الفهرس 
The Female Reproductive SystemOnly 14 pages are availabe for public view
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Abstract
Labor is characterized by regular, painful uterine contractions that increase in frequency and intensity and are associated with progressive cervical effacement and dilatation. This results in severe pain for many women. In the absence of a medical contraindication, maternal request is a sufficient medical investigation for pain relief during labor. Pain management should be provided whenever it is medially indicated. The experience of labor pain is different for each woman, and the different methods chosen to relieve pain depend upon the techniques available locally and the personal choice of the individual. The different methods for labor analgesia are: Non-pharmacological: Its advantages their relative ease of administration, easy availability and minimal side-effects; however, there is little evidence to support the efficacy of many of these techniques. Pharmacological method: (A) systemic (1) inhalational methods like entonox and sevoflurane gave significantly better pain relief scores compared with entonox, but there was more sedation in women who used sevoflurane. (2) systemic analgesics: 1: Opioid as Morphine, Pethidine, Fentanil, Sufentanil, Alfentanil, 2: Non-opioid analgesics: Nalbuphine, butorphanol, buprenorphine, 3: Ketamine: In sub-anesthetic doses, ketamine has been used in late labor or at delivery. (B) Regional techniques represent the ”gold standard” for labor analgesia they include: 1- Lumbar epidural analgesia: effective analgesia during the first stage of labor 2- Combined spinal epidural analgesia (CSEA): This technique has gained increasing popularity in recent years and has advantage of both spinal and epidural techniques without an increase in complications. 3- Continuous spinal analgesia (CSA): Some advantages over the single shot spinal or the continuous epidural techniques, however it increases the likelihood of complications, like cauda equina syndrome inherently. 4- Alternative regional anesthetic techniques: a) lumbar sympathetic block which provide only first-stage labor analgesia, b) paracervical block: the drawback being fetal bradycardia, c) pudendal nerve block is safe and effective only in the second stage.