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Reproduction > Pain Relief in Labour > Flashcards

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
Q

Who is Carboprost CI in and why

A

Asthmatics

Because it is a prostaglandin which stimulate bronchial smooth m. contraction

26
Q

What type of drug is carboprost

A

Prostaglandin

27
Q

What is the action of carboprost

A

Causes uterine contraction

28
Q

What type of drug is misoprostol

A

Prostaglandin

29
Q

What is syntometrine a combination of

A

Oxytocin and ergometrine

30
Q

Is paracetamol safe in pregnancy

A

Yes

Safe throughout

31
Q

Can you take NSAIDs in pregnancy

A

No

32
Q

What is Entonox commonly known as

A

Gas and Air

33
Q

What gas is used in entonox

A

Nitrous oxide

34
Q

Pros of entonox

A

Patient can self-administer
Quick onset
Short half life

35
Q

Cons of entonox

A 
Reserved until active labour 
Patient can feel:
Giddy or intoxicated 
Can feel nauseated 
May vomit
36
Q

Which stronger painkiller is sometimes given during labour

A

Opiates

37
Q

Which opiates are given during labour

A

Morphine
Pethidine
Diamorphine

38
Q

Cons of opiates

A 
Nausea
Vomiting 
Drowsiness
Respiratory depression 
Can cause neonatal respiratory depression
39
Q

What is the antidote for opiates

A

Naloxone

Opiod antagonist

40
Q

What is an opiate usually prescribe with

A

Antiemetic

41
Q

When are opiates used in labour

A

When the pain becomes more severe

42
Q

What are LA used for in labour

A 
Before IV cannula insertion 
Also:
Delivery
Sutures 
Episiotomy 
Vaginal tear
43
Q

Which nerve block is used in instrumental delivery

A

Pudendal nerve block

44
Q

What is an epidural anaesthesia

A

Regional aesthetic block

45
Q

What is required when an epidural is in situ

A

Maternal + Fetal monitoring

46
Q

Who is an epidural carried out by

A

Anaesthetist

47
Q

CI for epidural

A 
Thrombocytopenia 
Coagulopathy 
Raised ICP 
Local sepsis 
Septic shock 
Allergy to local anaesthetic
48
Q

Advantages of epidural

A 
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
Q

Cons of epidural

A 
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
Q

What is a spinal anaesthesia used mostly for

A

Non-emergency (elective) C-sections

51
Q

What is the components of a spinal anaesthesia

A

Local anaesthetic and opiate injected into the subarachnoid space

52
Q

Advantages of spinal anaesthesia

A

Gives dense anaesthetic bilateral block
Patient can stay away and protect own airways during surgery
Woman can stay awake to meet her baby

53
Q

Disadvantages of spinal anaesthesia

A 
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
Q

When is a GA mainly required in labour

A

Emergency C-section

If not enough time for spinal block

55
Q

Why can a GA be difficult in pregnancy

A

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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