Intrapartum

Question 1

Nifedipine (Procardia)

Answer 1

• CCB used as tocolytic
• inhibits myometrial contraction
• DO NOT use w/ terb and/or mag
• fetal effects secondary to maternal hypotension
• maternal effects: hypotension, HA, tachycardia

Question 2

Indomethacin (Indocin) MOA

Answer 2

• COX inhibitor used as tocolytic
• reduces prostaglandin production
• NOT recommended for >= 32 weeks

Question 3

Indomethacin (Indocin) Dosing

Answer 3

• Loading dose: 50-100 mg orally or 50 mg rectally

- Then 25- 50 mg orally q6hrs for 48 hrs

Question 4

Terbutaline (Brethine) MOA

Answer 4

• beta agonist
• causes depletion of intracellular calcium
• blocks myometrial receptors

Question 5

Terbutaline Dosing

Answer 5

• 0.25 mg SQ every 20-30 minutes up to 4 doses
• then 0.25 SQ every 3-4 hours
• FDA black box warning do NOT use for more than 72 hours

Question 6

Misoprostol (Cytotec) Dosing

Answer 6

• Prostaglandin E1
• 25-50 mcg PO q3-6 hours
• 25 mcg vaginally q3-6 hours

Question 7

Misoprostol (Cytotec) Considerations

Answer 7

• contraindicated w/ scarred uterus
• Inpatient only
• Oxytocin may be started 4 hours after last dose

Question 8

Dinoprostone (Cervidil) Dosing

Answer 8

• 10 mg (0.3 mg/hour)

- May be repeated q6hrs X 3 doses

Question 9

Cervidil Considerations

Answer 9

• may be used outpatient for some
• Monitor fetal HR for 1-2 hours after each dose
• Oxytocin may be started 6 -12 hours after last dose
• Rapid onset

Question 10

Which hormone initiates labor?

Answer 10

Prostaglandins

Question 11

Bishop Score

Answer 11

• based on cervical exam, helps determine readiness for IOL
• 3 or 5 point system
• > = 6 favorable
• <= 4 unfavorable

Question 12

Where is the sagittal suture line in the setting of anterior asynclitism?

Answer 12

• closer to the sacrum
• anterior parietal is the lowest presenting part
• anterior Most common

Question 13

Where is the sagittal suture line in the setting of posterior asynclitism?

Answer 13

• closer to the symphysis

- posterior parietal is the lowermost presenting part

Question 14

First Degree Laceration

Answer 14

• involves perineal skin only

Question 15

Second Degree Laceration

Answer 15

• involves skin, vaginal mucosa, and posterior fourchette

- perineal body fascia and musculature, but not anal sphincter

Question 16

3A Laceration

Answer 16

• <50% of the external anal sphincter

Question 17

3B Laceration

Answer 17

• > 50% of the external anal sphincter

Question 18

3C Laceration

Answer 18

• Complete rupture of the external anal sphincter and the internal anal sphincter is torn