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Flashcards in Obstetric & Gynaecology Deck (21):
1

Use of Dinoprostone

Prostaglandin E2 stimulates myometrium to contract similarly to the contraction during labour hence stimulates labour

2

Contraindication of dinoprostone

Active cardiac/pulmonary disease
Fetal distress
Fetal Malpresentation
History of c-section or difficult/traumatic labour

3

Routes of delivery for dinoprostone

Gel 1ml, 2ml (Prostin)
Vaginal pessary 10mg (Propess)

4

Advantages of dinoprostone pessary over gel

Less Vaginal examinations required
Reduced hospital costs

5

Oxytocin mode of action

Oxytocin promotes contractions by increasing the intracellular Ca2+, which in turn activates myosin's light chain kinase.. Oxytocin has specific receptors in the muscle lining of the uterus and the receptor concentration increases greatly during pregnancy, reaching a maximum in early labor at term.

6

Contraindication of oxytocin

1. Disproportion that is more than borderline.
2. Where the lie is other than longitudinal
3. In cases of previous caesarean section for contracted pelvis or who have failed in a previous trail of labor for disproportion.
4. Where a tumor occupies the pelvis.
5. When vaginal delivery is contraindicated in conditions like major degree placenta previa, vasa previa, cord presentation and prolapse, invasive carcinoma of cervix and infections like active herpes genitalis.
6. Previous classical caesarean section.
7. Regular contractions.
8. Unification surgery for uterine didelphis.

7

Side effects of oxytocin

Arrhythmia
Headaches
Nausea & Vomiting

8

Drugs for induction or augmentation of labour

Dinoprostone
Oxytocin

9

Drugs for prevention and treatment of hemorrhage

Carboprost (Deep IM 250ug)
Ergometrine
Oxytocin with ergometrine (Syntometrine)

10

Mechanism of action of carboprost

Carboprost is a synthetic prostaglandin. It binds the prostaglandin E2 receptor, causing myometrial contractions, casuing the induction of labour or the expulsion of the placenta. Prostaglandins occur naturally in the body and act at several sites in the body including the womb (uterus). They act on the muscles of the womb, causing them to contract.

11

Contraindications of carboprost

Cardiac/pulmonary disease
Untreated pelvic disease

12

Side effects of carboprost

Bronchospasm
cardiovascular collapse
chills
diaphoresis
diarrhoea
dizziness
dyspnoea
erythema at injection site
flushing
headache
hyperthermia
nausea

13

Prophylaxis of PPH at caesarian section

Carbetocin 100mcg/ml (Pabal)

14

Mode of action of ergometrine

Ergonovine directly stimulates the uterine muscle to increase force and frequency of contractions. With usual doses, these contractions precede periods of relaxation; with larger doses, basal uterine tone is elevated and these relaxation periods will be decreased. Contraction of the uterine wall around bleeding vessels at the placental site produces hemostasis. Ergonovine also induces cervical contractions. The sensitivity of the uterus to the oxytocic effect is much greater toward the end of pregnancy. The oxytocic actions of ergonovine are greater than its vascular effects.

15

Syntometrine consists of:

Oxytocin 5 unit per 1 ml
Ergometrine maleate 500 microgram per 1 ml

16

Mode of action of carbetocin

Oxytocin receptor agonist

17

Side effects of carbetocin

Abdominal pain
anaemia; back pain
chest pain
chills
dizziness
dyspnoea

18

Contraindications of carbetocin

Pre-eclampsia
Eclampsia
Epilepsy

19

Induction of abortion

Misoprostol
Methotrexate in conjunction with misoprostol

20

What is misoprostol

Prostaglandin E1 analogue works in this case via selective binding to the EP-2/EP-3 prostanoid receptors.

21

Side effects of misoprostol

Diarrhoea
Abdominal pain
Abnormal vaginal bleeding
Dizziness
Intramenstrual bleeding
menorrhagia