DRUGS USED IN PREGNANCY, LABOUR, PUERPERIUM &

NEWBORN-
There are various drugs in obstetrics which are used during pregnancy, labour,
puerperium & for newborn.

DRUGS
USED IN

Pregnancy Labour Puerperium Newborn

PREGNANCY-
Oxytocin
Ergot derivatives- Ergometrine, Methergin
Prostaglandins- Misoprost, Carboprost, Dinoprostone
Antihypertensive- Methyldopa, Sodium Nitroprusside, Labetalol, Nifedipine,
Prazocin, Propranol, Diuretics (Frusemide, Hydralazine Hydrochloride,
Spironolactone)
Tocolytic agents- Betamimetics(Terbutaline, Ritodrine & Isoxsuprine),
Nifedipine, Magnesium Sulphate, Indomethacin)
Anticonvulsant- Magnesium Sulphate, Diazepam, Phenytoin.
Anticoagulants- Heparin, Warfarin

LABOUR
Oxytocin
Ergot derivatives- Ergometrine, Methergin
Prostaglandins- Misoprost, Carboprost, Dinoprostone
Anticonvulsant- Magnesium Sulphate, Diazepam, Phenytoin

PUERPERIUM
Oxytocin
Ergot derivatives- Ergometrine, Methergin
Prostaglandins- Misoprost, Carboprost, Dinoprostone
Rhogam

NEWBORN
Betamethasone
Vit. K

OXYTOCICS
Oxytocics are the drugs of varying chemical nature that can excite uterine
contractions of the uterine muscles. There are a number of drugs but the important
ones are
Oxytocin
Ergot derivatives
Prostaglandins

OXYTOCIN
INTRODUCTION:

It is synthesized in the paraventricular nuclei of the hypothalamus. It has a half

life of 3-4 minutes.
MODE OF ACTION:
During labour, increase in myometrial oxytocin receptor concentration

Oxytocin acts through these oxytocin receptors & calcium channels

& stimulate amniotic & decidual prostaglandin production & initiate myometrial
contractions

PREPARATIONS USED:
Synthetic oxytocin (pitocin): is widely used. It has got oxytocic effect without
any vasopressor action. It is available in ampoules containing 5I.U/ml

Syntometrine(sandoz): combination of 5 units of syntocinon and 0.5 mg

ergometrine

Desamino oxytocin: It is more effective than oxytocin, used as buccal tablets

containing 50I.U

Oxytocin nasal solutions contain 40units/ml.

ROUTES OF ADMINISTERATION:
IV or IM
Buccal tablets
Nasal sprays
 Calculation of dose delivered in miliunits (mU) & its correlation with drop
rate per minute
Units of oxytocin mixed in 500ml Drops per minute
Ringer solution 15 drops =1ml
( 1Unit = 1000 miliunits) 15 30 60
In terms of mU / minute

2 4 8
4 8 16
16 32 64

INDICATIONS:
It may be conveniently given in pregnancy, labour and puerperium. It is grouped
as
Therapeutic
Diagnostic
THERAPEUTIC
Pregnancy
Labour
Puerperium

PREGNANCY:
1 To accelerate abortion
2 To stop bleeding
3 To induce labour
4 To facilitate cervical ripening of labour

LABOUR
In active management of 3rd stage of labour
Expulsion of placenta as an alternative to ergometrine
PUERPERIUM
To minimize blood loss and to control PPH
Out of many ergot derivatives two are used as oxytocics.

DIAGNOSTIC:
Contractions Stress test
Oxytocin sensitivity test

CONTRAINDICATIONS
PREGNANCY
 Grand multipara
 Contracted pelvis
 History of caesarean section or hysterotomy
 Malpresentation

LABOUR

 Grand multipara
 Contracted pelvis
 History of caesarean section or hysterotomy
 Malpresentation
 Obstructed labour
 Incoordinate uterine action
 Fetal distress

OTHER
 Hypovolaemic state
 Cardiac disease

DANGERS OF OXYTOCIN:

MATERNAL
1. Uterine hyper stimulation
2. Uterine rupture
3. Water intoxication
FETAL
1. Fetal distress or fetal death

ERGOT DERIVATIVES
Out of many ergot derivatives two are used as oxytocics
Ergometrine
Methargin

MODE OF ACTION:
Ergometrine, Methargin acts directly on the myometrium

& excites uterine contractions

PREPARATIONS USED:
Ergometrine-
0.25mg in ampoules
0.5 mg ampoules
Methargin
0.2 mg in ampoules
0.5-1mg tablet
INDICATIONS:
Therapeutic
Prophylactic

THERAPEUTIC
To stop the atonic uterine bleeding
Following delivery, abortion
Expulsion of hydatidiform mole

PROPHYLACTIC
Excessive heamorrhage following delivery
In active management of 3rd stage of labour

CONTRAINDICATIONS:
1 Suspected plural pregnancy
2 Organic cardiac diseases
3Severe eclampsia and preeclampsia
4 Heart disease and HTN

SIDE EFFECTS
Nausea & vomiting
Rise in blood pressure, stroke
Rarely gangrene of the toe

PROSTAGLANDINS

INTRODUCTION:
Prostaglandins are the derivatives of prostanoic acid they have the property of
acting as local hormone
 preprations of
PROSTAGLANDINS

Vaginal suppository
Or Parentral
Tablet
Vaginal pessary

PROSTAGLANDINS

PGE1-
Misoprostol

PGE2-
Prostaglandins
Dinoprostone

PGE2α -
Carboprost

MISOPROSTOL
It is a methyl ester of PGE1
MECHANISM OF ACTION
PGE1 Act on the myometrium

& causes the cervical ripening

INDICATIONS

1 Induction of abortion
2 Induction of labour
3 Acceleration of labour
4 Management of atonic postpartum hemorrhage
CONTRAINDICATIONS
Hypersensitivity to drug
Uterine scar
Pelvic inflammatory disease
Hepatic & renal disorder

ADVERSE EFFECTS
Tacysystole (Hyperstimulation)
Meconium passage

DINOPROSTONE
It is a PGE2 Prostaglandin
 MECHANISM OF ACTION
Change in myometrial cell membrane permeability

Or alteration of membrane bound calcium

Then they sensitise myometrium to produce uterine contractions

INDICATIONS
1 Induction of abortion
2 Induction of labour
3 Acceleration of labour
4 Management of atonic postpartum heamorrhage
5 Termination of molar pregnancy
6 Management of ectopic tubal pregnancy

CONTRAINDICATIONS

Hypersensitivity to drug
Uterine scar
Pelvic inflammatory disease
Hepatic & renal disorder

SIDE EFFECTS

Reproductive system: uterine rupture

Vascular Disorders: Hypotension
Pregnancy, Puerperium and Perinatal Conditions: Amniotic fluid embolism

CARBOPROST
It is a PGE2 Prostaglandin
MECHANISM OF ACTION
Change in myometrial cell membrane permeability

Or alteration of membrane bound calcium

Then, it produces strong uterine contractions of smooth muscles of uterus

INDICATIONS
1 Induction of abortion
2 Induction of labour
3 Acceleration of labour
4 Management of atonic postpartum heamorrhage
5 Termination of molar pregnancy
6 Management of ectopic tubal pregnancy

CONTRAINDICATIONS

Hypersensitivity to drug
Uterine scar
SIDE EFFECT

Vomiting and diarrhea

Nausea
Dysmenorrhea-like pain
Breast tenderness
Urinary tract infection
Uterine rupture

ADVANTAGES OF PROSTAGLANDINS OVER OXYTOCIN

It has got powerful oxytocic effect.

Ii is more effective than oxytocin

DISADVANTAGES OF PROSTAGLANDINS

It is costly
Tachysystole
Nausea
Vomiting

ANTIHYPERTENSIVES
INTRODUCTION:
Antihypertensive drugs are given when B.P. is 160/110mm of Hg to protect
mother from cerebral haemorrhage, cardiac failure and placantal abruption. First
line therapy is methyldopa and second line of therapy is nifedipine.
 Methyldopa

Labetalol

Prazosin

Antihypertensi
Nifedipine
ves

Propranol

Sodium
nitroprusside

Diuretics

METHYLDOPA
Drug of first choice during pregnancy, effective & safe for both mother & fetus.

MODE OF ACTION
Stimulates central α adrenergic receptors

Resulting in decrease of arterial pressure

DOSE
ORALLY-250mg-500mg
I.V- 250-500mg

INDICATIONS
Hypertension
Gestational hypertension (pregnancy-induced hypertension -PIH)
Pre-eclampsia

SIDE EFFECTS
MATERNAL-
Postural hypotension
Haemolytic anaemia
Sodium retention

FETAL-
Intestinal ileus

CONTRAINDICATIONS
Hepatic disorders
Psychic patients
CCF

LABETALOL
Efficacy & safety with short term use
MECHANISM OF ACTION

Decrease in systemic arterial blood pressure and systemic vascular resistance

Because of its combined α- and β-adrenergic blocking activity

INDICATIONS
Hypertension
Severe hypertension, hypertensive emergencies

DOSAGE
Orally -100mg t.i.d
I.V. Infusion- 1-2mg/min until desired effect

SIDE EFFECTS
MATERNAL-
Postural hypotension
Sodium retention

FETAL-
Intestinal ileus

CONTRAINDICATIONS
Hepatic disorders

PROPRANOL
Propranolol (INN) is a sympatholytic non-selective beta blocker.
MECHANISM OF ACTION

A non selective beta blocker that reduces cardiac oxygen demand

By blocking catecholamine –induced increases in heart rate, blood pressure &

force of myocardial contraction

DOSAGE
Orally – 80-240mg

INDICATIONS
Hypertension

SIDE EFFECTS

MATERNAL
Severe hypotension
Sodium retension
Bradicardia
Bronchospasm
Cardiac failure
Hypoglycemia

FETAL
Bradycardia
Impaired fetal response to hypoxia
IUGR when began in first & second trimester
Neonatal hypoglycemia
Contraindications
Bronchial asthma
Renal insufficiency
Diabetes
CONTRAINDICATIONS
Bronchial asthma
Cardiogenic shock

PRAZOSIN

It is a sympatholytic drug used to treat high blood pressure

DOSAGE
Orally -1mg b.i.d

INDICATIONS
Hypertension

SIDE EFFECTS
Hypotension
Nasal congestion
Fluid retention

CONTRAINDICATIONS
Hypotension
Syncope
NIFEDIPINE
It is a dihydropyridine calcium channel blocker

MODE OF ACTION

Calcium channel blockers

( Nifedipine)

Block the entry of

Calcium ions from
ECF to ICF

Reduces the contractility

of muscles.

DOSE
ORALLY-5-10mg

INDICATIONS
Pre term labour
Hypertension
Chronic or stable angina
SIDE EFFECTS
Flushing
Hypotension
Headache
Tachycardia a
Inhibition of labour
Bradycardia
Ankle edema
Constipation
Placental ischemia
Heart block

CONTRAINDICATIONS
It could be hazardous due to its synergic effect
Bradycardia
Cardiogenic shock
Systolic pressure < 90mmhg
Sick sinus syndrome
Left ventricle dysfunction

SODIUM NITROPRUSSIDE

Sodium nitroprusside is a potent vasodilator

PREPARATIONS
Nipride
Nitropress

MECHANISM OF ACTION
Directly relaxes arteriolar venous smooth muscle

Resulting in reduction of cardiac preload &after load

INDICATIONS
Hypertensive crisis
To decrease bleeding by creating hypotension during pregnancy

CONTRAINDICATIONS
MATERNAL
Nausea
Vomiting
Severe hypotension
Restlessness
Decreased reflexes
Loss of consciousness

FETAL
Toxicity due to metabolites-cyanide & thiocyanate
DIURETICS
COMMON PREPARATIONS USED:
FRUSEMIDE –

It is a loop diuretic
ACTION
Acts on loop of Henle

Prevents reabsorption of sodium and potassium

DOSE
Oral solution – 10mg/ml, 40mg/5ml
Injection-10mg/ml
Tablets-20mg, 40mg, 80mg, 500mg

INDICATIONS
Pregnancy induced HTN
In eclampsia with pulmonary edema

CONTRAINDICATIONS
Patient with anuria
Hypersensitive to drug

SIDE EFFECTS
MATERNAL-
Weakness
Fatigue
Muscle cramps
Postural hypotension
Hypokalemia
Hyponatremia

FETAL-
Fetal compromise

HYDROCHLOROTHIAZIDE
It is a thiazide diuretic.

PREPARATIONS
Esidrex, hydrodiuril , hydroozide

ACTION
Acts on distal tubule

Increasing excretion of water, sodium, chloride and potassium

INDICATIONS
Edema
Hypertension

DOSAGE AND ROUTE

P.O.-25-100mg/day
SIDE EFFECT
Polyuria, glycosuria, frequency
Nausea, vomiting, anorexia
Rash, urticaria, fever
Increased creatinine

CONTRAINDICATIONS
Hypersensitivity to thiazides
SPIRONOLACTONE
It is a potassium sparing diuretic

MODE OF ACTION
The drug antagonizes aldosterone

by competitive inhibition in the distal tubules

Thereby preventing the potassium excertion and decreasing the sodium

reabsorpition.

DOSE
Tablets- 25mg, 50mg, 100mg
INDICATIONS
Edema
Hypertension

CONTRAINDICATIONS
Hypersensitive to drug
Acute or progressive renal insufficiency

SIDE EFFECTS
Hyperkalemia
Weakness
Fatigue
Muscle cramps
Postural hypotension

TOCOLYTIC AGENTS
Preterm delivery can be delayed by drugs in order to improve the perinatal
outcome.

Tocolytic
agents

Magnesium
Betamimetics Indomethacin Nifedipine
Sulphate
BETAMIMETICS (TERBUTALINE, RITODRINE & ISOXSUPRINE)
ISOXSUPRINE
It is a betamimetic to halt premature labour

ACTION
Acts directly on vascular smooth muscle

Causes cardiac stimulation and uterine relaxation

DOSE
IV drip 100 mg in 5 percent dextrose
Rate 0.2 u.g. per minute

MAINTENANCE
I.M. 10 mg six hourly for 24 hours, Tab 10 mg 6-8 hourly
INDICATIONS
Delaying preterm birth
Management of preterm labour

SIDE EFFECTS
Hypotension
Tachycardia
Nausea
Vomiting
Pulmonary edema
Cardiac arrhythmias
Adult respiratory distress syndrome
Hyperglycemia
Hypocalcaemia
Lactic acidosis

RITODRINE HYDROCHLORIDE
It is a tocolytic drug, was used to treat premature labour

ACTION
Uterine relaxant –acts directly on vascular smooth muscle

Causes cardiac stimulation and uterine relaxation

DOSAGE AND ROUTES

IV drip 100 mg in 5 percent dextrose
Rate 0.1 mg per minute gradually increased by 0.05 mg per minute q 10 min until
desired response. To continue for at least 2 hours after the contractions cease.
MAINTENANCE
Tab 10 mg 6-8 hourly
P.O 10 mg given half hour before termination of IV, then 10 mg q2h × 24 hrs,
then 10- 20 mg q4h, not to exceed 120 mg/day.

INDICATIONS
Delaying preterm birth
Management of preterm labour

SIDE EFFECTS
Hyperglycemia, headache, restlessness, sweating, chills, and drowsiness.
Nausea, vomiting, anorexia and malaise
Altered maternal and fetal heart tone and palpitations

CONTRAINDICATIONS

Hypersensitivity, eclampsia, hypertension and dysrhythmias

TERBUTALINE
It is a tocolytic drug, was used to stop premature labour
MODE OF ACTION
Activation of intracellular enzymes

Causes smooth muscle relaxation

DOSE
I.V-50mg/ml

INDICATIONS
Delaying preterm birth
Management of preterm labour

SIDE EFFECTS
MATERNAL-
Headache
Palpitations
Oedema
Hyperglycemia

FETAL-
Tachycardia
Heart failure

INDOMETHACIN
It is a cyclo–oxygenase inhibitor appropriate first-line tocolytic for the pregnant
patient
MODE OF ACTION
Reduces synthesis of PGs

Thereby reduces intracellular free Ca++

Activation of MLCK & uterine contractions

DOSE
Loading dose25-50mg

INDICATIONS
In early preterm labor (< 30 wk)
Preterm labor associated with polyhydramnios

SIDE EFFECTS
MATERNAL-
Heart burn
G.I bleeding
Asthma
Thrombocytopenia
Renal injury
MAGNESIUM SULPHATE

Magnesium sulfate is widely used as the primary tocolytic agent because it has
similar efficacy to terbutaline with far better tolerance.

MECHANISM OF ACTION
Competitive inhibition to calcium ion either at motor end plate or at the cell
membrane

Reduces calcium influx

Decreases acetylcholine release & its sensitivity at the motor end plate

Direct depressant action on uterine muscles

INDICATIONS
Premature rupture of membranes
Active labor
Planned delivery within 24 hours

LOADING AND MAINTENANCE DOSES

It should not normally exceed 6 g, 1-2 g/h, and 24 hours

SIDE EFFECTS
MATERNAL
Flushing
Nausea
Headache
Drowsiness
Blurred vision

FETAL
Respiratory Depression
Motor Depression

CONTRAINDICATIONS
Patients with Myasthenia gravis & impaired renal function

NIFEDIPINE

Nifedipine, a calcium channel blocker, nifedipine has emerged as an effective and

safe alternative tocolytic agent for the management of preterm labor.

MECHANISM OF ACTION

Inhibit contractility in smooth muscle cells

By reducing calcium influx into cells

MAINTAINCE DOSE

A recommended initial dosage of nifedipine is 20 mg orally, followed by 20 mg

orally after 30 minutes. If contractions persist, therapy can be continued with 20
mg orally every 3-8 hours for 48-72 hours with a maximum dose of 160 mg/d.
After 72 hours, if maintenance is still required, long-acting nifedipine 30-60 mg
daily can be used.

CONTRAINDICATIONS

Allergy to nifedipine
Hypotension
Hepatic dysfunction
Concurrent use of beta-mimetics or mgso4 or other antihypertensive medication.
SIDE EFFECTS

MATERNAL
Tachycardia
Palpitations
Flushing
Headaches
Dizziness
Nausea

ANTICONVULSANTS

Anticonvulsants

Magnesium
Diazepam
Sulphate

MAGNESSIUM SULPHATE
MODE OF ACTION

It decreases the ACH release from the nerve endings

Reduces the motor and plate sensitivity

DOSE
IM-4gm-10gm
I.V-4-6gm

Regimen Loading dose Maintaince dose

Intramuscular 4gm I.V over 3-5 min 5gm I.M 4 hrly in
followed by 10gm deep alternate buttocks
I.M

Intravenous 4-6 gm I.V over 15-20 1-2gm /hr I.V infusion

min

INDICATIONS
Prevention or control of seizures in pre-eclampsia & eclampsia
Hypomagnesia

SIDE EFFECTS

MATERNAL
Muscular paresis
Respiratory failure

FETAL
Respiratory Depression
Motor Depression
CONTRAINDICATIONS
Patients with Myasthenia gravis & impaired renal function
Magnesium sulfate (magnesium sulfate injection should not be administered
parenterally in patients with heart block or myocardial damage

DIAZEPAM
ACTION

Depresses sulbcortical levels of CNS, antianxiety.

DOSAGE AND ROUTE OF ADMINISTRATION

PO-2 to 10 mg t.i.d – q.i.d
IV-5 to 20 mg (bolus), 2 mg/min, may repeat q5-10 min, not to exceed 60 mg may
repeat in 30 minute if seizures reappear

SIDE EFFECTS
MOTHER:
Hypotension
Dizziness
Drowsiness
Headache

FETUS:
Respiratory depression
Birth hypotonea
Thermoregulatory problems in newborn

PHENYTOIN
It is a centrally acting anticonvulsant

MECHANISM OF ACTION

Prolongs inactivation state of Na + channels

Reducing likelihood of repetitive discharge

INDICATIONS
Prevention or control of seizures in pre-eclampsia & eclampsia
Gen. tonic-clonic, partial [status epilepticus]
SIDE EFFECTS
MATERNAL
Occular
Ataxia [sedation]
Gingival hyperplasia
Hirsuitism
FETAL
Dysmorphogenic-cleft palate

ANTICOAGULANTS
HEPARIN SODIUM
Prevents conversion of fibrinogen to fibrin

INDICATIONS
Deep vein thrombosis
Thrombo-embolism
Disseminated intravasculation coagulation
Patients with prosthetic valves in the heart

ACTION
Interferes with blood clotting by indirect mean

depresses hepatic synthesis of vitamin K-dependent coagulation factors (II,7,9,10)

DOSAGE AND ROUTES

Administered parenterally; only 5,000-7,000 IU to be administered initially as IV
push, followed by 2,500 units subcutaneously every 24 hours
INDICATIONS
Deep vein thrombosis
Pulmonary embolism

DOSAGE AND ROUTE

10-15mg orally daily for 2 days, followed by 2-10 mg at the same time each day
depending upon the prothrombin time
SIDE EFFECTS
MATERNAL
Haemorrhage

FETAL
Skeletal & facial deformities
Optic atrophy
Microcephaly

RHOGAM
INTRODUCTION-
Prevention of anti Rh(d) antibody formation is most successful if the medication is
administered twice at 28 weeks of gestation and again within 72 hrs after delivery.
MECHANISM OF ACTION

Blocks Rh antigen of fetal cells

Antigen coated red cells are removed through maternal circulation.
Central inhibition-interfere the production of Ig G from B cells.

DOSE:-
<13 wk gestation: 50 mcg IM
>13 wk gestation: 300 mcg IM
UTERINE BLEEDING
Give 300 ug per 30 ml fetal whole blood or 15 ml pRBC
NO UTERINE BLEEDING
Gestation under 13 weeks: Rhogam 50 ug IM
Gestation over 13 weeks: Rhogam 300 ug IM

ADMINISTRATION:

First shot around 28 week.

Second within 72 hours following delivery or abortion.
May be given upto 14-28 days after delivery to avoid sensitisation.

INDICATION
To prevent Iso-immunisation in Rh negative clients exposed to Rh positive, MTP,
abdominal trauma or bleeding during pregnancy
ADVERSE REACTIONS-
Elevated temperature
Tenderness

CONTRAINDICATIONS-
Rh positive woman
Patients with allergic reactions
BETAMETHASONE
It is a glucocorticosteroid, It is similar as dexamethasone probably a little more
potent

MODE OF ACTION

It leads to improvement in neonatal lung function via two mechanisms

by enhancing maturational changes in lung architecture and by inducing lung

enzymes that play a role in biochemical maturation

OR

Alveoli are lined with two types of cells, the type 1 and type 2 pneumocytes

The type 1 pneumocyte is responsible for gas exchange in the alveoli, while the
type 2 pneumocyte is responsible for the production and secretion of surfactant

It accelerates morphologic development of both types of alveolar cells.

INDICATIONS-
Lactating mothers, to mature the lungs of premature babies
Betamethasone is also used to stimulate fetal lung maturation (prevention of
IRDS), and to decrease the incidence and mortality from intracranial hemorrhage
in premature infants.

DOSE
Dosage-4-20mg IV or IM

CONTRAINDICATIONS-
Hypersensitivity and systemic infections
SIDE EFFECTS-
Cataract
Osteoporosis
Peptic ulcers
Hypertension

VIT. K(PHYTONADIONE)
ACTION
An ant hemorrhagic factor that promotes

Hepatic formation of active coagulation

PREPRATIONS
Inj.-2mg/ml, 10mg/ml
Tablets-5mg

DOSE
0.5mg – 1mg vitamin K IM at birth

INDICATIONS
 Coagulation disorders due to decreased formation of phyton-dependent
factors II, VII, IX, and X
 Anticoagulant induced hypoprothrombinemia
 Prophylaxis & treatment of hemorrhagic disease of newborns
 Reversal of warfarin anticoagulant effects

CONTRAINDICATIONS
Hypersensitivity
Avoid IM if bleeding, 3rd trimester pregnancy

SIDE EFFECTS
 IV or IM use: Severe reactions, including fatalities, have occurred during
and immediately after IV administration, even when precautions have been
taken with proper dilution and avoiding rapid infusion
 Severe reactions, including fatalities, also have been reported following IM
administration; typically, these severe reactions are hypersensitivity or
anaphylaxis in nature and include shock and cardiac or respiratory arrest
 These reactions may occur with the first dose
DRUGS USED IN PREGNANCY, LABOUR,
PUERPERIUM & NEWBORN-