patch

Timings : Mon to Sat
6.00.pm-8.00. pm

Dr.Niraj Mahajan
Dr.Niraj Mahajan
Dr.Niraj Mahajan

BLOG

Preterm Labor and Tocolysis

By AdminPosted On 05-Oct-2016

1. Tocolysis

All of these drugs can be used as tocolytic EXCEPT:

a) Magnesium sulphate
b) Diazepam
c) Calcium channel blocker
d) Indomethacin
e) Ritodrine

Correct Answer: b) Diazepam

2. Tocolytic Drug

All are used as tocolytic drugs EXCEPT:

a) Antioxytocins
b) Anticholinergics
c) Ca channel blockers
d) B agonists (Ritodrine)
e) Prostaglandin synthesis inhibitors

Correct Answer: b) Anticholinergics. Indomethacin is Prostaglandin synthesis inhibitor which is used as tocolytic.

3. Preterm Labor

The following has a recognized relation with spontaneous preterm labor:

a) Fetus with anencephaly
b) Oligohydromnios
c) Maternal hypothyroidism
d) Bacterial Vaginosis
e) Transverse lie of the fetus

Correct Answer: d) Bacterial Vaginosis. Over the past several years, scientific studies from several sources have linked bacterial vaginosis (BV) with premature labor. In fact, evidence of a causal relationship between the relatively common vaginal infection and one of the mysteries of modern obstetrics was significant enough to suggest that health-care providers should monitor even asymptomatic pregnant women for BV, and/or prescribe low-grade antibiotics for a certain period during gestation.

4. Tocolytic Drugs

There is no clear evidence that tocolytic drugs improve outcome in preterm labour and therefore it is reasonable not to use them.

a) True
b) False

Correct Answer: a) True. However, tocolysis should be considered if the few days gained would be put to good use, such as completing a course of corticosteroids or in utero transfer.

5. Tocolysis in APH

Tocolysis should not be used to delay delivery in a woman presenting with a major APH, or who is haemodynamically unstable, or if there is evidence of fetal compromise.

a) True
b) False

Correct Answer: a) True. Women most likely to benefit from use of a tocolytic drug are those who are very preterm, those needing transfer to a hospital that can provide neonatal intensive care and those who have not yet completed a full course of corticosteroids. RCOG states that tocolytic therapy is contraindicated in placental abruption and is ‘relatively contraindicated’ in ‘mild haemorrhage’ due to placenta praevia. If tocolysis is employed, then the drug of choice in a woman with a history of APH should have fewest maternal cardiovascular side effects. The calcium antagonist nifedipine has been associated with cases of maternal hypotension and is probably best avoided.

6. Pulmonary Edema and Tocolysis

Drug that inhibits uterine contractility and causes pulmonary edemaa) Ritodrine b) Nifedipine c) Indomethacin d) Attosiban e) Magnesium sulphateCorrect Answer: a) Ritodrine. It is a beta-2 adrenergic receptor agonist - a class of medication used for smooth muscle relaxation. Since ritodrine has a bulky N-substituent, it has high β2-selectivity. Most side effects of beta-2 agonists result from their concurrent beta-1 activity, and include increase in heart rate, rise in systolic pressure, decrease in diastolic pressure, chest pain secondary to MI, and arrhythmia. Beta agonists may also cause fluid retention secondary to decrease in water clearance, which when added to the tachycardia and increased myocardial work, may result in cardiac failure.

7. Uterine Relaxation

Which of the following two anesthetic technique will produce the greatest uterine relaxation?

a) Spinal block.
b) Scoline
c) Nitrous oxide.
d) Halothane.
e) Epidural
f) IV-NTG

Correct Answer: f and d. NTG is highly potent uterine relaxant and short life is very short (1-3 min only). Although it causes tachycardia but the effect is very short. Halothane is less potent than IV-NTG.

8. Ritodrine

Ritodrine is a b-adrenergic receptor stimulator that is used to arrest preterm labor. Which of the following is a major maternal risk of its use?

a) Hypertension.
b) Decreased plasma glucose.
c) Decreased serum potassium.
d) Cardiac arrhythmias.
e) Asthma

Correct Answer: d) Cardiac arrhythmias. Most side effects of beta-2 agonists result from their concurrent beta-1 activity, and include increase in heart rate, rise in systolic pressure, decrease in diastolic pressure, chest pain secondary to MI, and arrhythmia. Beta agonists may also cause fluid retention secondary to decrease in water clearance, which when added to the tachycardia and increased myocardial work, may result in cardiac failure.

9. Nifedipine

Dose of nifedipine for preterm labour is an initial oral dose of 20 mg followed by 10–20 mg three to four times daily. A total dose above 60 mg appears to be associated with a three- to four-fold increase in adverse events.

a) True
b) False

Correct Answer: a) True. There is no clear consensus on the ideal dose regimen for nifedipine when used for tocolysis. A sensible recommendation is as mentioned. Total dose above 60 mg appears to be associated with a three- to four-fold increase in adverse events such as headache and hypotension.

Prev Next

"Authored By Dr.Niraj Mahajan"

Enquire Now

Location Map

Our Doctor

doctor

Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

Read more [+]

Call Us