Labor and Delivery

Question 1

Medications for PPROM

Answer 1

Antibiotics, tocolytics, corticosteroids

Question 2

When to use ABX for PPROM

Answer 2

If the patient experiences PPROM before 34 weeks gestation

Question 3

Tocolytic medications

Answer 3

Beta agonists (terbutaline), magnesium, CCBs, prostaglandin inhibitors like indomethacin

Question 4

Corticosteroids purpose in PPROM

Answer 4

Fetal lung maturation

Question 5

Corticosteroids medications

Answer 5

Betamethasone 12mg IM q24h x2 doses

Dexamethasone 6mg IM q12h x4 doses

Question 6

Medications used for labor induction and cervical ripening

Answer 6

Dinoprostone, misoprostol, mifepristone, oxytocin

Question 7

Dinoprostone MoA

Answer 7

Prostaglandin E2 analog that is used for cervical ripening

Question 8

Misoprostol MoA

Answer 8

Prostaglandin E1 analog used for cervical ripening and labor induction

Question 9

Mifepristone MoA

Answer 9

Antiprogesterone agent that triggers uterine contractions

Question 10

Oxytocin MoA

Answer 10

Triggers uterine contractions and stimulates the placenta to release from the wall

Question 11

Medications used for labor analgesia

Answer 11

parenteral analgesia/opioids, regional (epidural and spinal), nitrous oxide, general anesthesia

Question 12

Parental analgesia MoA (opioids)

Answer 12

Bind to opioid receptors in CNS to increase pain threshold and produce analgesia

Question 13

Epidural medications MoA (bupivacaine, ropivacaine)

Answer 13

Decrease neuronal membrane’s permeability to sodium ions which blocks initiation and conduction of nerve impulses

Question 14

Nitrous oxide MoA

Answer 14

general CNS depressant

Question 15

Top recommendation for analgesia during labor and delivery

Answer 15

Epidural

Question 16

Pearls/advantages of epidural

Answer 16

Administered as IV bolus, continuous infusion, or both
Single-injection spinal anesthesia includes injection of an opioid and/or local anesthetic into the subarachnoid space usually at the time of C-section or within 1 hour of expected delivery
No effects on baby

Question 17

Disadvantages of epidural

Answer 17

Minor maternal ADEs- HTN, pruritus, N/V, urinary retention, shivering, fever, reactivation of PO herpes and respiratory depression

Continuous spinal analgesia is seldom used for labor due to risk of postural puncture headache

Question 18

Pearls/advantages of systemic analgesia

Answer 18

Used IM or IV

Question 19

Disadvantages of systemic analgesia

Answer 19

variable pain relief, maternal adverse effects of N/V, fetal risks are more pronounced- depression of Apgar scores, respiratory depression, decreased muscle tone and suckling, hypotension, placental transfer of opioids

Question 20

Pearls/advantages of NO

Answer 20

Delivered via facemark or mouthpiece, less effective than epidural analgesia but there are limited CIs, no additional monitoring, patient control of effect, quick termination after mask removal

Question 21

Disadvantage of NO

Answer 21

Not readily available in the US

Question 22

Pearls/advantages of general anesthesia

Answer 22

Used for either vaginal or C-section delivery and only in emergency situations where other methods can’t be performed or failed

Question 23

Disadvantage of general anesthesia

Answer 23

Standard risks associated with general anesthetic administration

Question 24

Treatment of PPH

Answer 24

Oxytocin infusion; can add methylergonovine, carboprost, misoprostol, tranexamic acid

Question 25

Treatment of PPD

Answer 25

First-line are antidepressants (SSRIs), NO PAROXETINE

New agent: brexanolone, requires inpatient hospital stay because it’s an IV infusion, also on REMS program