MDSO - Obs

Question 1

MDSO: Preterm: Drugs, Dose, Patch, Condition

Answer 1

All are MANDATORY PATCH

TOCOLYTIC: Indomethacin (< 30 w only) : 100 mg PR (then 25-50 q 6 hrs for 48 hrs) , OR Nifedipine (Adalat) (MAP>70) : 20 mg PO - (then 10 mg PO q 20 min if contractions persist, to MAX of 40 mg in 1st hour, then 10-20 mg q 4 hrs to max 120 mg /day (if contractions persist)

STEROID:
< 35 w (can discuss up to 36 +6)
Dexamethasone: 6 mg IM q 12 hrs x 4….OR Betamethasone (Celestone) 12 mg IM q 24 hrs x 2

ANTIBIOTICS:
Ampicillin 2 g IV q 6 hrs AND Erythromycin 250mg IV q 6 hrs for 48 hrs

MgSO4: (< 32 w for neuroprotection)
4 g (150 mg/min MAX), then 1 g/hr
*comes as 5 g, mix into 250 = 20 mg/mL
*450 mL/hr for 200 mL , then 50 mL/hr for the rest

As per Flow Chart:
In Preterm Labour: give tocolytic, steroid < 35 w, and MgSO4 if < 32 w, ABX
PPROM no Labour: give steroid , ABX - monitor for fetal distress and infection

**Remember if bleeding : Left Lateral, Fetal Assessment, Consider Shock MDSO

Question 2

MDSO: Pre-Eclampsia / Eclampsia: Drug , Dose, Patch, Condition

Answer 2

Indication: Severe Pre-Eclampsia, up to 28 days post partum
Severe = HELLP = hemolysis, elevated liver, low platelet (< 100 000) , edema - pulm, neuro / visual

Seizure Prophylaxis / Seizure (1st line) - MP
MgSO4
5/250 - 200 cc (4g) @ 450 mL/hr - - - then last 50 mL / hr (1g)

HYPPERTENSION - MP
Labetalol 10-20 mg IV q 20 min PRN or 1-2 mg/min infusion …OR …. Hadralazine 5-10 mg > 2 min q 20 min

ACTIVE SEIZURE - IP
1st line is MgSO4 - if not already given/recently given - same dose as above
OR
Midaz (IP) - usual doses: 5 mg IV q 5 (max 0.2 mg/kg) min or 10 mg IM

Mg TOX: (IP)
CaCl: 1 g > 20 min PIV (> 5 min PIV) - - – if under 50 kg, 20 mg/kg
or
CaGluc 10%: 1g > 2-3 min SlowIVP q 5 min x 2 –if under 50 kg, max 40 mg/kg

Question 3

Signs of Severe Pre-Eclampsis

Answer 3

BP > 160/100
Headache / Blurry Vision / Neuro Symptoms
SOB / Pulm Edema / Generalized Edema
HELLP - Hemolysis, Elevated Liver Enzymes x 2, Low Platelet (< 100 000)
Proteinuria
Renal Failure / Oliguria

Question 4

MDSO: PPH

Answer 4

OCYTOCIN: - IP
10 units IM with anterior shoulder, then 10 more units AFTER Placental Delivery

BRANDT MANOEVRE (IP)
- gentle cord traction , with suprapubic counter pressure
**delivery of placenta > 15 min late, big increase in bleeding complication

ERONOVINE (MP) (alpha vasoconstrictor)
-contraindicated in HTN
-Major Bleed ..only AFTER PLACENTA DELIVERY.
0.2 mg IV or IM q 2-4hrs x 5

AFTER PLACENTAL DELIVERY:
External Uterine Massage
External Bimanual
Internal Bimanual
Bakri Balloon

**consider Blood Products

Question 5

PROM vs PPROM

Answer 5

PROM = rupture before labour ; PPROM = PREMATURE RoM (< 37 w)