid are to be given the best stage of administration is during the latent phase of first stage of labour, after assessing the maternal condition.

All opiods cause side effects such as respiratory depression, nausea, vomiting and sedation. The usual dose in labour is 25 to 50 microgram IV repeated at 30 to 60 minutes interval.

Fentanyl should not be given during second stage of labour, when the fetus has NRFS, and maternal respiratory rate less than 8 breaths per minute.