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Drugs Used in Pregnancy, Labour and Puerperium-PBBSc NSG Previous
Drugs Used in Pregnancy, Labour and Puerperium-PBBSc NSG Previous
PRESENTED BY:-
MS LISA CHADHA
F.Y. MSC NURSING
BVCON, PUNE
INTRODUCTION
• Drugs used in obstetrics have a huge impact
on the outcome of both mother and baby.
• Drugs used during first trimester can produce
congenital malformation and the period of
greatest risk is from the third to eleven weeks
of pregnancy
• During second and third trimester drugs can
affect the growth and functional development
of the fetus or they can have toxic effect on
fetus tissues.
DRUGS USED IN PREGNANCY
Preparation
•Injection- 10ml vial (5mg/ml with 1.5% benzyl
alchoal)
•Tablet- 0.4mg , o.8mg , 1mg
Action
Stimulates normal erythropoiesis and
nucleoprotein synthesis.
Indications
1. Megaloblastic or macrocytic anemia
during pregnancy to prevent fetal damage
2. Prevent fetal neural tube defect during
pregnancy
Contraindications
1. untreated vitamin B12 deficiency.
Adverse effects
1. Abdominal cramps
2. Diarrhoea
3. Rash
4. Irritability
5. nausea or bloating
Preparation
Each 100mg provides 33mg of elemental iron.
Tablet- 90mg,200mg,300mg,325mg,350mg
Action
Provides elemental iron, an essential component
in the formation of haemoglobin.
Indications
1. Iron deficiency
2. As a supplement during pregnancy
Contraindications
1. Primary haemolytic anemia
2. Peptic ulcer disease
3. Ulcerative colitis
4. Repeated blood transfusions
Adverse effects
1. Metallic taste
2. Temporary stained teeth
3. Nausea or vomiting
4. GI irritation
5. Black stools
Action
Replaces calcium and maintain calcium level
Indication
supplement
containdications
1. Cancer patients with bone metastasis
2. Hypercalcemia
3.Hypophosphatemia
4.Renal calculi
Adverse effects
1. Headache
2. Irritability
3.Hypercalcemia
4.Chalky taste
5. Nausea or vomitings
Action
Reduced peripheral vascular resistance as a
result of alpha and beta blockade.
Indications
1.Hypertension
2.Hypertensive emergencies
Contraindications
1.Hypersensitive to drug or its component.
2.Bronchial asthma
3.Hepatic or heart failure
4.Prolonged hypotension
5.Severe bradycardia
Adverse effects
1. Dizziness
2. Fatigue
3. Nausea or vomiting
4. Headache
5. Vertigo
Action
Thought to inhibit calcium ion reflex across
cardiac and smooth muscle cells, decreasing
contractility and oxygen demand and also dilates
arteries and arterioles.
Indications
1. Hypertension
2. Classic chronic stable angina pectoris.
Contraindications
1.Heart failure
2. Hypotension
3. Severe GI narrowing
Adverse effects
1. Dizziness
2. Syncope
3. Heart failure
4. Muscle cramps
5. Peripheral edema
Dosage and route of administrations
5-20mg OD orally.
Nursing considerations
1. Monitor BP & HR regularly
2. Advise patient to avoid taking this drug with
grapefruit juice.
3. Watch for symptoms for heart failure.
4. Advise patient if chest pain worsen
immediately report to doctor.
METHYLDOPA
Preparations
Tablet-250mg,500mg
Inj-50mg/ml
Action
Inhibit the central vasomotor centre, decreasing
sympathetic outflow to the heart, kidney and
peripheral vasculature.
Indications
1. Hypertension
2. Hypertensive crisis
Contraindications
1. Hepatic disease or liver cirrhosis
2. Lactating mother
Adverse effects
1. Decrease mental acuity
2. Sedation
3. Headache or depression
4. Bradycardia
5. Hepatic necrosis
6. Hepatitis
Dosage and routes of administration
250mg BD or TDS max 2g daily titrated by BP
Nursing considerations
1. Monitor BP regularly.
2. Monitor patient coomb’s test result.
3. Report for involuntary movements.
4.Tell patient to check weight daily and notify if he gains
2 or more pounds in a week
Hydralazine Hydrochloride
Preparation
Inj-20mg/ml in 1ml vial
Tablet-10mg,25g,50mg,100mg
Action
Direct acting peripheral vasodilator that relexes arteriolar
smooth muscle.
Indications
1. Hypertension
2. Severe essential hypertension
contraindications
1. Coronary artery disease
2. Rheumatic heart disease
3. Stroke
4. Severe renal impairment
Adverse effects
1. Neutropenia
2. Leukopenia
3.Thrombocytopenia
4. Orthostatic hypotension
Dosage and route of administration
25mg tablet BD and if necessary may increase to 50mg
BD
5mg diluted in 10ml of NS slow IV at 15-20minutes
interval.
Nursing considerations
1. Monitor patient BP, pulse rate, body weight frequently.
2. Monitor patient for muscle and joint pain, fever or
throat pain.
3. Advised patient to take drug after food to increase
absorption
DIURETICS
Diuretics are used in the following conditions
during pregnancy:
Action
Acts directly on vascular smooth muscle, causes cardiac
stimulation & uterine relaxation And thus causing relaxing the veins
and arteries and making them wider to increase the blood flow to
certain parts of the body.
Indication
1. Prevent Preterm labour
2. Inhibit uterine contractions.
Contraindications
1. Hypersensitivity
2. Postpartum
Adverse effects
1. Hypotension
2. Tachycardia
3. Nausea or vomiting
4. Pulmonary edema
5. Cardiac arrhythmias
6. Hyperglycemia or hypokalemia
Dosage & routes of administration
Initial: IV drip 100 mg in 5% dextrose @Rate0.2ug/minute.
To continue at least 2 hours after the contractions cease
Maintenance: IM 10mg 6 hourly for 24 hrs or tab 10mg 6-
8hrly.
Nursing considerations
1. Assess patient BP, pulse during treatment
2.Take BP lying & standing as orthostatic hypotension is
common
3. Monitor for Intensity & length of uterine contractions and
FHS.
4. Advise patient to make position changes slowly as
fainting may occur.
Ritodrine hydrochloride (yutopar)
Preparation
Inj-5ml amp-10mg/ml=50mg per amp.
Tablet-10mg
Action
Acts directly on vascular smooth muscle, causes cardiac stimulation &
uterine relaxant.
Indications
Prevent preterm labour
Contraindications
1. Hypersensitivity
2. Eclampsia
3. Hypertension
4. Dysrhythmias
Adverse effects
1.Hyperglycemia
2. Headache
3. Restlessness or sweating
4. Chills and drowsiness
5. Nausea or vomiting
6. Altered maternal & fetal heart tone & palpitations.
Dosage and routes of administration
Initial: IV drip 100 mg in 5% dextrose @ 0.1 mg/minute gradually
increased by 0.05mg/min ,To continue for at least 2 hrs after
contractions cease.
Maintenance -Tab 10mg 6-8 hourly PO 10 mg given half hour
before termination of iv, then 10 mg q2 hr x 24 hrs, then 10-20 mg
q4th, not to exceed 120 mg/day
Nursing considerations
Here are the drugs used in labor are:-
1.Oxytocics
2. Analgesics
3. Anticonvulsant
4. Anticoagulant
OXYTOCICS
Oxytocics are the drugs that have the power to
excite contractions of the uterine muscles.
Among a large number of drugs belonging to
this group the ones that are important and
extensively used are :-
1. Oxytocin
2. Ergot derivatives
3. Prostaglandins
OXYTOCIN
Oxytocin is an octapeptide synthesized in the hypothalamus and
stored in the posterior pituitary.
Preparations
Synthetic oxytocin available for parenteral use includes:-
•Syntocinon : 5units/ml in ampoules of 1 ml
•Pitocin 10 units/ml in ampoule of 0.5 ml
•Syntometrine : A combination of syntocinon on 5 units &
ergometrine 0.5mg
•Oxytocin nasal solution 40 unit/ml
Actions
Acts directly on myofibrils producing uterine contractions &
stimulates milk ejection by the breasts
Indications
Pregnancy
1.To induce abortion, labour
2.To expedite expulsion of hydatidiform mole
3. For oxytocin challenge test
4.To stop bleeding following evacuation.
Labour
1.To augment labour, in uterine inertia
2. to prevent & treat postpartum hemorrhage
Postpartum
1.To initiate milk let-down in breast engorgement.
Contraindications
In late pregnancy
1. Grand multipara
2. Contracted pelvis
3. History of LSCS or hysterectomy
4. Malpresentation
During labour
1. All contraindications mentioned in pregnancy
2. Obstructed labour
3. Incoordinate uterine action
Anytime
1. Hypovolemic state, cardiac disease
Adverse effects
1. Hypertonic uterine activity
2. Fetal distress & fetal death
3. Uterine rupture
4. Hypotension
5. Neonatal jaundice
6. Water retention & water intoxication
Dosage & routes of administration
Controlled IV infusion ( 10 units of oxytocin in 1 L of
RL/5% Dextrose in water)
Nasal spray for milk let- down
Nursing considerations
Contraindications
1. Suspected plural pregnancy
2. Organic cardiac disease
3. Severe Pre-eclampsia & Eclampsia
Adverse effects
1. Rise of BP due to vasoconstriction action
2. Prolonged use in puerperium may interfere by
decrease concentration of prolactin & gangrene of toes
due to vasoconstriction.
Contraindications
1. Hypersensitivity
2. Uterine fibroids
3. Cervical stenosis
4. PID
Side effects
1. Headache
2. Dizziness
3. Hypertension
4. leg cramps
5. Joint swelling
Indication
1. Cervical dilatation in the first stage of labor.
2. Symptomatic relief of GI tract and ureteric colic.
Contraindications
1. Paralytic ileus
2. Myasthemia Gravis
3. Hypertension
4. Ulcerative colitis
5. Closed angle glaucoma
6. CVS disorders
Adverse effects
1. Dryness of mouth
2. Thirst
3. Dilatation of pupil
4. Palpitations
5. Giddiness
Dosage and routes of administration
Inj-8mg deep IM. It may be repeated after 4 hours
if necessary.
Nursing considerations
1. Advise patient to report for any blurred vision,
giddiness ,dry mouth immediately.
2. Advise patient to get up from the bed carefully
and slowly.
Tramadol hydrochloride
Preparation
Inj-1amp=50mg
Tablet-50mg,100mg,200mg
Action
Bind to opioid receptor and inhibit reuptake of
norepinephrine and serotonin
Indications
1. Moderate to moderately severe pain
2. Safe given during labor as it does not cause depression
to fetal respiratory centre and hence safe for baby.
Contraindications
1. Breast feeding mothers
2. Hypersensitiviy
3. Hepatic impairment
4. Increased ICP
Adverse effects
1. Dizziness
2. Headache
3. Malaise
4. Hypertonia
5. Nausea or vomiting
Dosage and routes of administration
50 to 100mg IM 6hrly or as required.
Nursing considerations
1. Monitor patient CV and respiratory status.
2. Monitor patient at risk for seizure.
3. Monitor patient bowel and bladder function.
COAGULANT
Vitamin K(phytonadione
At birth, the newborn does not have bacteria in
the colon that necessary for synthesizing fat
soluble vitamin k. Therefore newborns have
decreased level of Prothrombin during the first 5
to 8 days of life.
Preparation
INJ- 2ml vial=2mg/ml
Action
It promotes the hepatic formation of the clotting factors
II,VII,IX and X.
Indications
1. It is used to treat or prevent certain bleeding problems.
2. It helps liver to produce blood clotting factors
Contraindications
Hypersensitivity
Adverse effects
1. Pain and edema may occur at injection site.
2. Allergic reaction such as rash and urticarial may
occur.
3. Hyperbilirubinemia
Dosage and routes of administration
0.5mg IM within 1 hour of birth.
Nursing considerations
1. Document the giving of the medication to
newborn to prevent an accidental doubling.
2. Observe for bleeding usually occurs on 2nd and
3rd day.
3. Observe for jaundice
4. Observe for local inflammation.
DRUGS GIVEN DURING PUERPERIUM
Here are the drugs given during puperium
are:-
1.Iron
2.Folic acid
3.Calcium
4.Acetaminophen(paracetamol)
5.Lactation suppressant (in case of stillbirth,
neonatal death, breast abscess or severe
psychiatric illness.
Acetaminophen (paracetamol)
Preparation
Tablet-80mg,160mg,500mg
Suppository-80mg,120mg
Oral solution-16m/ml,80mg/ml
Action
Produce analgesia by inhibiting prostaglandins and other
substances that sensitizes pain receptors.
Indications
1. Mild to moderate pain
2. Fever
Contraindications
1. Liver disease
2. Hypersensitivity
Adverse effects
1. Neutropenia
2. Hemolytic anemia
3. Hypoglycemia
4. Urticaria
Dosage and routes of administration
500mg tablet thrice a day for 5 days
Nursing considerations
1. Advise the patient to not to exceed the
prescribed dose.
2. Advise the patient hat drug is only for short
term use and avoid taking OTC drugs without
prescription.
3. Advise patient to take tablet after meal to
prevent GI symptoms.
Lactation suppressants
(Bromocriptine mesylate)
Preparation
Tablet-0.8mg,2.5mg
Action
It blocks the release of a prolactin from the pituitary
gland.
Indications
1. Suppression of lactation
2. Pregnancy with prolactinoma
3. Infertility
4.Amenorrhoea
Adverse effects
1. Dizziness or lightheadedness especially when getting
up from lying position.
2. Confusion
3. Hallucinations
4. Hypertension
5. Seizures
6. Myocardial infarction
Dosage and routes of administration
2.5mg tablet orally once in a day.
Nursing considerations
1.Cytotoxic drugs: multiple fetal malformations &
abortion
2.Androgenic steroids, hydroxy progesterone:
masculinization of the female offspring
3.Lithium: increased congenital malformations when
used in the 1st trimester, neonatal goitre, hypotonia &
cynosis
4.Diethyl stillbestrol: vaginal stenosis, cervical hoods
uterine hypoplasia in female fetuses.
Maternal drug intake & breastfeeding
Maternal drug intake of nursing mothers have adverse
effects on lactation & also on the baby as it may be
present on the breast milk
•Transfer of drugs through breast milk depends on the
following factors:
•Chemical properties
•Molecular weight
•Degree of protein binding
•Ionic dissociation
•Lipid solubility
•Tissue pH
•Drug concentration
•Exposure time
Drugs identified as having effects on
lactation & the neonates are listed below:
•Bromides: rash, drowsiness, poor feeding
•Iodides: neonatal hypothyroidism
•Chloramphenicol: bone marrow toxicity
•Oral pill: suppression of lactation
•Bromocriptine: suppression of lactation
•Ergot: suppression of lactation
•Metronidazol: anorexia, blood dyscrasias,
weakness, neurotoxic disorders
• Anticoagulants: hemorrhagic tendency
• Isoniazid: anti-DNA activity &
hepatotoxicity
• Antithyroid drugs & radioactive iodine:
hypothyroidism & goiter
• Diazepam, opiates, phenobarbitone:
sedation effect with poor sucking reflex.
CONCLUSION
• No drug should be administered to a woman during
pregnancy, labor and birth, unless the woman is fully
informed of the known risks and the relevant areas of
uncertainty regarding the effects of the drug on the
physiologic and neurologic development of the woman
or her baby
• The drugs that are used daily in obstetric can have a
huge impact on the outcome of both mother and child.
• Therefore, obstetric providers need to have a very clear
understanding of the mechanism of action, doses and
side-effects of the most commonly used drugs.
BIBLIOGRAPHY
• 1. Annamma Jacob “ A Comprehensive Textbook of
Midwifery & Gynecological Nursing” 3rd edition. Jaypee
Brothers Medical Publishers (P) Ltd page no. 604-619
• 2. D.C.Dutta’s “Textbooks of Obstetrics” 7th edition. New
Central Book Agency (P) Ltd page no.666.
• 3. A.K Debdas “Drug handbook in Obstetrics”,3rd
edition.Jaypee brothers and medical publishers private
limited, New Delhi.
• 4. wolter Kluwer “Drug handbook”32 edition.lippincot
William &Wilkinson publisher ,London.
• 5.
www.medicine.tcd.ie/pharmacology_therapeutics/....Obs&Gyn.pd