Medication in Labour Flashcards
What are prostaglandins (misoprostol) use for?
Encourage cervical dilatation + effacement
Require CTG monitoring
What is oxytocin used for?
Initiate uterine contraction
Often after amniotomy performed
Or if poor progression
Or after labour for placenta
What are the risks of oxytocin
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
What are steroids used for?
Between 24-35 weeks so if preterm <36 weeks
Improve lung development and outcome
Can take 24 hours to work
What is tocolysis used for
Inhibit uterine contraction
When is tocolysis used
Threatened preterm
Allow transfer
Allow steroids to work
Examples of tocolytic drugs
CCB - nifedipine = 1st line
B2 agonist
Oxytocin antagonist
Prostaglandin inhibitors - indomethacin / NSAID
When is tocolysis CI
Severe PET or PIH
Abruption
Active bleeding
Cardiac
What anti-hypertensives are CI in pregnancy
ACEI
ARB
Spirnolactone
How do you treat high BP in labour
How do you prevent seizures if PET or seizure
Labetalol = 1st line Hydralazine = 2nd line Nifedipine Methyldopa IV magensium sulphate to prevent seizure
How is 3rd stage managed
Early clamping and cutting Uterotonic medication - Syntometrine - Oxytocin alone if high BP Controlled cord traction to delivery placenta
What are non pharmacological pain relief
Breathing Aromatherapy Hot bath Acupuncture Hypnotherapy TENS
Simple analgesia and what is CI
Paracetamol
Dihydrocodiene
Avoid
Aspirin
Ibuprofen
Why should Ibuprofen be avoided / aspirin
Premature closure
Oligo
Bleeding
What is entonox
Oxygen and NO
Quick onset and short half life
Use in active labour
SE of entonox
Intoxication
N+V
Dry mouth
Weak analgesia
What are the SE of opiates
Respiratory depression - cross placenta
Nausea + V (prescribe anti-emetic)
Constipation
Drowsy
When do you never give opiates
If birth imminent
What is opiate antagonist
Nalaxone
When is local anaesthetic used (lignocaine)
Epiostomy
Tears
Pudendal nerve block
What are the signs of LA toxicity and how do you treat
Tinitius Visual disturbance Paraesthesia Tingling Confusion Drowsy Seizures Cardiorespiratory arrest
Lipid emulsion therapy IV
What is an epidural
Regional anaesthetic block into epidural space requiring monitoring
Ice to see block
Move legs
Monitor BP
When is epidurals CI
Thrombocytopenia Coagulopathy / anti-coagulant Raised ICP Sepsis Allergic Can't consent
What are the advantages of epidural
Can be topped up
Effective relief
Prevent raised BP
Best for baby
What are the disadvantages of epidural
Slow contraction Dural puncture = epidural blood patch Haematoma Respiratory depression Neurological Not adequate pain relief HYpotension
When is spinal anaesthesia used
C-section
What are the advantages of spinal anaesthesia
Patient awake to protect airway
Use in severe res disease / avoid GA
What are the disadvantages of spinal anaesthesia
Hypotension
Urinary catheter
Dural puncture
Nerve damage
When is general anaesthesia used
C-section if no time for spina
What are the SE of GA
Risk of aspiration
More difficult to intubate a pregnant women
What are the CI to spinal
Coagulation Infection Bleeding Spinal problems Fixed CO due to stenosis
What do babies get offered when born
Vitamin K
Prevent haemorrhagic disease of the newborn - bruising to IVH / kidney
Breast milk babies prone as lack vitamin K (clotting)
When are prostaglandins CI
Asthma
Foetal distress
SE of prostaglandin
Bronchospasm
Hypotension
N+V
When is a pudendal nerve block performed
2nd stage
If inadequate epidural for assisted delivery
When magnesium sulphate given to mother
If delivery in 24 hours and <34 weeks
What does it do
Helps protect fatal brain and reduce risk of cerebral palsy
What do mothers need
Close monitoring for toxicity
- Reflexes
- RR
- UO
- O2
