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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
What Antihypertensive Medications are contraindicated in Pregnancy?
1. ACE Inhibitors 2. Angiotensin Receptor Blockers (ARB's) 3. Spironolactone (Diuretic)
26
What are the methods of Analgesia in Pregnancy?
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
What methods of Analgesia are not permitted in Pregnancy?
NSAID's - Ibuprofen/ Diclofenac
28
When is Local Anaesthesia used in Pregnancy?
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
What local Anaesthesia is given?
Lignocaine | Note - can be allergic which leads to Anaesthetic Toxicity
30
What is involved in an Epidural Anaesthetic?
Injection of Local Anaesthetic + Opiate Medications into the Epidural Space using a Catheter
31
What are the Contraindications of an Epidural Anaesthetic?
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
What are the Advantages of an Epidural Anaesthetic?
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
What are the Disadvantages of an Epidural Anaesthetic?
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
When is Spinal Anaesthesia used?
Most Caesarian Sections
35
What is used in a Spinal Anaesthetic?
Local Anaesthetic + Opiate Medication injected into the Subarachnoid Space
36
What are the Advantages of Spinal Anaesthesia?
1. Dense Anaesthetic Bilateral Block | 2. Patient can stay awake and protect their own airway
37
What are the Disadvantages of Spinal Anaesthesia?
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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