L&D Flashcards
What effect does calcium play in uterine contractions?
muscle contraction
What effect does stimulation of ATP-sensitive potassium channels?
inhibits muscle contraction
3 reasons for promotion of uterine contractions?
- Cervical ripening (thinning and softening)
- Control of postpartum hemorrhage
- Pregnancy termination
Name 5 drugs that promote uterine contractions
- Oxytocin
- Prostaglandin E2
- Carboprost
- Mifepristone
- Methylergonovine
Oxytocin: indications
- induce labor
- promote cervical ripening
- control post partum hemorrhage
Prostaglandin E2: indications
-promote cervical ripening and contractions
Carboprost: indications
-postpartum hemorrhage
Mifepristone: indication
terminate pregnancy
Methylergonovine: indication
-postpartum hemorrhage
Which drugs are indicated for controlling postpartum hemorrhage?
- Oxytocin (IV)
- Carboprost (IM)
- Methylergonovine (IM)
What complications can come from giving too much Oxytocin too fast?
- *excessive uterine contractions
- Uterine rupture
- fetal distress (robs O2 from baby)
What forms does prostaglandin E2 come in? What are each used for?
- PGE2 gel
- Vaginal insert
**cervical ripening + uterine contractions
- Vaginal suppository
* *termination of pregnancy (weeks 12-20) [higher dose]
Prostaglandin side effects
- Nausea, vomiting, (sometimes fever)
- Hypertension and hypotension
What is carboprost used for?
- postpartum hemorrhage (IM)
- induce uterine emptying at 13-20 weeks with non-viable infant (but not for elective abortion)
When is it contraindicated to give a women Carboprost?
asthma (gives bronchospasm)
Carboprost side effects
- Bronchospasm**
- HTN
- Diarrhea, vomiting
- “choking”
Mifepristone uses
-terminate pregnancy up through 49 days gestation
Why is methylergonovine given IM?
given IM after delivery to lessen postpartum bleeding
IV use not recommended due to increased risk of severe hypertension (if given too rapidly)
What do tocolytic agents do?
- suppress uterine contractions
- suppress labor so baby isn’t born prematurely (can delay 48hrs to a week)
If you need to accelerate fetal lung maturity what drugs to you give?
- Betamethasone IM
- Dexamethasone IM
-give to women between 24 and 34 weeks gestation at risk for giving birth in the next 7 days
Name the 4 drugs that suppress uterine contractions (Tocolytics)
- Terbutaline (beta-2 agonist)
- Nifedipine (CCB)*
- NSAIDs
- Magnesium sulfate
Terbutaline
- beta 2 agonist
- causes uterine smooth muscle relaxation
- oral, SQ, or IV
Terbutaline: side effects
- syndrome of tachycardia
- pulmonary edema
- hypokalemia
- metabolic acidosis
- hypotension
Terbutaline: black box warning
Oral and prolonged IM, or IV use (more than 48-72hrs) due to maternal cardiotoxicity and death
Magnesium sulfate
- DO NOT use for more than 5-7 days –> may lead to in utero exposure may lead to hypocalemia, increased risk of osteopenia and bone fractures in newborns
- category D (according to FDA: evidence of human fetal risk)
In what way is magnesium sulfate protective in premature infants?
neuroprotective, decreases occurrence of moderate to severe cerebral palsy
Magnesium sulfate: side effects/toxicity
High serum levels:
- weakness
- paralysis
- respiratory failure
- hypotension
What type of patient do you need to use caution for Magnesium sulfate?
-Renal patients
if insufficiency body won’t eliminate and may predispose to toxicity –> hemodialysis may be needed to correct
Nifedipine
- CCB
- relaxes uterine smooth muscle and vascular muscle
Side effects: constipation
NSAIDs
ex. indomethacin, Ibuprofen
- 2nd or 3rd line agent
Side effects:
- decrease GFR in baby
- narrowing/closure of fetal ductus arteriosis
Hydroxyprogesterone caproate
- Maintains pregnancy (improves action of progesterone)
- Given IM weekly (starting at 16 weeks) if hx of recurrent miscarriage at greater than 20 weeks
