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Pain Relief in Labour Flashcards

1
Q

What is Labour Induction

A

Attempt to instigate labour artificially using medications and/or by artificial rupture of the amniotic membranes

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2
Q

What is an amniotomy

A

Artificial rupture of the membranes

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3
Q

Why would an overdue baby be induced

A

Increased risk of stillbirth

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4
Q

Which score is used to clinically assess the cervix

A

Bishop’s Score

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5
Q

What does a higher Bishops Score indicate

A

A higher indication to perform an amniotomy

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6
Q

Absolute CI to labour induction

A

Abnormal lie
Known pelvic obstruction (e.g tumour, large ovarian cyst)
Placent praevia
Fetal distress

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7
Q

Relative CI to labour induction

A

Previous CS

Asthma (prostaglandins can cause respiratory smooth m. contraction)

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8
Q

Which routes are used for induction of labour

A

PV

IV

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9
Q

Which 2 medications are used to induce labour

A

Prostaglandin analogues

Oxytocin

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10
Q

How is oxytocin given to induce labour

A

as IV infusion

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11
Q

What is the action of oxytocin in induction of labour

A

Initiates uterine contractions

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12
Q

How is prostaglandins given to induce labour

A

PV as a pessary

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13
Q

What is given for the augmentation of labour

A

Oxytocin IV infusion

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14
Q

What is augmentation of labour

A

Required when contractions reduce in frequency or in strength in active labour

Even potentially after spontaneous onset

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15
Q

What is physiological 3rd stage management

A

When the patient does not want any pharmacological intervention

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16
Q

What is active management of 3rd stage labour

A

When medical intervention is used in 3rd stage labour

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17
Q

What does active management of 3rd stage labour involve

A

Early clamping and cutting of cord
Use of uterotonic medication
Delivery of placenta by controlled cord traction

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18
Q

Which uterotonic drugs are given in active management of 3rd stage labour

A

Syntometrine (combination of oxytocin and ergometrine)

Synthetic oxytocin

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19
Q

Definition of PPH

A

> 500ml blood loss within 24hrs

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20
Q

Which steroids are given in preterm labour

A

Betamethasone
Dexamethasone
IM injection

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21
Q

What is the action of tocolytic medication

A

Inhibits uterine contractions

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22
Q

When are tocolytic medications usually given

A

In women with threatened preterm labour

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23
Q

Why are steroids given in pre-term labour

A

To improve fetal lung development and improve other neonatal outcomes in preterm babies

24
Q

Which drugs can be given to manage PPH

A 
Oxytocin 
Syntometrine 
Carboprost 
Misoprostol 
Tranexamic acid
25
Who is Carboprost CI in and why
Asthmatics | Because it is a prostaglandin which stimulate bronchial smooth m. contraction
26
What type of drug is carboprost
Prostaglandin
27
What is the action of carboprost
Causes uterine contraction
28
What type of drug is misoprostol
Prostaglandin
29
What is syntometrine a combination of
Oxytocin and ergometrine
30
Is paracetamol safe in pregnancy
Yes | Safe throughout
31
Can you take NSAIDs in pregnancy
No
32
What is Entonox commonly known as
Gas and Air
33
What gas is used in entonox
Nitrous oxide
34
Pros of entonox
Patient can self-administer Quick onset Short half life
35
Cons of entonox
``` Reserved until active labour Patient can feel: Giddy or intoxicated Can feel nauseated May vomit ```
36
Which stronger painkiller is sometimes given during labour
Opiates
37
Which opiates are given during labour
Morphine Pethidine Diamorphine
38
Cons of opiates
``` Nausea Vomiting Drowsiness Respiratory depression Can cause neonatal respiratory depression ```
39
What is the antidote for opiates
Naloxone | Opiod antagonist
40
What is an opiate usually prescribe with
Antiemetic
41
When are opiates used in labour
When the pain becomes more severe
42
What are LA used for in labour
``` Before IV cannula insertion Also: Delivery Sutures Episiotomy Vaginal tear ```
43
Which nerve block is used in instrumental delivery
Pudendal nerve block
44
What is an epidural anaesthesia
Regional aesthetic block
45
What is required when an epidural is in situ
Maternal + Fetal monitoring
46
Who is an epidural carried out by
Anaesthetist
47
CI for epidural
``` Thrombocytopenia Coagulopathy Raised ICP Local sepsis Septic shock Allergy to local anaesthetic ```
48
Advantages of epidural
``` Effective analgesia Can be topped to if need for C-section Effective after delivery if vaginal tears Best for baby Can prevent further BP in pre-eclampsia ```
49
Cons of epidural
``` Can fail to provide adequate pain relief Causes hypotension mobility Dural puncture Epidural haematoma can form Risk of resp. depression Risk of neurological deficits ```
50
What is a spinal anaesthesia used mostly for
Non-emergency (elective) C-sections
51
What is the components of a spinal anaesthesia
Local anaesthetic and opiate injected into the subarachnoid space
52
Advantages of spinal anaesthesia
Gives dense anaesthetic bilateral block Patient can stay away and protect own airways during surgery Woman can stay awake to meet her baby
53
Disadvantages of spinal anaesthesia
``` Risk of inadequate pain relief Shorter duration (can wear off in longer operations) Causes hypotension Patient need urinary catheter Risk of dural puncture Patient may suffer: Pruritus Nausea Vomiting Small risk nerve damage ```
54
When is a GA mainly required in labour
Emergency C-section | If not enough time for spinal block
55
Why can a GA be difficult in pregnancy
Due to increased risk of aspiration of stomach contents | And it is more difficult to intubate a pregnant woman

Reproduction (14 decks)

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