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Obs & Gynae > Medication in Labour > Flashcards

Medication in Labour Flashcards

1
Q

What are prostaglandins (misoprostol) use for?

A

Encourage cervical dilatation + effacement

Require CTG monitoring

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2
Q

What is oxytocin used for?

A

Initiate uterine contraction
Often after amniotomy performed
Or if poor progression
Or after labour for placenta

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3
Q

What are the risks of oxytocin

A 
Hypertonicity of uterus - CTG
CI in fetal distress 
Hypotension 
Hyponatraemia 
Give IV fluids 
Assess to ensure no complications with labour before use  
Short half life
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4
Q

What are steroids used for?

A

Between 24-35 weeks so if preterm <36 weeks
Improve lung development and outcome
Can take 24 hours to work

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5
Q

What is tocolysis used for

A

Inhibit uterine contraction

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6
Q

When is tocolysis used

A

Threatened preterm
Allow transfer
Allow steroids to work

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7
Q

Examples of tocolytic drugs

A

CCB - nifedipine = 1st line
B2 agonist
Oxytocin antagonist
Prostaglandin inhibitors - indomethacin / NSAID

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8
Q

When is tocolysis CI

A

Severe PET or PIH
Abruption
Active bleeding
Cardiac

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9
Q

What anti-hypertensives are CI in pregnancy

A

ACEI
ARB
Spirnolactone

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10
Q

How do you treat high BP in labour

How do you prevent seizures if PET or seizure

A 
Labetalol = 1st line
Hydralazine = 2nd line 
Nifedipine 
Methyldopa
IV magensium sulphate to prevent seizure
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11
Q

How is 3rd stage managed

A 
Early clamping and cutting
Uterotonic medication
- Syntometrine 
- Oxytocin alone if high BP
Controlled cord traction to delivery placenta
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12
Q

What are non pharmacological pain relief

A 
Breathing
Aromatherapy
Hot bath
Acupuncture
Hypnotherapy
TENS
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13
Q

Simple analgesia and what is CI

A

Paracetamol
Dihydrocodiene

Avoid
Aspirin
Ibuprofen

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14
Q

Why should Ibuprofen be avoided / aspirin

A

Premature closure
Oligo
Bleeding

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15
Q

What is entonox

A

Oxygen and NO
Quick onset and short half life
Use in active labour

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16
Q

SE of entonox

A

Intoxication
N+V
Dry mouth
Weak analgesia

17
Q

What are the SE of opiates

A

Respiratory depression - cross placenta
Nausea + V (prescribe anti-emetic)
Constipation
Drowsy

18
Q

When do you never give opiates

A

If birth imminent

19
Q

What is opiate antagonist

A

Nalaxone

20
Q

When is local anaesthetic used (lignocaine)

A

Epiostomy
Tears
Pudendal nerve block

21
Q

What are the signs of LA toxicity and how do you treat

A 
Tinitius
Visual disturbance 
Paraesthesia
Tingling 
Confusion
Drowsy 
Seizures 
Cardiorespiratory arrest

Lipid emulsion therapy IV

22
Q

What is an epidural

A

Regional anaesthetic block into epidural space requiring monitoring
Ice to see block
Move legs
Monitor BP

23
Q

When is epidurals CI

A 
Thrombocytopenia 
Coagulopathy / anti-coagulant
Raised ICP
Sepsis 
Allergic 
Can't consent
24
Q

What are the advantages of epidural

A

Can be topped up
Effective relief
Prevent raised BP
Best for baby

25
Q

What are the disadvantages of epidural

A 
Slow contraction 
Dural puncture = epidural blood patch 
Haematoma 
Respiratory depression 
Neurological 
Not adequate pain relief 
HYpotension
26
Q

When is spinal anaesthesia used

A

C-section

27
Q

What are the advantages of spinal anaesthesia

A

Patient awake to protect airway

Use in severe res disease / avoid GA

28
Q

What are the disadvantages of spinal anaesthesia

A

Hypotension
Urinary catheter
Dural puncture
Nerve damage

29
Q

When is general anaesthesia used

A

C-section if no time for spina

30
Q

What are the SE of GA

A

Risk of aspiration

More difficult to intubate a pregnant women

31
Q

What are the CI to spinal

A 
Coagulation 
Infection 
Bleeding
Spinal problems 
Fixed CO due to stenosis
32
Q

What do babies get offered when born

A

Vitamin K
Prevent haemorrhagic disease of the newborn - bruising to IVH / kidney
Breast milk babies prone as lack vitamin K (clotting)

33
Q

When are prostaglandins CI

A

Asthma

Foetal distress

34
Q

SE of prostaglandin

A

Bronchospasm
Hypotension
N+V

35
Q

When is a pudendal nerve block performed

A

2nd stage

If inadequate epidural for assisted delivery

36
Q

When magnesium sulphate given to mother

A

If delivery in 24 hours and <34 weeks

37
Q

What does it do

A

Helps protect fatal brain and reduce risk of cerebral palsy

38
Q

What do mothers need

A

Close monitoring for toxicity

  • Reflexes
  • RR
  • UO
  • O2

Obs & Gynae (23 decks)

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