Intrapartum Care - Medications Flashcards
(36 cards)
Pain Relief in Labour.
- Simple Analgesia : Paracetamol or Codeine (not NSAIDs).
- Gas and Air (Entonox).
- IM Pethidine/Diamorphine.
- Patient-Controlled Analgesia.
What is Gas and Air (Entonox)?
- 50% Nitrous Oxide and 50% Oxygen - short-term pain relief in contractions.
- Deep breaths using mouthpiece at start of contraction and stop as contractions ease.
- Adverse Effects : Lightheadedness, Nausea, Sleepiness.
What is IM Pethidine/Diamorphine?
- Opioid medications to help with anxiety and distress.
- Adverse Effects : Maternal Nausea and Drowsiness and Foetal Respiratory Depression and Poor First Feed (avoid too close to birth).
What is Patient-Controlled Analgesia? (2)
- IV Remifentanil - press a button at the start of contraction to administer a bolus of short-acting opiate.
- Careful Monitoring : Naloxone for Respiratory Depression and Atropine for Bradycardia.
How do Epidurals work? (3)
- Insert a catheter into the epidural space in the lower back.
- Infuse Local Anaesthetics into Epidural Space.
- They will diffuse to the surrounding tissues and through to the spinal cord.
- Requires indwelling urinary catheter and confined to bed.
What options are available for Epidural? (2).
Usually Mixed with Fentanyl :
- Levobupicaine.
- Bupivacaine.
Adverse Effects of Epidurals (8).
- Headache after Insertion.
- Hypotension.
- Motor Weakness in Legs.
- Nerve Damage.
- Prolonged Second Stage.
- Increased Probability of Instrumental Delivery.
- Risk of Epidural Haematoma.
- Contraindication : Coagulopathy.
When would women need urgent anaesthetic review?
If they develop significant motor weakness (unable to straight leg raise) - this might be due to incorrect siting of the catheter into the SAH space.
What is Oxytocin?
A hormone secreted by the posterior pituitary gland, produced by the hypothalamus - Syntocinon (Brand Name).
Function of Oxytocin (3).
During Labour and Delivery : 1. Stimulate Ripening of the Cervix. 2. Stimulate Contractions of the Uterus. During Breastfeeding : 3. Lactation.
Indications of Oxytocin (4).
- Induce Labour.
- Progress Labour.
- Improve Frequency/Strength of Uterine Contractions.
- Prevent/Treat PPH.
- Active Management of Third Stage of Labour.
Alternative to Nifedipine in Tocolysis (Premature Labour).
Atosiban - Oxytocin Receptor Antagonist.
Mechanism of Action of Nifedipine.
CCB - reduces smooth muscle contraction in blood vessels and the uterus.
Indications of Nifedipine in Pregnancy (2).
- Reduce BP in HTN and PET.
2. Tocolysis - Suppress Uterine Activity and Delay Onset of Labour.
Mechanism of Action of Ergometrine.
Stimulates smooth muscle contraction in the uterus and blood vessels via a-Adrenergic, Dopaminergic and Serotonergic receptors.
Indications of Ergometrine.
- Prevent/Treat PPH.
2. Support Delivery of Placenta (3rd Stage of Labour).
Contraindication of Ergometrine.
- Before Delivery of Baby.
- Eclampsia.
- CAUTION : HTN.
Adverse Effects of Ergometrine.
- Hypertension.
- Diarrhoea.
- Vomiting.
- Angina.
- Coronary Artery Spasm.
What is Syntometrine?
Combination drug containing Oxytocin and Ergometrine - prevention/treatment of PPH.
Mechanism of Action of Prostaglandins.
Dinoprostone (Prostaglandin E2) : Stimulate contraction of uterine muscles and ripen cervix before delivery.
Why are NSAIDs contraindicated in Pregnancy?
Vasodilator - lower BP.
What forms are Prostaglandins used in? (3)
- Vaginal Pessaries (Propess).
- Vaginal Tablets (Prostin Tablets).
- Vaginal Gel (Prostin gel).
Mechanism of Action of Misoprostol.
Prostaglandin Analogue - binds to Prostaglandin receptors and activates them to cause uterine contractions.
Indications of Misoprostol (3).
- Medical Management - Miscarriage.
- With Mifepristone - Abortions.
- Induction of Labour after Intrauterine Foetal Death.
