Intra/post - Medications used in labour

Question 1

what is induction of labour

Answer 1

when an attempt is made to instigate labour artificially

Question 2

what are different ways of instigating labour

Answer 2

medications

artificial rupture of the amniotic membrane

Question 3

for what reasons might about be induced

Answer 3

overdue pregnancy

medical emergencies

Question 4

what is used to clinically assess the cervix

Answer 4

bishops score - assesses cervical ripening

higher the score = more likely indiction will be successful

Question 5

what factors does bishops score take into account

Answer 5

dilatation 
length of cervix
position
consistency 
station

Question 6

what are some absolute contraindications to induction of labour

Answer 6

abnormal lie
known pelvic obstruction/large ovarian cyst
placenta praevia
fetal distress

Question 7

what are some relative contraindications to induction of labour

Answer 7

previous c section (risk of rupture due to scaring)

asthma - prostaglandins cause rest smooth muscle to contract)

Question 8

what two drugs are commonly used to induce labour

Answer 8

prostaglandin analogues

oxytocin (synthetic - syntocinon)

Question 9

what prostaglandin analogues are used

Answer 9

prostaglandin E2 analogues = Dinoprostone (propess/prostin E2)

prostaglandin E1 synthetic analogue = Misoprostel (mysodelle)

Question 10

how do prostaglandin analogues help with the induction labour

Answer 10

encourage cervical dilatation and effacement - ripen the cervix so it can be used for induction

Question 11

how are prostaglandin analogues used

Answer 11

inserted PV and placed in posterior fornix

Question 12

what are some risks/side effects of prostaglandin analogue use

Answer 12

can lead to severe contractions/hypertonic uterus, nausea and vommiting, bowel upset, pyrexia, hypertension

Question 13

what precautions are needed when using prostaglandin analogues

Answer 13

intermittent or continuous fetal monitoring (CTG)

frequent vaginal exams to assess progress

Question 14

how does oxytocin help with inducing labour

Answer 14

initiates uterine contractions by attaching to uterine oxytocin receptors - increases frequency and force of contractions

Question 15

how is oxytocin administered

Answer 15

through IV infusion - often used after prostaglandin treatment once amniotomy is performed

Question 16

is oxytocin found naturally in the body - if so where

Answer 16

produced physiologically by the paraventricular nuclei and secreted by he posterior pituitary gland

Question 17

what is a benefit of using oxytocin

Answer 17

short half life so can be stopped quickly by stopping the infusion

Question 18

what precautions must be taken when using oxytocin

Answer 18

CTG monitoring to assess foetal wellbeing

put women on IV fluids alongside IV infusion to keep fluids/salts up

Question 19

what are some risks of oxytocin

Answer 19

uterine hypertonicity
hypotension
hyponatraemia

Question 20

what is labour augmentation

Answer 20

act of stimulating labour contractions to speed up the birthing process when labour slows down or stops

Question 21

why must women be fully assessed before labour augmentation is started

Answer 21

in late stage 1 or 2 of labour contractions may have reduced due to a complication of labour e.g. labour is obstruction ie there is a malposition so meds to increased contractions would be harmful

Question 22

what medication is used to augment labour

Answer 22

oxytocin - given as an IV infusion similar to that used for induction

Question 23

what is physiological management of the 3rd stage of labour

Answer 23

waiting for the placenta to be delivered naturally without active involvement once the baby has been born

Question 24

what group is advisable to have physiological management of 3rd stage labour

Answer 24

only advisable to groups at low risk of post partum haemorrhage or complications related to the delivery of the placenta

Question 25

what is involved in active management of the 3rd stage of labour

Answer 25

1. early clamping and cutting of the umbilical cord (routine practice is to allow 2-5 mins of delayed clamping unless contraindicated)
2. use of uterotonic medications
3. delivery of the placenta by controlled cord traction

Question 26

what medications can be used as active management of 3rd stage labour

Answer 26

syntometrine - combo of oxytocin and ergometrine

oxytocin

Question 27

how is syndometrine administered

Answer 27

given IM only - IV has risk of vasospasm

Question 28

how does syntometrine help with active management

Answer 28

alpha agonist = casues smooth muscle (uterine) contractions

Question 29

when is syntometrine contraindicated

Answer 29

pre-eclampsia, hypertension, some cardiac conditions

can also cause nausea and vomiting

Question 30

how is oxytocin administered in active management

Answer 30

can be given as IM injection or via slow IV injection at caesarean section

Question 31

how does oxytocin help with active management

Answer 31

causes uterus to contract

Question 32

how can oxytocin be used prophylactically in third stage labour

Answer 32

can be used for prophylaxis of post part haemorrhage in women who are ergometrine contraindicated - i.e. women who cannot have syndometrine e.g. those with hypertension or pre-eclpampsia