infant feeding Flashcards
benefits of breast feeding
• Reduced risk in baby: Reduced risk in baby Chest infections o Gastroenteritis o Ear infections o Urinary infections o Insulin dependent diabetes o Allergies o Sudden infant death synd. o Childhood leukaemia o Heart disease
Reduced risk in mother o Breast, uterine and ovarian cancers o Type 2 diabetes o Osteoporosis Protective of mothers’ mental health, increasing resilience to stress and improves quality of sleep
medications used in labour
Induction of labour • IOL Contraindications o Absolute ♣ Fetal lie is not longitudinal ♣ Known pelvic obstruction such as tumour or large ovarian cyst ♣ Placenta praevia (often need caesarean section due to placental position) ♣ Cardiac disease ♣ Fetal distress Relative: previous c section asthma
medication
-prostaglandin analogues
nausea and vomitting
need intermittent or continuos fetal monitering
-oxytocin
physiologically produced by paraventricular nuclei and secreted post pituitatry
Can lead to hypotension and hyponatraemia
augmentation of labour
when contractions reduce in frequency or strength in active labour even after spontaneous onset of labour
if labour is obstructed i.e. if there is a malposition and therefore medications to increase contractions could be harmful
• Oxytocin (Syntocinon®) is used, if indicated, to augment labour
It is given in an IV infusion similar to use for induction of labour
pharmacological management of 3rd stage
active management
o Early clamping and cutting of the umbilical cord
o Use of uterotonic medications (pharmacological management)
Delivery of the placenta by controlled cord traction
medications used in active 3 rd stage
syntometrine
♣ Combination of oxytocin (syntocinon®) and ergometrine
• Ergometrine = ergot alkaloid
o Alpha agonist – causes smooth muscle (uterine) contraction
o Contraindicated in pre-eclampsia, hypertension, some cardiac conditions
o Can cause nausea and vomiting
o Syntocinon® - synthetic oxytocin only
-prophylaxis of post partum haemorrhage in women where ergometrine contraindicated
Pharmacological management of post partum management
ergometrine-IM
• Carboprost (Hemabate®)
o Carboprost is a prostaglandin (Prostaglandin F2α) which causes uterine contractions
o If bleeding is unresponsive to syntometrine and syntocinon as well as physical measures, Carboprost is given
Given as IM injection (250 micrograms) at 15 minute intervals
use of steroids
o Antenatal corticosteroids are associated with a significant reduction in neonatal deaths, respiratory distress syndrome and intraventricular haemorrhage.
o Benefits are seen even when delivery occurs within 24 hours of the first dose.
o They have no benefits for the mother but are safe for her to take.
tocolytic drugs
anti-contraction medications or labour suppressants
• Usually used in women in threatened preterm labour from 24 weeks and 34 weeks of gestation
o Oxytocin receptor antagonist
e.g. Atosiban – this is the only licensed tocolytic medication currently in the UK
o Calcium channel blocker e.g. Nifedipine
o Beta 2 agonists e.g. Terbutaline, salbutamol – act by causing relaxation of smooth muscle
o Indomethacin
• Occasionally tocolysis is indicated acutely for example if there is fetal distress and need for emergency CS, obstructed labour, or hypertonic uterus causing fetal distress. In this situation terbutaline or GTN can be used.
Magnesium sulfate
• does reduce the risk of cerebral palsy.
o Women who are between 24+0 and 29+6 weeks of gestation and who are expected to deliver within the following 24 hours should be offered magnesium sulfate for up to 24 hours.
It may also be considered in women between 30+0 and 33+6 weeks of gestation
Antihypertensive medications
• Several anti-hypertensives are used during pregnancy such as:
o Methyldopa
o Hydralazine
o Combined alpha & beta-blockers e.g. labetalol
in labour labetalol-first line therapy
second line hydralazine
• Several anti-hypertensives are used during pregnancy such as:
o Methyldopa
o Hydralazine
o Combined alpha & beta-blockers e.g. labetalol
• Contraindicated anti-hypertensives
ACE inhibitors, angiotensin receptor blockers, spironolactone
Analgesia
• Non-pharmacological
o Breathing exercises, aromatherapy, warm baths, acupuncture, hypnotherapy, etc
o TENS machine (trans-cutaneous electrical nerve stimulation)
simple analgesia
-paracetamol
-dihydrocodiene
aspirin
• Do not use: Ibuprofen / Diclofenac
o NSAIDs can cause closure of the fetal ductus arteriosus, fetal oliguria, oligohydramnios after 30 weeks’ gestation, and increase risk of bleeding in fetus
o However, commonly used post partum for pain relief
Entonox
50:50 mixture of oxygen and nitrous oxide
o Usually reserved until in active labour (i.e. not for latent phase)
Patient can feel “giddy” or intoxicated, can feel nauseated or may vomit
Opiates
o Morphine / Pethidine / Diamorphine
o Can cause nausea & vomiting, drowsiness and respiratory depression in the woman
♣ Usually co-prescribe with an antiemetic
o Can cause neonatal respiratory depression
o Remifentanyl PCA (Patient controlled analgesia) – patient self-administers bolus doses via a hand-held button; syringe driver attached to IV cannula
♣ Benefits – fast metabolism, does cross placenta but is rapidly metabolised and redistributed
Antidote (opioid antagonist) is Naloxone
local anaesthetic
o LA is also used after delivery to suture (repair) an episiotomy or vaginal tear
o You may also see an obstetrician using local anaesthetic to infiltrate transvaginally to provide a pudendal nerve block before an assisted/instrumental vaginal delivery such as a forceps delivery
o Usually Lignocaine is used – you get different strengths
o Local anaesthetic agents temporarily block action potentials at nerve endings
epidural
-requires monitoring
o Involves injection of local anaesthetic + opiate medications into the epidural space using a catheter
o Contraindications:
Thrombocytopenia, coagulopathy, raised intracranial pressure, local sepsis, septic shock,
advantages
♣ Effective analgesia during labour
♣ Can be topped up if need to transfer to theatre for instrumental or caesarean section delivery
♣ Effective after delivery if need repair of vaginal tears or manual removal of placenta (MROP)
♣ Best for baby
♣ Can prevent further raised blood pressure in pre-eclampsia
disadvantages
-causes hypotension
reduces mobility
dural puncture
inadequate analgesia
spinal anaesthesia
o Used for most caesarean sections (elective and emergency)
o Usually a local anaesthetic + opiate medication; injected into the subarachnoid space
o The anaesthetist must check the level of the anaesthetic block is adequate before the operation
o Advantages:
♣ Gives dense, anaesthetic bilateral block
♣ Patient can stay awake & protect own airway during operation – can stay awake to meet her baby!
disadvantages
similar to epidural
