Intra/post - Medications used in labour Flashcards
what is induction of labour
when an attempt is made to instigate labour artificially
what are different ways of instigating labour
medications
artificial rupture of the amniotic membrane
for what reasons might about be induced
overdue pregnancy
medical emergencies
what is used to clinically assess the cervix
bishops score - assesses cervical ripening
higher the score = more likely indiction will be successful
what factors does bishops score take into account
dilatation length of cervix position consistency station
what are some absolute contraindications to induction of labour
abnormal lie
known pelvic obstruction/large ovarian cyst
placenta praevia
fetal distress
what are some relative contraindications to induction of labour
previous c section (risk of rupture due to scaring)
asthma - prostaglandins cause rest smooth muscle to contract)
what two drugs are commonly used to induce labour
prostaglandin analogues
oxytocin (synthetic - syntocinon)
what prostaglandin analogues are used
prostaglandin E2 analogues = Dinoprostone (propess/prostin E2)
prostaglandin E1 synthetic analogue = Misoprostel (mysodelle)
how do prostaglandin analogues help with the induction labour
encourage cervical dilatation and effacement - ripen the cervix so it can be used for induction
how are prostaglandin analogues used
inserted PV and placed in posterior fornix
what are some risks/side effects of prostaglandin analogue use
can lead to severe contractions/hypertonic uterus, nausea and vommiting, bowel upset, pyrexia, hypertension
what precautions are needed when using prostaglandin analogues
intermittent or continuous fetal monitoring (CTG)
frequent vaginal exams to assess progress
how does oxytocin help with inducing labour
initiates uterine contractions by attaching to uterine oxytocin receptors - increases frequency and force of contractions
how is oxytocin administered
through IV infusion - often used after prostaglandin treatment once amniotomy is performed
is oxytocin found naturally in the body - if so where
produced physiologically by the paraventricular nuclei and secreted by he posterior pituitary gland
what is a benefit of using oxytocin
short half life so can be stopped quickly by stopping the infusion
what precautions must be taken when using oxytocin
CTG monitoring to assess foetal wellbeing
put women on IV fluids alongside IV infusion to keep fluids/salts up
what are some risks of oxytocin
uterine hypertonicity
hypotension
hyponatraemia
what is labour augmentation
act of stimulating labour contractions to speed up the birthing process when labour slows down or stops
why must women be fully assessed before labour augmentation is started
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
what medication is used to augment labour
oxytocin - given as an IV infusion similar to that used for induction
what is physiological management of the 3rd stage of labour
waiting for the placenta to be delivered naturally without active involvement once the baby has been born
what group is advisable to have physiological management of 3rd stage labour
only advisable to groups at low risk of post partum haemorrhage or complications related to the delivery of the placenta
what is involved in active management of the 3rd stage of labour
- early clamping and cutting of the umbilical cord (routine practice is to allow 2-5 mins of delayed clamping unless contraindicated)
- use of uterotonic medications
- delivery of the placenta by controlled cord traction
what medications can be used as active management of 3rd stage labour
syntometrine - combo of oxytocin and ergometrine
oxytocin
how is syndometrine administered
given IM only - IV has risk of vasospasm
how does syntometrine help with active management
alpha agonist = casues smooth muscle (uterine) contractions
when is syntometrine contraindicated
pre-eclampsia, hypertension, some cardiac conditions
can also cause nausea and vomiting
how is oxytocin administered in active management
can be given as IM injection or via slow IV injection at caesarean section
how does oxytocin help with active management
causes uterus to contract
how can oxytocin be used prophylactically in third stage labour
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
