medication s used in labour

Question 1

absolute contraindications to induction of labour

Answer 1

abnormal lie
known pelvic obstruction
placenta praevia
fetal distress

Question 2

why is prev CS a relative contraindication to induction

Answer 2

scar at risk of rupture

risk rupture inc by using PG

Question 3

why is asthma a relative contraindication to induction

Answer 3

PG can cause resp smooth muscle contraction

Question 4

what to prostaglandin analogues do

Answer 4

encourage cervical dilatation and effacement

ripen cervix for induction of labout

Question 5

where are PG analogues inserted

Answer 5

vPV into posterior fornix of vagina

Question 6

monitoring whilst using PG

Answer 6

frequent vaginal exam to assess cervix

intermittent or continuous fetal monitoring

Question 7

what does synthetic oxytocin do

Answer 7

initiates uterine contractions by attaching to uterine oxytocin receptors
inc frequency and force of contractions

Question 8

oxytocin physiological production

Answer 8

produced by paraventricular nuclei and secreted by posterior pituitary gland

Question 9

oxytocin monitoring

Answer 9

CTG to monitor fetal well-being due to risk of uterine hypertonicty

Question 10

what can PG analogues cause

Answer 10

severe contractions/hypertonic uterus
N&V
bowel upset 
pyrexia
hypotension

Question 11

what can oxytocin cause

Answer 11

hypotension and hyponatreamia

Question 12

when is augmentation of labour required

Answer 12

when contractions reduce in frequency or strength in active labour even after spontaneous onset of labour

Question 13

what medication is used to augment labour

Answer 13

oxytocin

Question 14

medications used in active management of 3rd stage labour

Answer 14

sntometrine (combo of oxytocin and ergometrine)

oxytocin

Question 15

when is ergometrine contraindicated

Answer 15

pre-eclampsia
htn
some cardiac conditions

Question 16

pharmacological management PPH

Answer 16

oxytoxin 
syntometrin or ergometrine
carboprost
misoprostol
tranexamic acid

Question 17

carboprost

Answer 17

prostaglandin

causes uterine contractions

Question 18

when is carboprost CI

Answer 18

asthmatics - can cause bronchospasm

Question 19

tranexamic acid

Answer 19

antifibrinolytic medication - reduce bleeding

Question 20

steroids used in threatened preterm labour

Answer 20

betamethasone or dexamethasone given by im injection

24-35wks of gestation (and up to 39wks if planned CS)

Question 21

tocolytic drugs

Answer 21

inhibit uterine contractions

used in women threatened preterm labour 24-35wks

Question 22

when can tocolytic medication be considered

Answer 22

• facilitate transfer of woman in labour to another hosp

- give steroid medication enough time to work

Question 23

drugs which can be used for tocolysis

Answer 23

CCB e.g. nifedipine
oxytocin receptor antagonist
beta2 agnosit
indomethacin

Question 24

antihypertensives used in pregnancy

Answer 24

combined alpha + beta blockers e.g. labetolol
nifedipine
methyldopa
hydralazine

Question 25

first line therapy htn

Answer 25

labetalol

Question 26

when may IV magnesium sulphate be used

Answer 26

symptomatic pre-eclampsia, at risk of eclampsia

Question 27

antihypertensives CI in pregnancy

Answer 27

ACEI
ARBs
spironolactone

Question 28

simple analgesia

Answer 28

paracetomal
dyhydocodeine/codeina
aspirin

Question 29

why to avoid aspirin in labour

Answer 29

increases bleeding risk

Question 30

what not to use for analgesia

Answer 30

ibuproden/diclofenac

Question 31

why don’t use NSAIDs

Answer 31

can cause premature closure of fetal ductus arteriosus, fetal oliguria, oligohydramnios after 30wks
risk bleeding in fetus

Question 32

entonox

Answer 32

nitrous oxide

usually reserved until in active labour

Question 33

epidural contraindication

Answer 33

thrombocytopenia
coagulopathy 
raised ICP 
local sepsis
septic shock 
allergy to local anaesthetic