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Drowsiness, dizziness, sweating, headache, nausea, restlessness,
itching, vomiting, dry mouth or constipation may occur. If these
effects persist or worsen, inform your doctor. Very unlikely to occur
but report depression, confusion, mood changes, hallucinations,
trouble breathing or blurred vision. In the unlikely event you have an
allergic reaction to this drug, seek immediate medical attention.
Symptoms of an allergic reaction include rash, itching, swelling,
dizziness or trouble breathing. If you notice other effects not listed
above, contact your doctor or pharmacist.


NUBAINE: NUBAINE is given by injection under the skin or into a vein
or muscle by a health care professional. How much and how often you
use this is based on your condition and response. Use NUBAINE
exactly as directed by your doctor. Do not increase your dose, use it
more frequently or use it for a longer period of time than prescribed
because NUBAINE can be habit-forming. Also, if used for an extended
period, do not suddenly stop using NUBAINE without your doctor's
approval. Over time, NUBAINE may not work as well. Consult your
doctor if NUBAINE isn't relieving the pain sufficiently.

NUBAINE is a narcotic pain reliever. It is used to treat moderate to
severe pain and to boost the effects of anesthesia.

Before using this, tell your doctor if you have any heart, liver, kidney
or lung disease, any brain disorder, a history of drug dependence or
any drug allergies. Limit use of alcohol while using NUBAINE. Use
caution driving or performing task requiring alertness as NUBAINE may
cause drowsiness or dizziness. NUBAINE should be used with caution
in elderly persons. Use of nalbuphine in children under 18 years of age
is not recommended. Tell your doctor if you are pregnant before using
this medication. Nalbuphine is not recommended for prolonged use or
in high doses at the end of pregnancy. It is not known is nalbuphine is
excreted into breast milk. Consult your doctor before breast-feeding.
Tell your doctor or pharmacist of all the other drugs you take (both
prescription and nonprescription) especially other narcotic pain
relievers (e.g., codeine, morphine), sedatives, tranquilizers, drugs
used as sleep aids, anti-anxiety drugs, barbiturates, drugs for
seizures, psychiatric medicines, muscle relaxants, certain
antihistamines (e.g., diphenhydramine) and cimetidine. Do not start or
stop any medicine without doctor or pharmacist approval.

If overdose is suspected, contact your local poison control center or
emergency room immediately. Symptoms of overdose may include
sleepiness, restlessness, and general discomfort.

Do not allow anyone else to use NUBAINE.


NUBAINE is only given as needed by a health care professional.

Store this at room temperature between 59 and 86 degrees F (15 to
30 degrees C), away from heat, light and moisture. Do not store in the
bathroom. Keep out of the reach of children.

Methergine, the brand name for methylergonovine maleate, was originally
developed for the treatment of postpartum bleeding and for improvement in
the uterine tone. It is related to the ergot amine medications. In addition to
its effects on the uterus, Methergine also causes constriction of the smooth
muscles in the blood vessels.

This vasoconstriction action makes Methergine useful in several situations as

related to some headache patients. It can be helpful in treating vascular
headaches, such as migraine (including menstrual migraine) or cluster.

It is more commonly used for prevention of headaches, but can be taken for
acute attacks. Because of the vasoconstricting effects, Methergine is used for
limited periods of time in most patients and only under careful supervision of
a physician.

The side effects of Methergine are similar to those seen with other ergot
agent medications. It may cause high blood pressure in some patients.
Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline
can be already palpated.
1. Instruct woman to empty her bladder first.
2. Place woman in dorsal recumbent position, supine with knees flexed to relax
abdominal muscles. Place a small pillow under the head for comfort.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warms hands by rubbing together. (Cold hands can stimulate uterine
6. Use the palm for palpation not the fingers.
Purpose Procedure Findings
First To determine Using both Head is more firm, hard and
Maneuver: fetal part lying hands, feel for round that moves
Fundal Grip in the fundus. the fetal part independently of the body.
To determine lying in the Breech is less well defined
presentation. fundus. that moves only in
conjunction with the body.
Second To identify One hand is Fetal back is smooth, hard,
Maneuver: location of used to steady and resistant surface
Umbilical fetal back. the uterus on Knees and elbows of fetus
Grip To determine one side of the feel with a number of angular
position. abdomen while nodulation
the other hand
moves slightly
on a circular
motion from
top to the
lower segment
of the uterus to
feel for the
fetal back and
small fetal
Use gentle but
deep pressure.
Third To determine Using thumb The presenting part
Maneuver: engagement of and finger, is notengaged if it is not
Pawlik’s Grip presenting grasp the lower movable.
part. portion of the It is not yet engaged if it is
abdomen still movable.
pubis, press in
slightly and
make gentle
from side to
Fourth To determine Facing foot Good attitude – if brow
Maneuver: the degree of part of the correspond to the side (2nd
Pelvic Grip flexion of fetal woman, maneuver) that contained the
head. palpate fetal elbows and knees.
To determine head pressing Poor atitude – if examining
attitude or downward fingers will meet an
habitus. about 2 inches obstruction on the same side
above the as fetal back (hyperextended
inguinal head)
ligament. Also palpates infant’s
Use both anteroposterior position. If
hands. brow is very easily palpated,
fetus is at posterior position
(occiput pointing towards
woman’s back)