Medication in Labour

Question 1

What are prostaglandins (misoprostol) use for?

Answer 1

Encourage cervical dilatation + effacement

Require CTG monitoring

Question 2

What is oxytocin used for?

Answer 2

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

Question 3

What are the risks of oxytocin

Answer 3

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

Question 4

What are steroids used for?

Answer 4

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

Question 5

What is tocolysis used for

Answer 5

Inhibit uterine contraction

Question 6

When is tocolysis used

Answer 6

Threatened preterm
Allow transfer
Allow steroids to work

Question 7

Examples of tocolytic drugs

Answer 7

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

Question 8

When is tocolysis CI

Answer 8

Severe PET or PIH
Abruption
Active bleeding
Cardiac

Question 9

What anti-hypertensives are CI in pregnancy

Answer 9

ACEI
ARB
Spirnolactone

Question 10

How do you treat high BP in labour

How do you prevent seizures if PET or seizure

Answer 10

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

Question 11

How is 3rd stage managed

Answer 11

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

Question 12

What are non pharmacological pain relief

Answer 12

Breathing
Aromatherapy
Hot bath
Acupuncture
Hypnotherapy
TENS

Question 13

Simple analgesia and what is CI

Answer 13

Paracetamol
Dihydrocodiene

Avoid
Aspirin
Ibuprofen

Question 14

Why should Ibuprofen be avoided / aspirin

Answer 14

Premature closure
Oligo
Bleeding

Question 15

What is entonox

Answer 15

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

Question 16

SE of entonox

Answer 16

Intoxication
N+V
Dry mouth
Weak analgesia

Question 17

What are the SE of opiates

Answer 17

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

Question 18

When do you never give opiates

Answer 18

If birth imminent

Question 19

What is opiate antagonist

Answer 19

Nalaxone

Question 20

When is local anaesthetic used (lignocaine)

Answer 20

Epiostomy
Tears
Pudendal nerve block

Question 21

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

Answer 21

Tinitius
Visual disturbance 
Paraesthesia
Tingling 
Confusion
Drowsy 
Seizures 
Cardiorespiratory arrest

Lipid emulsion therapy IV

Question 22

What is an epidural

Answer 22

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

Question 23

When is epidurals CI

Answer 23

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

Question 24

What are the advantages of epidural

Answer 24

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

Question 25

What are the disadvantages of epidural

Answer 25

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

Question 26

When is spinal anaesthesia used

Answer 26

C-section

Question 27

What are the advantages of spinal anaesthesia

Answer 27

Patient awake to protect airway | Use in severe res disease / avoid GA

Question 28

What are the disadvantages of spinal anaesthesia

Answer 28

Hypotension Urinary catheter Dural puncture Nerve damage

Question 29

When is general anaesthesia used

Answer 29

C-section if no time for spina

Question 30

What are the SE of GA

Answer 30

Risk of aspiration | More difficult to intubate a pregnant women

Question 31

What are the CI to spinal

Answer 31

``` Coagulation Infection Bleeding Spinal problems Fixed CO due to stenosis ```

Question 32

What do babies get offered when born

Answer 32

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

Question 33

When are prostaglandins CI

Answer 33

Asthma | Foetal distress

Question 34

SE of prostaglandin

Answer 34

Bronchospasm Hypotension N+V

Question 35

When is a pudendal nerve block performed

Answer 35

2nd stage | If inadequate epidural for assisted delivery

Question 36

When magnesium sulphate given to mother

Answer 36

If delivery in 24 hours and <34 weeks

Question 37

What does it do

Answer 37

Helps protect fatal brain and reduce risk of cerebral palsy

Question 38

What do mothers need

Answer 38

Close monitoring for toxicity - Reflexes - RR - UO - O2