Labor and Delivery

Question 1

Prostaglandins E and F role in labor

Answer 1

strongly contract uterine smooth muscle and promote oxytocin-induced contractions

Question 2

inhibitors of prostaglandins prolong gestation …

Answer 2

NSAIDs and Cox-2 inhibitors

Question 3

Oxytocin involved in maintenance of labor - not initiation

Answer 3

:)

Question 4

Estrogens effect on myomerium

Answer 4

increases the number of oxytocin receptors

Question 5

Stage 1 of labor

Answer 5

cervical effacement and dilation

dependent on prostaglandins

Question 6

Stage 2 of labor

Answer 6

Descent of the presenting party and delivery of fetus

Contractions stimulated by prostaglandins and oxytocin

Question 7

Stage 3 of labor

Answer 7

Separation and delivery of the placenta

Oxytocin promotes hemostasis by continued contraction of uterus

Question 8

Uterine smooth muscle relaxation via

Answer 8

B2 adrenergic receptor stimulation

Question 9

Misoprostol (Cytotec) Use

Answer 9

Oxytocic agent
Induces uterine contractions PO
Vaginal gel stimulates cervical ripening

Question 10

Oxytocin (Pitocin) Use

Answer 10

Produces uterine and mammary ductal contractions
No effect on cervical dilation but most commonly used for labor induction after cervical ripening
used also for postpartum hemorrhage

Question 11

Tocolytic therapy goal

Answer 11

to delay delivery long enough to reduce prematurity symptoms in baby

Question 12

Nifedipine for tocolytic use

Answer 12

Calcium channel blocker
relaxes uterine smooth muscle
Concern that falling BP of mom will effect baby

Question 13

Terbutaline for tocolytic use

Answer 13

B2-adrenergic agonist - smooth muscle relaxer
Suppresses contractions and treats pre-mature labor
Not effective is cervix is dilated and/or ROM

Question 14

Terbutaline for tocolytic use concerns

Answer 14

Increased HR, palpitations, hypokalemia, hyperglycemia, hypotension, pulmonary edema

Question 15

Magnesium Sulfate for tocolytic use

Answer 15

Depress smooth muscle contractions by blocking calcium action.
Not proven to prevent premature birth

Question 16

Indomethacin for tocolytic use

Answer 16

Prostaglandin synthesis inhibitor - very potent and widely used NSAID
Remember: ductus arteriosis patency dependent on prostaglandins
Can cause pulmonary hypertension in fetus and postnatally

Question 17

Acetaminophen is safest NSAID for use during pregnancy

Answer 17

:)

Question 18

Mifepristone use in medical abortion

Answer 18

Progesterone derivative
Competitively antagonizes progesterone receptors –> causes decidual breakdown in early pregnancy
Used orally up to 9 weeks of pregnancy
Must be followed by a prostaglandin (misoprostol)

Question 19

Methotrexate use in medical abortion

Answer 19

Folic acid antagonist that disrupts rapidly growing tissues

NOT FDA approved … must be followed by a misoprostol