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3rd Year - Reproductive Diseases > 5.1. Intra-Partum and Post-Partum Care - Medications of Labour > Flashcards

5.1. Intra-Partum and Post-Partum Care - Medications of Labour Flashcards

1
Q

What are the Absolute Contraindications for the Induction of Labour?

A
  1. Foetal Lie is not Longitudinal
  2. Known Pelvic Obstruction
  3. Placenta Praevia
  4. Cardiac Disease
  5. Foetal Distress
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2
Q

What are the Relative Contraindications for Induction of Labour?

A
  1. Previous Caesarian Section

2. Asthma

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3
Q

What is used for the Induction of Labour?

A
  1. Prostaglandin Analogues

2. I.V. Oxytocin

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4
Q

What is the function of the Prostaglandin Analogue, used in Induction of Labour?

A
  1. Encourages Cervical Dilation and Effacement

2. May lead to contractions

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5
Q

What is the function of the I.V. Oxytocin, used in Induction of Labour?

A

Initiates Uterine contractions

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6
Q

When is Augmentation of Labour required?

A

When contractions reduce in Frequency or Strength in Active Labour
Note - This happens even after spontaneous onset of Labour

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7
Q

Why might Augmentation of Labour be needed?

A

Complication of Labour - Obstruction etc.

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8
Q

What is used to Augment Labour?

A

I.V. Oxytocin

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9
Q

What does Active Management of the Third Stage of Labour Involve?

A
  1. Early Clamping and Cutting of the Umbilical Cord
  2. Use of Uterotonic Medications (Pharmacological Management)
  3. Delivery of the Placenta by Controlled Cord Traction
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10
Q

What Medications are used in the Active Management of the Third Stage of Labour?

A
  1. I.M. Injection of Synometrine - Combination of Syntocinon and Ergometrine
  2. Syntocinon - Synthetic Oxytocin
  3. Ergometrine = Ergot Alkaloid, causes smooth Muscle Contraction
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11
Q

What are the 2 types of Post-Partum Haemorrhage?

A
  1. Primary - >500mls blood loss within 24 hours

2. Secondary - >500mls blood loss after 24 hours

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12
Q

What are the Medthods of managing a Post-Partum Haemorrhage?

A
  1. Physical
  2. Invasive
  3. Surgical
  4. Pharmacological
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13
Q

What is the Physical management of a Post-Partum Haemorrhage?

A
  1. Rubbing up a Contraction

2. Bimanual Compression

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14
Q

What is the Pharmaological Management of Post-Partum Haemorrhage?

A
  1. Syntocinon - Synthetic Oxytocin
  2. Synometrine / Ergometrine Alone
  3. Carboprost (Prostaglandin)
  4. Misoprostol (Prostaglandin)
  5. Tranexamic Acid (Anti-Fibrinolytic)
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15
Q

What is needed for the immediate management of a Primary Post-Partum Haemorrhage?

A
  1. Wide Bore I.V. Access
  2. I.V. Fluids
  3. Blood Transfusion
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16
Q

When are Steroids used in Preterm Labour?

A
  1. If a woman is at risk of Pre-Term Labour
  2. If a woman has a Medical Need to Expedite Delivery before Term
  3. If a woman presents with Threatened Spontaneous Pre-Term Labour
    Note - Administration can take 12-24 hours to get to full dose, so avoid delays
17
Q

What Steroids are used in Preterm Labour?

A
  1. I.M. Injection Betamethasone
  2. I.M. Injection Dexamethosone
    Between the 24th-35th week of Gestation (up to the 39th week if planned Caesarian Section)
18
Q

What is the purpose of Steroid Use in Preterm Labour?

A
  1. Improve Neonatal Outcomes in Preterm Babies

2. Improve Foetal Lung Development

19
Q

What is the function of Tocolytic Medications?

A

Inhibition of Uterine Contraction

20
Q

Who is given Tocolytic Medication?

A
  1. Women in Threatened Preterm Labour (from 24 - 34 weeks of Gestation)
  2. Acutely - Foetal Distress and need for Emergency Caesarian Section
21
Q

What drugs can be used for Toxolysis?

A
  1. Oxytocin Receptor Antagonist - Atosiban
  2. Calcium Channel Blockers - Nifedipine
  3. Beta-2 Agonsts - Salbutamol
  4. Indomethacin
22
Q

When might Antihypertensive Medications be prescribed in Pregnancy?

A
  1. Pre-Existing Hypertension
  2. Pregnancy-Induced Hypertension
  3. Pre-Eclampsia
    Note - Specialist Obstetric Input
23
Q

What Antihypertensive Medications are used in Pregnancy?

A
  1. Labetolol (Combined Alpha and Beta Blocker) - 1st Line Therapy
  2. Methyldopa (Antiadregenergic)
  3. Hydralazine (Vasodilator)
24
Q

How is the Risk of / Symptomatic Pre-Eclampsia treated?

A

I.V. MAgnesium Sulphate - to prevent / treat seizures

25
Q

What Antihypertensive Medications are contraindicated in Pregnancy?

A
  1. ACE Inhibitors
  2. Angiotensin Receptor Blockers (ARB’s)
  3. Spironolactone (Diuretic)
26
Q

What are the methods of Analgesia in Pregnancy?

A
  1. Non-Pharmacological - Breathing Exercises / Warm Bath / Acupuncture / Hypnotherapy
  2. Simple - Paracetamol / (Dihydro)codiene / Aspirin
  3. Entonox - 50:50 mix of O2 and Nitrus Oxide
  4. Opiates - Morphine
  5. Local Anaesthesia
  6. Epidural Anaesthesia
  7. Spinal Anaesthesia
27
Q

What methods of Analgesia are not permitted in Pregnancy?

A

NSAID’s - Ibuprofen/ Diclofenac

28
Q

When is Local Anaesthesia used in Pregnancy?

A
  1. Intradermally before I.V. Cannula is Inserted
  2. Suture an Episiotomy / Vaginal Tear
  3. Infiltrate Transvaginally
  4. Pudendal Nerve Block before Instrumental (Foreceps) Vaginal Delivery
29
Q

What local Anaesthesia is given?

A

Lignocaine

Note - can be allergic which leads to Anaesthetic Toxicity

30
Q

What is involved in an Epidural Anaesthetic?

A

Injection of Local Anaesthetic + Opiate Medications into the Epidural Space using a Catheter

31
Q

What are the Contraindications of an Epidural Anaesthetic?

A
  1. Thrombocytopenia
  2. Coagulopathy
  3. Raised Intracranial Pressure
  4. Local Sepsis / Septic Shock
  5. Allergy to the local Anaesthetic
  6. Lack of Patient Consent
  7. Anticoagulants within 12 hours of insertion
32
Q

What are the Advantages of an Epidural Anaesthetic?

A
  1. Effective Analgesia
  2. Can be topped up if need Instrumental / C-Section
  3. Effective after delivery if Vagina needs repair / Manual Removal of the Placenta (MROP)
  4. Best for the Baby
  5. Can prevent further raised blood pressure in Pre-Eclampsia
33
Q

What are the Disadvantages of an Epidural Anaesthetic?

A
  1. Can fail to provide adequate analgesia
  2. Causes hypotension
  3. Reduces a Womans Mobility
  4. Risk of Dural Puncture
  5. Risk of Epidural Haematoma / Abscess
  6. Risk of Respiratory Depression
  7. Risk of Neurological Deficits
34
Q

When is Spinal Anaesthesia used?

A

Most Caesarian Sections

35
Q

What is used in a Spinal Anaesthetic?

A

Local Anaesthetic + Opiate Medication injected into the Subarachnoid Space

36
Q

What are the Advantages of Spinal Anaesthesia?

A
  1. Dense Anaesthetic Bilateral Block

2. Patient can stay awake and protect their own airway

37
Q

What are the Disadvantages of Spinal Anaesthesia?

A
  1. Risk of Inadequate Pain Relief
  2. Shorter Duration - it can wear off
  3. Causes Hypotension
  4. Needs a Urinary Catheter
  5. Risk of Dural Puncture
  6. Small risk of Nerve Damage

3rd Year - Reproductive Diseases (41 decks)

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