labor and delivery

Question 1

which electrolyte plays a critical role in controlling uterine muscle contraction?

Answer 1

Calcium

Question 2

which electrolyte has a an inhibitory effect on uterine m. contraction?

Answer 2

ATP-sensitive potassium

Question 3

what is the MC cause of perinatal maternal death in developed world?

Answer 3

postpartum hemorrhage

Question 4

what drugs promote uterine contractions?

Answer 4

oxytocin
prostaglandin E2
carboprost
Mifepristone
Methylergonovine

Question 5

Oxytocin’s effect on the body?

Answer 5

produces excessive uterine contractions and ripens the cervix

Question 6

The PGE2 gel is placed where? and what does it cause?

Answer 6

in the cervical canal –> cervical ripening and also promotes uterine contractions

Question 7

Prostaglandin E2: where is the vaginal insert (dinoprostone, cervidil) placed and when is it removed?

Answer 7

into posterior fornix of the vagina and removed just before delivery

Question 8

what is the vaginal suppository of PGE2 used for?

Answer 8

termination of pregnancy from 12-20th wk of gestation (HIGH DOSE = 20mg)

Question 9

side effects for PGE2’s?

Answer 9

N/V and sometimes fever, HTN and hypotension

Question 10

Carboprost causes….

Answer 10

strong uterine contractures MCly for postpartum hemorrhage but can also induce uterine emptying

Question 11

when should you not use carboprost?

Answer 11

for elective induction of uterine contractures w/viable infant

Question 12

side effects of carboprost?

Answer 12

bronchospasm- contraindicated in asthma, HTN, V/D, “choking”

Question 13

Mifepristone use

Answer 13

to terminate pregnancy up through day 49 of gestation

Question 14

what drug is routinely given after delivery of the placenta in all vaginal deliveries or C-sections to enhance uterine contraction?

Answer 14

oxytocin usu. single IV infusion

Question 15

what effect does Methylergonovine during pregnancy?

Answer 15

causes uterine contractions and vasoconstriction, usu. given IM after delivery of baby

Question 16

what complications can occur if methylergonovine cause?

Answer 16

risk of severe HTN and CVA’s when IV is given too rapidly

Question 17

what agents suppress uterine contractions?

Answer 17

Tocolytic agents- MCly to suppress labor that would result in premature infant

Question 18

Hoq long can tocolytic agents delay delivery?

Answer 18

by 48hrs to 1wk (allows drugs to accelerate fetal lung maturity)

Question 19

what drugs suppress uterine contractions?

Answer 19

terbutaline, nifedipine, NSAID’s (indomethacin, ibu), Mag sulfate

Question 20

terbutaline off label use in pregnancy?

Answer 20

beta2 agonist that causes uterine smooth m. relaxation

Question 21

SE’s for terbutaline off label use in pregnancy?

Answer 21

a syndrome of tachycardia, pulmonary edema, hypokalemia, metabolic acidosis, and hypotension

BBox warning: no oral or prolonged parenteral use (beyond 48-72hrs) d/t maternal cardiotoxicity and death

Question 22

Using Magnesium sulfate for more than 5-7 days in utero may lead to –>

Answer 22

hypocalcemia and incr’d risk of osteopenia and bone fx’s in newborns

Question 23

Use of mag sulfate is assoc. w/ decreased risk of which condition?

Answer 23

cerebral palsy

Question 24

SE’s/ toxicity of mag sulfate?

Answer 24

very high serum magnesium levels produce weakness, paralysis, respiratory failure, and hypotension

renal insufficiency will impair Mg2+ elimination

Question 25

Nifedipine MOA?

Answer 25

CCB that relaxes uterine smooth and vascular m.

Question 26

SE’s of Nifedpine?

Answer 26

constipation

Question 27

NSAID’s (indomethacin, ibu) MOA?

Answer 27

cause uterine relaxation

Question 28

SE’s for NSAID use in pregnancy?

Answer 28

decrease GFR in the baby, narrowing or closure of fetal ductus arteriosis

Question 29

NSAID indications during pregnancy?

Answer 29

avoid unless given specifically for tocolytic therapy

Question 30

Hydroxyprogesterone caproate use?

Answer 30

given IM wkly to women w/recurrent miscarriage at greater than about 20wks