Obs: L&D - CTG, pain relief & drugs

Question 1

what are some indications for contonuous CTG monitoring?

Answer 1

• Sepsis
• Maternal tachycardia (> 120)
• Significant meconium
• Pre-eclampsia (particularly blood pressure > 160 / 110)
• Fresh antepartum haemorrhage
• Delay in labour
• Use of oxytocin
• Disproportionate maternal pain

Question 2

what do we look for on CTG?

Answer 2

• DR – Define Risk (define the risk based on the individual woman and pregnancy before assessing the CTG)
• C – Contractions
• BRa – Baseline Rate
• V – Variability
• A – Accelerations
• D – Decelerations
• O – Overall impression (given an overall impression of the CTG and clinical picture)

Question 3

what are some options (non-pharmacological) which can improve pain in labour?

Answer 3

• Understanding what to expect
• Having good support
• Being in a relaxed environment
• Changing position to stay comfortable
• Controlled breathing
• Water births may help some women
• TENS machines may be useful in the early stages of labour

Question 4

what are some pharmacological options for pain relief in labour?

Answer 4

simple analgesia - paracetamol, codeine

entonox

IM pethidine or diamorphine

PCA

Epidural

Question 5

describe use of entonox in labour

Answer 5

50% nitrous oxide and 50% oxygen

short term during contraction

can cause lightheadedness, nausea and sleepiness

Question 6

describe the use of pethidine or diamorphine as pain relief in labour

Answer 6

opioid medication given IM

may help with anxiety and distress but can cause nausea in mother and resp depression in the neonate if given too close to birth

can make first feed harder

Question 7

describe the use of patient controlled analgesia in labour

Answer 7

patient controlled IV remifentanil

pt presses button at start of contraction

needs careful monitoring and input from anaesthetics and access to naloxone and atropine

Question 8

describe the use of epidural in labour

Answer 8

inserting small tube known as catheter into the epidural space in the lower back (OUTSIDE the dura mater, separate from the spinal cord and CSF)

local anaesthetic medications are infused

usually levobupivacaine or bupivacaine mixed with fentanyl

Question 9

what are some adverse effects of an epidural?

Answer 9

• Headache after insertion
• Hypotension
• Motor weakness in the legs
• Nerve damage
• Prolonged second stage
• Increased probability of instrumental delivery

Question 10

what is oxytocin?

Answer 10

hormone secreted by the posterior pituitary gland, produced in the hypothalamus and travels to the pituitary before being released

stimulates the ripening of the cervix and contractions of the uterus during labour and delivery

role in lactation and breastfeeding

Question 11

what are oxytocin infusions used for?

Answer 11

induce labour, progress labour, improve frequency and strength of uterine contractions, prevent or treat pph

Question 12

what is the brand name for drug oxytocin?

Answer 12

syntocin

Question 13

what is atosiban?

Answer 13

oxytocin receptor antagonist

used as an alternative to nifedipine for tocolysis in premature labour

Question 14

what is ergometrine?

Answer 14

stimulates smooth muscles contraction, both in uterus and blood vessels

useful for delivery of the placenta and to reduce postpartum bleeding

used in 3rd stage of labour and postpartum to prevent and treat pph

only used AFTER delivery of baby

Question 15

what are the side effects of ergometrine and why are they cause?

Answer 15

action on smooth muscle in blood vessels and gi tract

causes hypertension, diarrhoea, vomiting, angina

AVOID in eclampsia and with caution in hypertension

Question 16

what is syntometrine?

Answer 16

combination drug containing oxytocin and ergometrine

used to prevent or treat pph

Question 17

what are prostaglandins?

Answer 17

act like local hormones, triggering specific effects in local tissues

tissues throughout the entire body contain and respond to prostaglandins

needed for menstruation and labour - stimulating contraction of uterine muscles, ripening cervix before delivery

Question 18

what is dinoprostone?

Answer 18

prostaglandin E2

used fro induction of labour

comes in 3 forms:

vaginal pessaries, vaginal tablets, vaginal gel

Question 19

Prostaglandins act as vasodilators, and lower blood pressure. NSAIDs such as ibuprofen and naproxen inhibit the action of prostaglandins. As a result, NSAIDs can increase blood pressure. NSAIDs are generally avoided in pregnancy, and also after delivery in women with raised blood pressure (although research has shed doubt on whether the effects on blood pressure is significant enough to justify avoiding them). NSAIDs (e.g. ibuprofen and mefenamic acid) are useful in treating dysmenorrhoea (painful periods), as they reduce the painful cramping of the uterus during menstruation.

Question 20

what is misoprostol?

Answer 20

prostaglandin analogue meaning it binds to prostaglandin receptors and activates them

medical management in miscarriage to help complete miscarriage

Question 21

what is mifepristone?

Answer 21

anti-progestogen medication that blocks action of progesterone, halting pregnancy and ripening cervix

enhances the effects of prostaglandins to stimulate contraction of the uterus

Question 22

what is nifedipine?

Answer 22

calcium channel blockers that acts to reduce smooth muscles contraction in blood vessels and the uterus

2 main uses in pregnancy - reduce BP in hypertension and pre-eclampsia, tocolysis in premature labour

Question 23

what is terbutaline?

Answer 23

beta 2 agonist similar to salbutamol

stimulates 2 beta-2 adrenergic receptors

acts on the smooth muscle of the uterus to suppress uterine contractions

tocolysis in uterine hyperstimulation

Question 24

what is carboprost

Answer 24

synthetic prostaglandin analogue meaning it binds to prostaglandin receptors

stimulates uterine contraction

given as deep IM injection in pph where ergometrine and oxytocin have been inadequate

avoided/used with cation in asthma

Question 25

what is tranexamic acid?

Answer 25

antifibrinolytic medication that reduces bleeding

binds to plasminogen and prevents it from converting to plasma

plasmin is an enzyme that works to dissolve the fibrin within blood clots

fibrin is a protein that helps hold blood clots together

decreasing the activity of the enzyme plasmin - tranexamic acid helps prevent breakdown of blood clots

used in pph