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OBS & GYNAE (Obstetrics & Gynaecology) > Intrapartum Care - Medications > Flashcards

Intrapartum Care - Medications Flashcards

1
Q

Pain Relief in Labour.

A
  1. Simple Analgesia : Paracetamol or Codeine (not NSAIDs).
  2. Gas and Air (Entonox).
  3. IM Pethidine/Diamorphine.
  4. Patient-Controlled Analgesia.
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2
Q

What is Gas and Air (Entonox)?

A
  1. 50% Nitrous Oxide and 50% Oxygen - short-term pain relief in contractions.
  2. Deep breaths using mouthpiece at start of contraction and stop as contractions ease.
  3. Adverse Effects : Lightheadedness, Nausea, Sleepiness.
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3
Q

What is IM Pethidine/Diamorphine?

A
  1. Opioid medications to help with anxiety and distress.
  2. Adverse Effects : Maternal Nausea and Drowsiness and Foetal Respiratory Depression and Poor First Feed (avoid too close to birth).
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4
Q

What is Patient-Controlled Analgesia? (2)

A
  1. IV Remifentanil - press a button at the start of contraction to administer a bolus of short-acting opiate.
  2. Careful Monitoring : Naloxone for Respiratory Depression and Atropine for Bradycardia.
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5
Q

How do Epidurals work? (3)

A
  1. Insert a catheter into the epidural space in the lower back.
  2. Infuse Local Anaesthetics into Epidural Space.
  3. They will diffuse to the surrounding tissues and through to the spinal cord.
  4. Requires indwelling urinary catheter and confined to bed.
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6
Q

What options are available for Epidural? (2).

A

Usually Mixed with Fentanyl :

  1. Levobupicaine.
  2. Bupivacaine.
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7
Q

Adverse Effects of Epidurals (8).

A
  1. Headache after Insertion.
  2. Hypotension.
  3. Motor Weakness in Legs.
  4. Nerve Damage.
  5. Prolonged Second Stage.
  6. Increased Probability of Instrumental Delivery.
  7. Risk of Epidural Haematoma.
  8. Contraindication : Coagulopathy.
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8
Q

When would women need urgent anaesthetic review?

A

If they develop significant motor weakness (unable to straight leg raise) - this might be due to incorrect siting of the catheter into the SAH space.

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9
Q

What is Oxytocin?

A

A hormone secreted by the posterior pituitary gland, produced by the hypothalamus - Syntocinon (Brand Name).

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10
Q

Function of Oxytocin (3).

A 
During Labour and Delivery : 
1. Stimulate Ripening of the Cervix.
2. Stimulate Contractions of the Uterus.
During Breastfeeding :
3. Lactation.
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11
Q

Indications of Oxytocin (4).

A
  1. Induce Labour.
  2. Progress Labour.
  3. Improve Frequency/Strength of Uterine Contractions.
  4. Prevent/Treat PPH.
  5. Active Management of Third Stage of Labour.
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12
Q

Alternative to Nifedipine in Tocolysis (Premature Labour).

A

Atosiban - Oxytocin Receptor Antagonist.

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13
Q

Mechanism of Action of Nifedipine.

A

CCB - reduces smooth muscle contraction in blood vessels and the uterus.

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14
Q

Indications of Nifedipine in Pregnancy (2).

A
  1. Reduce BP in HTN and PET.

2. Tocolysis - Suppress Uterine Activity and Delay Onset of Labour.

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15
Q

Mechanism of Action of Ergometrine.

A

Stimulates smooth muscle contraction in the uterus and blood vessels via a-Adrenergic, Dopaminergic and Serotonergic receptors.

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16
Q

Indications of Ergometrine.

A
  1. Prevent/Treat PPH.

2. Support Delivery of Placenta (3rd Stage of Labour).

17
Q

Contraindication of Ergometrine.

A
  1. Before Delivery of Baby.
  2. Eclampsia.
  3. CAUTION : HTN.
18
Q

Adverse Effects of Ergometrine.

A
  1. Hypertension.
  2. Diarrhoea.
  3. Vomiting.
  4. Angina.
  5. Coronary Artery Spasm.
19
Q

What is Syntometrine?

A

Combination drug containing Oxytocin and Ergometrine - prevention/treatment of PPH.

20
Q

Mechanism of Action of Prostaglandins.

A

Dinoprostone (Prostaglandin E2) : Stimulate contraction of uterine muscles and ripen cervix before delivery.

21
Q

Why are NSAIDs contraindicated in Pregnancy?

A

Vasodilator - lower BP.

22
Q

What forms are Prostaglandins used in? (3)

A
  1. Vaginal Pessaries (Propess).
  2. Vaginal Tablets (Prostin Tablets).
  3. Vaginal Gel (Prostin gel).
23
Q

Mechanism of Action of Misoprostol.

A

Prostaglandin Analogue - binds to Prostaglandin receptors and activates them to cause uterine contractions.

24
Q

Indications of Misoprostol (3).

A
  1. Medical Management - Miscarriage.
  2. With Mifepristone - Abortions.
  3. Induction of Labour after Intrauterine Foetal Death.
25
Q

Mechanism of Action of Mifepristone.

A
  1. Anti-Progestogen : blocks the action of Progesterone to halt the pregnancy and ripen the cervix.
  2. Enhances effects of Prostaglandins to stimulate uterine contractions.
26
Q

Indications of Mifepristone.

A
  1. With Misoprostol - Abortions.

2. Induction of labour after Intrauterine Foetal Death.

27
Q

Contraindications of Mifepristone.

A

Healthy Pregnancy.

28
Q

Adverse Effects of Mifepristone.

A

Menorrhagia.

29
Q

Mechanism of Action of Terbutaline.

A

B-2 Agonist to stimulate B2 Adrenoceptors to relax smooth muscle of the uterus to suppress uterine contractions.

30
Q

Indications of Terbutaline.

A

Tocolysis - Uterine Hyperstimulation (especially when excessive contractions during induction of labour).

31
Q

Mechanism of Action of Carboprost.

A

Synthetic Prostaglandin Analogue - binds to Prostaglandin Analogues and stimulates uterine contractions.

32
Q

Indications of Carboprost.

A

Deep IM Injection in PPH if Ergometrine and Oxytocin are inadequate.

33
Q

Contraindications of Carboprost.

A

Asthma - can cause Life-Threatening Asthma.

34
Q

Mechanism of Action of Tranexamic Acid.

A

Antifibrinolytic medication that reduces bleeding by binding to Plasminogen’s Lysine Receptor Sites which usually is converted into Plasmin (which dissolves Fibrin within blood clots).

35
Q

Indications of Tranexamic Acid.

A
  1. Prevention and Treatment of PPH.

2. Menorrhagia.

36
Q

How is Tranexamic Acid given?

A

IV Bolus followed by an infusion in cases of major haemorrhage.

OBS & GYNAE (Obstetrics & Gynaecology) (73 decks)

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