ABC of Transfer and Retrieval Medicine (ABC Series) by Adam Low & Jonathan Hulme

Author:Adam Low & Jonathan Hulme
Language: eng
Format: azw3
ISBN: 9781118719633
Publisher: Wiley
Published: 2017-04-24T04:00:00+00:00

Contraindications ergometrine: known hypertension/pre-eclampsia, cardiac disease, or severe renal impairment

oxytocin: enhances sympathomimetics; antidiuretic effects may complicate fluid resuscitation and coagulation disorders

Side-effects: ergometrine: palpitations, pulmonary oedema and abdominal pain

oxytocin: headache, vomiting, hyponatraemia, hypotension if rapidly bolused. In excess: disseminated intravascular coagulation and uterine rupture.

Uterine relaxants

Tocolytic use in major antepartum haemorrhage should be discussed with a senior obstetrician case by case. Indicated in the very preterm: allows administration of corticosteroids and/or transfer to a facility with neonatal intensive care. Nifedipine should be avoided because of associated hypotension. Tocolysis is contraindicated in placental abruption.

In preterm labour the use of tocolysis has no clear evidence of benefit to prevent perinatal/neonatal morbidity or neonatal mortality and as such it is reasonable not to use them. Consider if it facilitates completion of therapy or transfer.

Nifedipine is used in preterm labour because of its smooth muscle relaxing effects (unlicensed indication). It does have several benefits: oral medication; simple dosing; comparable effectiveness to Atosiban; better neonatal outcome when compared to the β2 agonists and fewer side effects.

Cautions atosiban: abnormal placental site increases risk of PPH.

β2 agonists: pre-eclampsia, hypokalaemia, diabetes.

nifedipine: poor cardiac reserve/ heart failure, acute porphyria, diabetes. Risk of pulmonary oedema in multiple pregnancy

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