Obstetrics Flashcards by Tara Betts

What are prostaglandins and oxytocics used for in obstetrics? (3)

Induce abortion
Induce or augment labour
Minimise blood loss from the placental site

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Which drug can be used prior to the administration of prostaglandin during an abortion to sensitize the uterus?

Mifepristone

Sensitises the uterus to prostaglandin - the abortion occurs in shorter time and with a lower dose of prostaglandin

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Name two prostaglandins that are licensed for the induction of abortion

Misoprostol

Gemeprost

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What is the mode of administration of misoprostol for termination of pregnancy following mifepristone for gestation up to 49 days?

Oral

- 400 micrograms for 1 dose, given 24-48 hours after mifepristone

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What drug needs to be given prior to misoprostol in termination of pregnancy?

Mifepristone

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What is the mode of administration of misoprostol for termination of pregnancy following mifepristone for gestation 50-63 days? (3 options)

Vaginal 
OR
Busccal
OR
Sublingual

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What is the mode of administration of misoprostol for termination of pregnancy following mifepristone for gestation of 9-24 weeks?

Vaginal

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What are the common side effects of misoprostol? (10)

Chills
Constipation
Diarrhoea
Dizziness
Fever
Flatulence
GI discomfort
Headache
Nausea and vomiting
Skin reactions

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What advice about driving should patients taking misoprostol be told?

Increased risk of dizziness may have an effect on driving and performance of skilled tasks

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Misoprostol is a synthetic (?) analogue that acts as a potent uterine stimulant

prostaglandin

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Misoprostol is a synthetic prostaglandin analogue that acts as a potent (?) stimulant

uterine

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Mifepristone, an (?), sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix.

anti-progestogenic steroid

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Mifepristone, an anti-progestogenic steroid, sensitises the (?) to prostaglandin-induced contractions and ripens the cervix.

myometrium

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Mifepristone, an anti-progestogenic steroid, sensitises the myometrium to (?)-induced contractions and ripens the cervix.

prostaglandin

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Mifepristone, an anti-progestogenic steroid, sensitises the myometrium to prostaglandin-induced contractions and ripens the (?).

cervix

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What are the contra-indications to the use of mifepristone?

Acute porphyrias
Chronic adrenal failure
Suspected ectopic pregnancy
Uncontrolled severe asthma

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What are the common side effects of mifepristone?

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Abdominal cramps
Diarrhoea
Infection
Nausea and vomiting
Pelvic inflammatory disease
Uterine disorders
Vaginal haemorrhage (sometimes severe)

What is the mode of administration for gemeprost (prostaglandin licensed for the medical induction of abortion in the second trimester)?

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Vaginal

What are the indications for the use of gemeprost?

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Induction of abortion in the second trimester

2. Soften and dilate the cervix before surgical abortion in early pregnancy

Which trimester is gemeprost most commonly used to induce abortion?

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Second trimester

What are the contra-indications for the use of gemeprost?

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Placenta praevia
Unexplained vaginal bleeding
Uterine scarring

What monitoring is essential in patients with who takes gemeprost in combination with mifepristone?

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BP and pulse for 3 hours

Risk of profound hypotension

When gemeprost is used for induction of abortion during the second trimester, what needs to be monitored during treatment?

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Coagulopathy

Dinoprostone is available as vaginal tablets and vaginal gels for the (?).

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Induction of labour

(?) is licensed for induction or augmentation of labour, usually in conjunction with amniotomy; it is administered by slow intravenous infusion, using an infusion pump.

Oxytocin

What needs to be monitored carefully if oxytocin is used for induction or augmentation of labour?

Uterine activity Fetal heart rate DIC after parturition

What may result if oxytocin is used in large doses?

Excessive fluid retention

What two drugs can be given for induction of labour in women who have intrauterine fetal death (unlicensed use)?

Mifepristone and misoprostol

What are the common side effects of oxytocin? (3)

1. Arrhythmias 2. Headache 3. Nausea and vomiting

Why must you avoid rapid IV injection of oxytocin?

May transiently reduce BP Oxytocin is administered by slow IV infusion

Excessive doses of oxytocin can cause uterine hyperstimulation, what are the complications associated with uterine hyperstimulation? (7)

1. Fetal distress 2. Fetal asphyxia 3. Fetal death 4. Hypertonicity 5. Tetanic contractions 6. Soft-tissue damage 7. Uterine rupture

What may occur in an oxytocin overdose? (2)

Placental abruption | Amniotic fluid embolism

What drug(s) is given as prophylaxis to prevent postpartum haemorrhage? (2 options)

Oxytocin (IM injection) OR Ergometrine with oxytocin (IM injection) *carboprost and misoprostol are alternative options Given on delivery of the anterior shoulder OR immediately after the baby is delivered

Ergometrine with oxytocin cannot be used as prophylaxis for postpartum haemorrhage in patients with which condition?

Hypertension Oxytocin alone causes less nausea, vomiting and hypertension than when given with ergometrine maleate

Oxytocic drugs are used to treat potpartum haemorrhage caused by ...

uterine atony Treatment options include oxytocin, ergometrine maleate, or a combination of ergometrine with oxytocin. Carboprost and misoprostol [unlicensed] are alternative options.

Which drug is used for the medical management of ectopic pregnancy?

Methotrexate (systemic)

(?) drugs postpone premature labour and they are used with the aim of reducing harm to the child.

Tocolytic

Which drug is the first-line for tocolysis in women between 24-33 weeks of gestation who have intact membranes and are in suspected or diagnosed premature labour?

Nifedipine [unlicensed indication] Alternative: atosiban

What are the contraindications for the use of nifedipine?

1. Acute attacks of angina 2. Cardiogenic shock 3. Significant aortic stenosis 4. Unstable angina 5. Within 1 month of MI

What class of drug is nifedipine?

Calcium-channel blocker Obstetrics: Used as a tocolytic to delay premature labour

What are the contraindications for the use of atosiban as a tocolytic? (9)

1. Abnormal fetal heart rate 2. Abruptio placenta 3. Antepartum haemorrhage 4. Severe pre-eclampsia 5. Eclampsia 6. Intra-uterine fetal death 7. Intra-uterine infection 8. Placenta praevia 9. Premature rupture of membranes after 30 weeks' gestation

Why are beta-2 agonists (salbutamol and terbutaline sulfate) NO LONGER USED for inhibiting uncomplicated premature labour?

Serious, sometimes fatal cardiovascular events in the mother and fetus

Obstetrics Flashcards

(42 cards)