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Roomies Collab Deck 2: Endocrinology and NeuroPsych > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What are prostaglandins and oxytocics used for in obstetrics? (3)

A
  1. Induce abortion
  2. Induce or augment labour
  3. Minimise blood loss from the placental site
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2
Q

Which drug can be used prior to the administration of prostaglandin during an abortion to sensitize the uterus?

A

Mifepristone

Sensitises the uterus to prostaglandin - the abortion occurs in shorter time and with a lower dose of prostaglandin

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3
Q

Name two prostaglandins that are licensed for the induction of abortion

A

Misoprostol

Gemeprost

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4
Q

What is the mode of administration of misoprostol for termination of pregnancy following mifepristone for gestation up to 49 days?

A

Oral

- 400 micrograms for 1 dose, given 24-48 hours after mifepristone

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5
Q

What drug needs to be given prior to misoprostol in termination of pregnancy?

A

Mifepristone

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6
Q

What is the mode of administration of misoprostol for termination of pregnancy following mifepristone for gestation 50-63 days? (3 options)

A 
Vaginal 
OR
Busccal
OR
Sublingual
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7
Q

What is the mode of administration of misoprostol for termination of pregnancy following mifepristone for gestation of 9-24 weeks?

A

Vaginal

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8
Q

What are the common side effects of misoprostol? (10)

A
  1. Chills
  2. Constipation
  3. Diarrhoea
  4. Dizziness
  5. Fever
  6. Flatulence
  7. GI discomfort
  8. Headache
  9. Nausea and vomiting
  10. Skin reactions
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9
Q

What advice about driving should patients taking misoprostol be told?

A

Increased risk of dizziness may have an effect on driving and performance of skilled tasks

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10
Q

Misoprostol is a synthetic (?) analogue that acts as a potent uterine stimulant

A

prostaglandin

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11
Q

Misoprostol is a synthetic prostaglandin analogue that acts as a potent (?) stimulant

A

uterine

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12
Q

Mifepristone, an (?), sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix.

A

anti-progestogenic steroid

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13
Q

Mifepristone, an anti-progestogenic steroid, sensitises the (?) to prostaglandin-induced contractions and ripens the cervix.

A

myometrium

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14
Q

Mifepristone, an anti-progestogenic steroid, sensitises the myometrium to (?)-induced contractions and ripens the cervix.

A

prostaglandin

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15
Q

Mifepristone, an anti-progestogenic steroid, sensitises the myometrium to prostaglandin-induced contractions and ripens the (?).

A

cervix

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16
Q

What are the contra-indications to the use of mifepristone?

A
  1. Acute porphyrias
  2. Chronic adrenal failure
  3. Suspected ectopic pregnancy
  4. Uncontrolled severe asthma
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17
Q

What are the common side effects of mifepristone?

A
  1. Abdominal cramps
  2. Diarrhoea
  3. Infection
  4. Nausea and vomiting
  5. Pelvic inflammatory disease
  6. Uterine disorders
  7. Vaginal haemorrhage (sometimes severe)
18
Q

What is the mode of administration for gemeprost (prostaglandin licensed for the medical induction of abortion in the second trimester)?

A

Vaginal

19
Q

What are the indications for the use of gemeprost?

A
  1. Induction of abortion in the second trimester

2. Soften and dilate the cervix before surgical abortion in early pregnancy

20
Q

Which trimester is gemeprost most commonly used to induce abortion?

A

Second trimester

21
Q

What are the contra-indications for the use of gemeprost?

A
  1. Placenta praevia
  2. Unexplained vaginal bleeding
  3. Uterine scarring
22
Q

What monitoring is essential in patients with who takes gemeprost in combination with mifepristone?

A

BP and pulse for 3 hours

Risk of profound hypotension

23
Q

When gemeprost is used for induction of abortion during the second trimester, what needs to be monitored during treatment?

A

Coagulopathy

24
Q

Dinoprostone is available as vaginal tablets and vaginal gels for the (?).

A

Induction of labour

25
Q

(?) is licensed for induction or augmentation of labour, usually in conjunction with amniotomy; it is administered by slow intravenous infusion, using an infusion pump.

A

Oxytocin

26
Q

What needs to be monitored carefully if oxytocin is used for induction or augmentation of labour?

A

Uterine activity
Fetal heart rate

DIC after parturition

27
Q

What may result if oxytocin is used in large doses?

A

Excessive fluid retention

28
Q

What two drugs can be given for induction of labour in women who have intrauterine fetal death (unlicensed use)?

A

Mifepristone and misoprostol

29
Q

What are the common side effects of oxytocin? (3)

A
  1. Arrhythmias
  2. Headache
  3. Nausea and vomiting
30
Q

Why must you avoid rapid IV injection of oxytocin?

A

May transiently reduce BP

Oxytocin is administered by slow IV infusion

31
Q

Excessive doses of oxytocin can cause uterine hyperstimulation, what are the complications associated with uterine hyperstimulation? (7)

A
  1. Fetal distress
  2. Fetal asphyxia
  3. Fetal death
  4. Hypertonicity
  5. Tetanic contractions
  6. Soft-tissue damage
  7. Uterine rupture
32
Q

What may occur in an oxytocin overdose? (2)

A

Placental abruption

Amniotic fluid embolism

33
Q

What drug(s) is given as prophylaxis to prevent postpartum haemorrhage? (2 options)

A

Oxytocin (IM injection)
OR
Ergometrine with oxytocin (IM injection)

*carboprost and misoprostol are alternative options

Given on delivery of the anterior shoulder OR immediately after the baby is delivered

34
Q

Ergometrine with oxytocin cannot be used as prophylaxis for postpartum haemorrhage in patients with which condition?

A

Hypertension

Oxytocin alone causes less nausea, vomiting and hypertension than when given with ergometrine maleate

35
Q

Oxytocic drugs are used to treat potpartum haemorrhage caused by …

A

uterine atony

Treatment options include oxytocin, ergometrine maleate, or a combination of ergometrine with oxytocin. Carboprost and misoprostol [unlicensed] are alternative options.

36
Q

Which drug is used for the medical management of ectopic pregnancy?

A

Methotrexate (systemic)

37
Q

(?) drugs postpone premature labour and they are used with the aim of reducing harm to the child.

A

Tocolytic

38
Q

Which drug is the first-line for tocolysis in women between 24-33 weeks of gestation who have intact membranes and are in suspected or diagnosed premature labour?

A

Nifedipine [unlicensed indication]

Alternative: atosiban

39
Q

What are the contraindications for the use of nifedipine?

A
  1. Acute attacks of angina
  2. Cardiogenic shock
  3. Significant aortic stenosis
  4. Unstable angina
  5. Within 1 month of MI
40
Q

What class of drug is nifedipine?

A

Calcium-channel blocker

Obstetrics: Used as a tocolytic to delay premature labour

41
Q

What are the contraindications for the use of atosiban as a tocolytic? (9)

A
  1. Abnormal fetal heart rate
  2. Abruptio placenta
  3. Antepartum haemorrhage
  4. Severe pre-eclampsia
  5. Eclampsia
  6. Intra-uterine fetal death
  7. Intra-uterine infection
  8. Placenta praevia
  9. Premature rupture of membranes after 30 weeks’ gestation
42
Q

Why are beta-2 agonists (salbutamol and terbutaline sulfate) NO LONGER USED for inhibiting uncomplicated premature labour?

A

Serious, sometimes fatal cardiovascular events in the mother and fetus

Roomies Collab Deck 2: Endocrinology and NeuroPsych (49 decks)

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