medication s used in labour Flashcards
absolute contraindications to induction of labour
abnormal lie
known pelvic obstruction
placenta praevia
fetal distress
why is prev CS a relative contraindication to induction
scar at risk of rupture
risk rupture inc by using PG
why is asthma a relative contraindication to induction
PG can cause resp smooth muscle contraction
what to prostaglandin analogues do
encourage cervical dilatation and effacement
ripen cervix for induction of labout
where are PG analogues inserted
vPV into posterior fornix of vagina
monitoring whilst using PG
frequent vaginal exam to assess cervix
intermittent or continuous fetal monitoring
what does synthetic oxytocin do
initiates uterine contractions by attaching to uterine oxytocin receptors
inc frequency and force of contractions
oxytocin physiological production
produced by paraventricular nuclei and secreted by posterior pituitary gland
oxytocin monitoring
CTG to monitor fetal well-being due to risk of uterine hypertonicty
what can PG analogues cause
severe contractions/hypertonic uterus N&V bowel upset pyrexia hypotension
what can oxytocin cause
hypotension and hyponatreamia
when is augmentation of labour required
when contractions reduce in frequency or strength in active labour even after spontaneous onset of labour
what medication is used to augment labour
oxytocin
medications used in active management of 3rd stage labour
sntometrine (combo of oxytocin and ergometrine)
oxytocin
when is ergometrine contraindicated
pre-eclampsia
htn
some cardiac conditions
pharmacological management PPH
oxytoxin syntometrin or ergometrine carboprost misoprostol tranexamic acid
carboprost
prostaglandin
causes uterine contractions
when is carboprost CI
asthmatics - can cause bronchospasm
tranexamic acid
antifibrinolytic medication - reduce bleeding
steroids used in threatened preterm labour
betamethasone or dexamethasone given by im injection
24-35wks of gestation (and up to 39wks if planned CS)
tocolytic drugs
inhibit uterine contractions
used in women threatened preterm labour 24-35wks
when can tocolytic medication be considered
- facilitate transfer of woman in labour to another hosp
- give steroid medication enough time to work
drugs which can be used for tocolysis
CCB e.g. nifedipine
oxytocin receptor antagonist
beta2 agnosit
indomethacin
antihypertensives used in pregnancy
combined alpha + beta blockers e.g. labetolol
nifedipine
methyldopa
hydralazine
first line therapy htn
labetalol
when may IV magnesium sulphate be used
symptomatic pre-eclampsia, at risk of eclampsia
antihypertensives CI in pregnancy
ACEI
ARBs
spironolactone
simple analgesia
paracetomal
dyhydocodeine/codeina
aspirin
why to avoid aspirin in labour
increases bleeding risk
what not to use for analgesia
ibuproden/diclofenac
why don’t use NSAIDs
can cause premature closure of fetal ductus arteriosus, fetal oliguria, oligohydramnios after 30wks
risk bleeding in fetus
entonox
nitrous oxide
usually reserved until in active labour
epidural contraindication
thrombocytopenia coagulopathy raised ICP local sepsis septic shock allergy to local anaesthetic
