Common drugs during pregnancy

Cairo university

Faculty of nursing

2024/2025

Under supervision/Dr Fatma Ahmed

Outline:-

 Oxytocin

 Prostaglandin

 Methergine

 Xylocian

 Pethidine

 Antc +primperan

(Definition, indications, contraindications, side effects, nursing Management)

Objective:-

At the end of lecture each student will able to:-

 Know definition of this drugs

 Know contraindications of this drugs

 Know side effects of this drugs

 Know indications of this drugs

 Know nursing Management of this drugs

Student name:-

 Esraa Mohamed habib

 Nahad Hamada

 Basma Mohamed

 Rasha Nasser

 Esraa Mujahid

 Eman Araby
Oxytocin:-

Main action:-

Oxytocin is a hormone that is used to induce labor or

strengthen uterine contractions, or to control bleeding after childbirth.

Indication:-

 Oxytocin used to induce labor or strengthen uterine contractions,

 or to control bleeding after childbirth.

 Oxytocin is also used to stimulate uterine contractions in a woman with an incomplete or

threatened miscarriage.

Contraindications:-

 Hypersensitivity to the drug

 Disproportion of the fetal head in the pelvis,

 or the position of the fetus is not suitable for natural birth

 Cases that require caesarean section

 Prolonged use in the inactive uterine contraction or in cases of severe septicemia

 When the uterus is hyperactive or hypertonic.

 Conditions for which vaginal delivery is not permitted (such as cervical cancer, active

genital herpes, placenta previa, vas deviation, umbilical cord prolapse)

Adverse effects:-

 redness and irritation at the injection site

 Fetal hypoxia

 Perinatal hepatic necrosis

 fetal hypercapnia -severe uterine contraction

 loss of appetite nausea or vomiting

 Severe decrease in systolic and diastolic blood pressure, increase in heart rate, systemic

 venous return, cardiac output, arrhythmia

 bradycardia, tachycardia, arrhythmias

 Low Apgar score

 Permanent central nervous system or brain damage, death secondary to suffocation

 newborn seizure

 fetal death

 Heterotopic hypoplasia and fetal heart rate change -neonatal jaundice

Nursing care of the oxytocin:-

 Monitor maternal vital signs especially blood pressure

 -Monitor fetal heart rate during and after uterine contraction

 -Monitor injection site for redness and irritation

 -Monitor any signs of allergies -Monitor the uterine contraction (duration, frequency, intensity)

 -Monitor maternal oxygen saturation

 -Monitor that the show appears

 -Monitor the descent of the amniotic fluid

Prostaglandin: -

Main action-:

relaxes cervical smooth muscle and stimulates uterine contractions. It is

used to induce labor or abortion. Its exact mechanism of action is

unclear; it is suggested that it increases intracellular calcium leading to

contractions. However, the mechanism of cervical dilation is yet to be

studied.

Indication :-

 -Preventing closure of ductus arteriosus in newborns with cyanotic heart defects (PGE1)

 -Treatment of NSAID

 -induced gastric ulcers

 -Reducing pulmonary hypertension(PGI2)

 -Induction of childbirth (PGE2, PGF2)

 -Vasodilation of digits for treatment of severe Raynaud

disease or critical limbi ischemia

 -Management of glaucoma(PGF2 alpha)

 -Treatment of erectile dysfunction(PGE1)

Contraindications of the prostaglandin:-

prostaglandin E2 should be avoided in scenarios in which vaginal delivery or the induction of labor is

contraindicated and should be stopped before administering oxytocin

  hypersensitivity to the drug

 History of C.S ✓ Fetal cephalo pelvic disproportion

 Unfavorable fetal position

 Fetal distress

 Risk uterine rupture

 Vaginal bleeding

 Pelvic infection / sepsis

 Obstetric emergency require surgical

intervention

 Grand multiparity ( > 5 )

Adverse effects:-

 Uterine hyperstimulation

o Abnormal fetal heart rate

o Nausea

o Vomiting

o Diarrhea

o Diaphoresis

 Burning sensation in the vagina

o Cardiac arrhythmia

Nursing care :-
  Ensure No Contraindication

 Assess status of Cervix, uterine Activity & obtain baseline Fetal heart rate.

 Bring medication to room Temp.

 Place client in dorsal /lithotomy position

 Instruct Client to remain in supine position for 15 - 30 min

 Monitor Vital Signs, uterine activity (Strength, Frequency, duration) & FHR.

 Assess Cervical dilation and effacement

 Assess hypersensitivity reaction (rash, dyspnea, Chest pain)

 Asses Uterine hyper-stimulation (Freq. > 6/10min , Dura. >90sec)

 No PV after insertion of medication

 Oxytocin administered4-6hr after prostaglandin, at least 4hrs between each dose of

prostaglandin

Methergine:
Main action:
Methergine (Methylergonovine maleate) acts directly on the
smooth muscle of the uterus and increases the tone, rate and
amplitude of rhythmic contractions. Thus, it induces a rapid
and sustained tetanic uterotonic effect which shortens the
third stage of labor and reduces blood loss. It makes a
contraction without retraction.

Indication of methergine:
-Following delivery of the placenta, for routine management of uterine atony, hemorrhage, and
subinvolution of the uterus.
-control of uterine hemorrhage in the second stage of labor following delivery of the anterior shoulder.
-prevent or treat bleeding from the uterus that can happen after childbirth or an abortion.
Contraindications of methergine:-
 Cardiac disease.
 Kidney /liver / heart Problems.
 Hypertension (All types) →Help syndrome.
 Breast feeding after 12 hrs.
 Milk secreted during this period should be discarded.
 During pregnancy, but not allowed during labor

Adverse effects of methergine:-

 Increased blood pressure (severe headache, blurred vision, anxiety, shortness of breath).
 Chest pain, sweating, pounding heartbeats and seizure (convulsions).
 Numbness, tingling fingers or toes.
 Confusion, hallucinations, vision problems.
 blood in urine or a light-headed feeling,
 Nausea, vomiting and dizziness.
 Leg Cramps
 Foul taste in the mouth and Stuffy nose

Nursing care of methergine:

❖This drug should not be administered I.V. Routinely because of the possibility of inducing sudden
hypertensive and cerebrovascular accidents.
❖Methergine should be given slowly over a period of no less than 60 seconds with careful monitoring
of blood pressure.
❖Intra-arterial should be avoided.
❖Assess the blood pressure before and routinely throughout drug administration.
❖Monitor fundal height, consistency, the amount and characteristics of the lochia
❖Mothers should not breast-feed during treatment with Methergine. Milk secreted during this period
should be discarded.
❖Methergine may produce adverse effects in the breast-feeding infant. Methergine may also reduce the
yield of breast milk.
Xylocaine: -

Main action: -

Lidocaine ( local anesthesia) works by stopping the sodium

ions from passing through the voltage- gated channels. So, the

signals for pain are stopped even before the signals are formed.

The pudenda nerve innervates the genitalia, so a pudenda nerve

block provides pain relief in the lower vagina, the vulva, and

the perineum. Pudenda nerve blocks would be used during an episiotomy or a vacuum/forceps-assisted

birth. This specific nerve block does not affect the belly or help alleviate contraction pains.

Indication of xylocaine: -

 Provide superior pain relief in first and second stages of labor

 Facilities patient cooperation during labor and delivery

 Provide anesthesia for episiotomy and instrumental

 Allows extension of anesthesia for caesarean delivery

Provides superior pain relief in first and second stages of labor

Adverse effects of xylocaine: -

 twitching, tremors, convulsions (seizures),

 dark urine, blue appearance of the skin

 lightheadedness

 severe anxiety
  slow heart rate, weak pulse

 drowsiness, dizziness

 weak or shallow breathing.

 vomiting, feeling hot or cold

 sudden feeling of warmth with muscle stiffness and pai

Nursing care of xylocaine: -

 When Lidocaine is administered as an antiarrhythmic the nurse should monitor the ECG

continuously.

 monitor Blood pressure and respiratory status should be monitored frequently during the drug

administration.

 When administered as an anesthetic, the numbness of the affected part should be assessed.

 Serum Lidocaine levels should be monitored frequently during prolonged use.

Pethidine: -

Main Action: -

narcotic analgesics cause CNS depression used for relief severe or

moderate pain in some post operative and in labor.

Indications: -

 Pethidine is a strong opioid pain-relief medicine.

 Pethidine is no longer commonly prescribed, and its use is discouraged. This is because it has a

higher risk of side effects than other opioids.

 pethidine is still used to help relieve labour pain during childbirth. In recent years, pethidine has

been used less often in labour wards, as morphine has been shown to give longer-lasting pain

relief with fewer side effects.

Contraindications: -

 Breathing difficulties, Severe respiratory depression, acute asthma, Lung problems Severe renal

impairment.

 Severe hepatic impairment Hypersensitivity to the active substance or to any of the excipients

diabetic acidosis.
Side Effects:

 Dizziness

 Headache

 Blurred Vision

 Constipation

 Dry Mouth

 Loss of appetite

 Nausea, Vomiting

Nursing Care:

 Monitor pulse oximetry

 perform pulmonary function tests to quantify suspected changes in ventilation and respiratory

function.

 Excessive respiratory depression requires emergency care.

 Be alert for excessive sedation or changes in mood and behavior (euphoria, dysphoria, confusion,
hallucinations).

 Assess for decrease pain in 30 minutes -assess vital signs

Antec +primperan
Main action:-

Promote cervical ripening

Contraindications: -

mechanical obstruction and perforation phaeochromocytoma history of seizures.

Adverse effects :

 headache

 trouble sleeping

 confusion

 restlessness

 dizziness

 exhaustion

 sleepiness

Nursing considerations :-

• Assessment

History: Allergy to metoclopramide, Gl hemorrhage, mechanical obstruction or perforation,

phaeochromocytoma,
Interventions

 Monitor BP carefully during IV administration.

 Monitor for extrapyramidal reactions and consult physician if they occur.

 Monitor diabetic patients.

 monitor liver function tests.

 Monitor the frequency, severity, and duration of Gl problems (nausea, vomiting, heartburn,

hiccups) to help document drug effectiveness.

 Reference

Briggs GG, Wan SR. Drug therapy during labor and delivery, part 1. Am J Health Syst Pharm.

2006;63:1038-1047. https://www.endocrine.org/patient-engagement/endocrine-library/hormones-

and-endocrine-function/reproductive-hormones

Kelsey JJ, Prevost RR. Drug therapy during labor and delivery. Am J Hosp Pharm. 1994;51:2394-

2402. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182611/