Obs: L&D - CTG, pain relief & drugs Flashcards
what are some indications for contonuous CTG monitoring?
- 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
what do we look for on CTG?
- 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)
what are some options (non-pharmacological) which can improve pain in labour?
- 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
what are some pharmacological options for pain relief in labour?
simple analgesia - paracetamol, codeine
entonox
IM pethidine or diamorphine
PCA
Epidural
describe use of entonox in labour
50% nitrous oxide and 50% oxygen
short term during contraction
can cause lightheadedness, nausea and sleepiness
describe the use of pethidine or diamorphine as pain relief in labour
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
describe the use of patient controlled analgesia in labour
patient controlled IV remifentanil
pt presses button at start of contraction
needs careful monitoring and input from anaesthetics and access to naloxone and atropine
describe the use of epidural in labour
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
what are some adverse effects of an epidural?
- Headache after insertion
- Hypotension
- Motor weakness in the legs
- Nerve damage
- Prolonged second stage
- Increased probability of instrumental delivery
what is oxytocin?
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
what are oxytocin infusions used for?
induce labour, progress labour, improve frequency and strength of uterine contractions, prevent or treat pph
what is the brand name for drug oxytocin?
syntocin
what is atosiban?
oxytocin receptor antagonist
used as an alternative to nifedipine for tocolysis in premature labour
what is ergometrine?
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
what are the side effects of ergometrine and why are they cause?
action on smooth muscle in blood vessels and gi tract
causes hypertension, diarrhoea, vomiting, angina
AVOID in eclampsia and with caution in hypertension
what is syntometrine?
combination drug containing oxytocin and ergometrine
used to prevent or treat pph
what are prostaglandins?
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
what is dinoprostone?
prostaglandin E2
used fro induction of labour
comes in 3 forms:
vaginal pessaries, vaginal tablets, vaginal gel
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.
what is misoprostol?
prostaglandin analogue meaning it binds to prostaglandin receptors and activates them
medical management in miscarriage to help complete miscarriage
what is mifepristone?
anti-progestogen medication that blocks action of progesterone, halting pregnancy and ripening cervix
enhances the effects of prostaglandins to stimulate contraction of the uterus
what is nifedipine?
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
what is terbutaline?
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
what is carboprost
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
what is tranexamic acid?
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