labor and delivery Flashcards
which electrolyte plays a critical role in controlling uterine muscle contraction?
Calcium
which electrolyte has a an inhibitory effect on uterine m. contraction?
ATP-sensitive potassium
what is the MC cause of perinatal maternal death in developed world?
postpartum hemorrhage
what drugs promote uterine contractions?
oxytocin prostaglandin E2 carboprost Mifepristone Methylergonovine
Oxytocin’s effect on the body?
produces excessive uterine contractions and ripens the cervix
The PGE2 gel is placed where? and what does it cause?
in the cervical canal –> cervical ripening and also promotes uterine contractions
Prostaglandin E2: where is the vaginal insert (dinoprostone, cervidil) placed and when is it removed?
into posterior fornix of the vagina and removed just before delivery
what is the vaginal suppository of PGE2 used for?
termination of pregnancy from 12-20th wk of gestation (HIGH DOSE = 20mg)
side effects for PGE2’s?
N/V and sometimes fever, HTN and hypotension
Carboprost causes….
strong uterine contractures MCly for postpartum hemorrhage but can also induce uterine emptying
when should you not use carboprost?
for elective induction of uterine contractures w/viable infant
side effects of carboprost?
bronchospasm- contraindicated in asthma, HTN, V/D, “choking”
Mifepristone use
to terminate pregnancy up through day 49 of gestation
what drug is routinely given after delivery of the placenta in all vaginal deliveries or C-sections to enhance uterine contraction?
oxytocin usu. single IV infusion
what effect does Methylergonovine during pregnancy?
causes uterine contractions and vasoconstriction, usu. given IM after delivery of baby
what complications can occur if methylergonovine cause?
risk of severe HTN and CVA’s when IV is given too rapidly
what agents suppress uterine contractions?
Tocolytic agents- MCly to suppress labor that would result in premature infant
Hoq long can tocolytic agents delay delivery?
by 48hrs to 1wk (allows drugs to accelerate fetal lung maturity)
what drugs suppress uterine contractions?
terbutaline, nifedipine, NSAID’s (indomethacin, ibu), Mag sulfate
terbutaline off label use in pregnancy?
beta2 agonist that causes uterine smooth m. relaxation
SE’s for terbutaline off label use in pregnancy?
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
Using Magnesium sulfate for more than 5-7 days in utero may lead to –>
hypocalcemia and incr’d risk of osteopenia and bone fx’s in newborns
Use of mag sulfate is assoc. w/ decreased risk of which condition?
cerebral palsy
SE’s/ toxicity of mag sulfate?
very high serum magnesium levels produce weakness, paralysis, respiratory failure, and hypotension
renal insufficiency will impair Mg2+ elimination
Nifedipine MOA?
CCB that relaxes uterine smooth and vascular m.
SE’s of Nifedpine?
constipation
NSAID’s (indomethacin, ibu) MOA?
cause uterine relaxation
SE’s for NSAID use in pregnancy?
decrease GFR in the baby, narrowing or closure of fetal ductus arteriosis
NSAID indications during pregnancy?
avoid unless given specifically for tocolytic therapy
Hydroxyprogesterone caproate use?
given IM wkly to women w/recurrent miscarriage at greater than about 20wks
