Il Servizio di Partoanalgesia fa parte del

Dipartimento di Anestesia Rianimazione e Terapia Antalgica

directed by Dr. Massimo Zamperini.

The Service has been active since January 20, 2005. A team of hospital anesthetist doctors ensures 24-hour epidural analgesia for all days of the year.
As part of the pregnancy assistance program, the issue of pain control in labor will be addressed in special meetings, in which an anesthesiologist will provide all the information regarding epidural analgesia.
These are meetings that allow both to comprehensively illustrate the technique and to answer the various questions, clarifying any doubts, clearly explaining the advantages, the indications but also the risks, the contraindications and any complications. The meeting is part of the courses for women in labor force organized monthly by the obstetrics department.

It is located on the 3rd floor of the “Sacro Cuore” hospital, in the operating rooms.
To signal your arrival, ring the operating theater bell.

Responsible Physician: Dr. L. Cappi

Nursing Coordinator: Mr. P. Cipriani

Booking visits to outpatient clinics

ACCESS MODE:

By the seventh month of pregnancy, the parturient women interested in this possibility can participate in the meeting with an anesthesiologist who will explain the technique and deliver the forms.
The meetings are fortnightly.

Calendar 2018Calendar 2019

Information on dates and times: tel. 0456013358 – 0456014550.
Location: Training Center (near the outpatient clinics).

For all the parturient women who, once informed, want to take advantage of analgesia during labor:
About 4-6 weeks from the supposed date:
Anesthetic visit with:
– collection of anamnestic questionnaire
– required tests (blood count, PT, PTT, Fibrinogen, AT III)
– signature of consent
– any explanations
Location: Intensive Care, 3rd floor “Sacred Heart” Hospital
Hours: Tuesday and Thursday from 13.00 to 15.00
Booking: at Poliambulatori.

mode:
– From the primary care physician, ask for a binding prescription for “anesthetic examination”;
– Before the visit go to the Acceptance Office (“Sacro Cuore” hospital ground floor) for the payment of the ticket;
– Go up to the third floor of the Hospital, and play on the intercom of the Intensive Care Unit.

WHAT IS PARTOANALGESIA

The birth of a child is an emotionally involving event for the woman both for the expectations matured during the previous nine months and for the anxiety related to the labor of childbirth.
Many women are able to face labor peacefully without the need for any therapy or pain relief technique, for others however pain and anxiety can prevent this event from being lived in a serene way.

Childbirth is a technique that uses the specific effect of some drugs to reduce the pain of childbirth.

This technique consists in positioning, through a needle, a catheter in the peridural space, through which local anesthetics and analgesics are administered which act selectively on pain nerve fibers. The effect of these drugs is to reduce the pain of birth contractions, with negligible effects on the ability to use muscles and on other forms of sensitivity. During labor, you will be able to move freely.

HOW YOU DO IT

To perform the positioning of the epidural catheter you will have to take a position (sitting or sideways) such as to create a large C with your spine, bending your head forward and exposing your back to the anesthesiologist who will be behind you.

After a local skin anesthetic, the anesthesiologist will sterilely search for the peridural space with a needle and then place a catheter. It is through this catheter that the drugs will be injected.

WHEN YOU DO

Upon entering the ward, if you have decided to give birth with analgesia and have followed the entire described route, you must communicate it to the midwife, who at the appropriate time will notify the anesthesiologist. In fact, analgesia will start only when there are precise obstetric conditions, ie a well-started labor with frequent and effective uterine contractions.
When entering the delivery room, your choice must be clear: if you have opted not to do analgesia, a later rethink may be late and for the reasons listed below you may not be able to receive analgesia.
In the event that the anesthesiologist is engaged in other emergency situations, the childbirth may be delayed but will still be assured.

WHEN YOU DON’T

There are fortunately rare cases in which you will not be able to receive analgesia.

Obstetric contraindications:
– Previous interventions on the uterus (myomectomies, cesarean section)
– In case you arrive in the delivery room with a labor so advanced as to be in the expulsive phase.

Anesthetic contraindications:
– Changes in coagulation (which is why blood tests are required)
– Septic syndromes with fever
– Serious neurological diseases
– Presence of skin diseases or tattoos in the skin area where the catheter should be placed.
– An unfavorable shape of the back that can create difficulties in positioning the needle and catheter.

PROBLEMS, UNDESIDERATED REACTIONS, COMPLICATIONS

As in all medical acts, even in the analgesia of childbirth, unwanted reactions, problems and complications related to the technique of epidural may occur.
Among the drawbacks and unwanted reactions there may be
· Appearance of paresthesia, that is of shocks and tingling in the sacrum and lower limbs, motor block (reversible)
· Appearance of dizziness, chills and itching
· Realization of unilateral and non-uniform analgesia
· Difficult bladder emptying
· temperature

In the case of ineffective analgesia (3%) or partial repetition of the puncture is possible and in extreme cases the abandonment of the technique.
Peridural complications are rare, their percentage is very low, but they must be mentioned for a conscious choice:
– Headache. Its frequency is between 0.2% and 4% of cases. Generally it occurs after 24 hours from the epidural puncture in the occipital site, appears in an upright position and disappears in the supine position. It can last about a week. In some cases there may be associated, nause a, vomiting, and visual or hearing disturbances. All this requires an extension of hospitalization, bed rest, hydration and administration of anti-inflammatory drugs.
– After childbirth some women complain of back pain and sometimes sciatic pain and this, sometimes, regardless of having performed a peridural. In most cases these phenomena are related to the stress to which the spine and nerves of the pelvic region are subjected during labor and delivery.
– Only rarely in postpartum pain limited to the site of the puncture with a duration of less than three or four days can be attributed to the epidural technique.

Major neurological complications:
The reports of major neurological complications in women who have given birth with the epidural are very rare, with a variable incidence between 0 and 1 in 6000. They are:
– Temporary or permanent injuries that may cause sensitivity disorders are rare. Temporary paralysis may develop in the lower limbs caused by compression or stretching that occurred during the phases of labor; however in most cases they regress spontaneously in a few months.
– The occurrence of direct spinal cord injuries can be almost completely ruled out, as this generally ends up above the injection point.
– Hematomas, severe bleeding and infections at the injection site are rare.

Changes in the natural course of delivery:
– The analgesia of childbirth generally shortens the duration of the first phase of the birth favoring the dilation of the uterine neck.
– It is instead ascertained that childbirth can prolong the duration of the expulsive period by slowing down the frequency of uterine contractions and sometimes reducing the force of voluntary thrusts.
– Although there have been conflicting opinions in the past, it seems by now established that the use of caesarean section has not increased by birth control or even the use of the suction cup.