Medicines during labour

Question 1

What should be given to prevent vertical transmission of Group B strep?

Answer 1

IV penecillin

Question 2

Risk factors for group B strep infection of newborn

Answer 2

Previous affected neonate
\+urinary culture for GBS
Preterm labour
PROM >18hr
Maternal fever in labour

Question 3

If an epidural results in hypotension, what should be given?

Answer 3

IV fluids + ephedrine

Question 4

Entonox

Answer 4

quick onset and short half life

SE - feeling faint, N+V, hyperventilation

Question 5

Non-opiods

Answer 5

paracetamol

NB. NSAIDS cannot be used (cause premature closure of the PDA)

Question 6

Opioids

Answer 6

Pethidine
Meptid
Occasionally - diamorphine

IM/IV
SE - sedation, confusion, nausea
Can cause respiratory depression of newborn - naloxone reversal

Antiemetic usually required

Question 7

Advantages of regional anaesthesia

Answer 7

Pain free - can be topped up

Good in:
prolonged labour
HTN women
Abolish premature urges to push
Analgesia for instrumental delivery

Question 8

Disadvantages of regional analgesia

Answer 8

Hypotension
Local anaesthetic toxicity
Increased instrumental delivery
Bed bound --> pressure sores
Urinary retention - require catheter 
Maternal fever
Spinal tap --> headache

Question 9

Regional anaesthesia of choice for CS

Answer 9

Spinal (straight into CSF)

Question 10

Position of epidural

Answer 10

L4/L5

Question 11

Contraindications for regional anaesthesia

Answer 11

Absolute:

• Patient refusal
• Anti-coagulants + bleeding disorders
• Local or severe infection
• anaphylaxis to LA

Relative:

• Spinal surgery
• Massive haemorrhage

Question 12

Complications of regional anaesthesia

Answer 12

Immediate:

• Failure
• Hypotension
• LA toxicity
• Total spinal

Delayed:

• post-dural puncture headache
• Infection
• Haematoma
• Neurological damage