genitourinary - obstetrics Flashcards
(35 cards)
Pre treatment with this drug can FACILITATE the process of medical abortion
Mifepristone
MOA Mifepristone
pretreatment with this can facilitate process of medical abortion
it sensitises uterus to subsequent administration of a PG (misoprostol) and therefore abortion can occur in shorter time and a lower dose of PG
This prostaglandin is given by mouth, buccally, SL, or vaginally to induce medical abortion following sequential use with mifepristone. It is also used for cervical priming before surgical abortion
misoprostol
this PG is administered vaginally as pessaries and is licensed for medical induction of abortion in 2nd trimester; also licensed to soften and dilate cervix before surgical abortion in early pregnancy
gemeprost
Which PG drug is licensed for medical induction of abortion in 2nd trimester
gemeprost
Which PG drug is licensed to soften and dilate cervix before surgical abortion in early pregnancy
gemeprost
This is used (unlicensed) for the prevention of miscarriage and should be offered after a woman with an intra0uterine pregnancy confirmed by a scan has vaginal bleeding, if they have previously had a miscarriage
vaginal micronised progesterone
If fetal heartbeat is confirmed, how long should you continue vaginal micronised progesterone for? (for the prevention of miscarriage, it is offered following vaginal bleeding in females with intra-uterine pregnancy confirmed by a scan, if they have prev had miscarriage)
continue until 16 completed weeks of pregnancy
in pregnant females with antiphospholipid syndrome who have suffered recurrent miscarriage, you can give the following 2 under specialist supervision only
low dose aspirin + prophylactic dose of LMWH = may decrease risk of fetal loss
for medical. management of missed miscarriage, these two can be offered UNLESS gestational sac has already been passed
mifepristone [unlicensed use] followed by misoprostol [unlicensed use] may be offered
you can offer mifepristone [unlicensed use] followed by misoprostol [unlicensed use] for the medical management of missed miscarriage UNLESS
gestational sac has already been passed
This PG may be used for the medical management of miscarriage
misoprostol unlicensed use
this immunosuppressant is used for the management of ectopic pregnancy
systemic MTX unlicensed
Preterm prelabour rupture of membranes (P‑PROM): prevention of intra-uterine infection - which abx? (1st line and alt)
Erythromycin.
Alternative if oral erythromycin is contra-indicated or unsuitable: consider an oral penicillin for up to 10 days or until established labour, whichever is sooner.
What can you give as an alt to cervical cerclage in pregnant females with either Hx spontaneous preterm birth (up to 34+0 weeks of pregnancy) or loss (from 16+0 weeks of pregnancy onwards), and a short crevice, to reduce risk of preterm birth
prophylactic progesterone
if only one of these risk factors, consider use of prophylactic progesterone
When should you initiate prophylactic progesterone treatment, and how long should you continue it for?
(as alternative to cervical cerclage in pregnant females with either hx spontaneous preterm birth (up to 34+0 weeks of pregnancy), or loss (from 16+0 weeks of pregnancy onward), and a short cervix, to reduce the risk of preterm birth)
Treatment with progesterone should be initiated between 16+0 and 24+0 weeks of pregnancy, and continued until at least 34 weeks.
myometrial relaxants - what are tocolytic drugs used for?
Tocolytic drugs postpone preterm labour and they are used with the aim of reducing harm to the child.
Discuss the use of nifedipine (unlicensed), and oxytocin receptor antagonist (e.g. atosiban) as an alternative
Females between 24+0 and 33+6 weeks of gestation who have intact membranes and are in suspected or diagnosed preterm labour can be given nifedipine [unlicensed use] for tocolysis.
An oxytocin receptor antagonist (such as atosiban) is an alternative if nifedipine is contra-indicated or unsuitable.
What is tocolysis?
Tocolysis is an obstetrical procedure carried out with the use of medications with the purpose of delaying the delivery of a fetus in women presenting preterm contractions
What drugs can be given for tocolysis for females between 24+0 and 33+6 weeks of gestation who have intact membranes and are in suspected or diagnosed preterm labour? (2)
nifedipine unlicensed
alternative if CI or unsuitable: oxytocin receptor antagonist e.g. atosiban
True or false - B2 agonists salbutamol and terbutaline are recommended for inhibiting uncomplicated preterm labour
False
no longer recommended
Why are beta2 agonists salbutamol and terbutaline sulfate are no longer recommended for inhibiting uncomplicated preterm labour?
Use of high-dose short acting beta2 agonists in obstetric indications has been associated with serious, sometimes fatal cardiovascular events in the mother and fetus, particularly when used for a prolonged period of time.
When can dexamethasone (unlicensed indication) be offered?
Depending on the stage of pregnancy, individual circumstances, and the balance of risks and benefits, corticosteroids such as dexamethasone [unlicensed use] may be offered to females who are in suspected or established preterm labour, or who are having a planned preterm birth, or who have preterm prelabour rupture of membranes (P‑PROM).
Depending on the stage of pregnancy, individual circumstances, and the balance of risks and benefits,
THIS
may be offered to females who are in suspected or established preterm labour, or who are having a planned preterm birth, or who have preterm prelabour rupture of membranes (P‑PROM).
corticosteroids such as dexamethasone [unlicensed use]
