DRUGS IN

OBSTETRICS
DR DEEPALI JADHAV
ASSISTANT PROFESSOR
BJGMC & SGH, PUNE
 Drugs in early pregnancy

Mifepristone- 200mg PO

Mechanism: Antiprogestogenic steroid

Sensitizes myometrium to prostaglandin-

induced

contractions & ripens the cervix Clinical use:

Medical termination of pregnancy
Medical management of miscarriage/IUD

Side effects: Gastro intestinal cramps, rash, urticaria,

headache,dizziness,
Contraindication: severe asthma
 Misoprostol
Synthetic prostaglandin
 PO/PV route
Clinical use:

Medical termination of pregnancy

Medical management of miscarriage/ IUD ( For 1st
trimester single dose of 400mcg)
Induction of labour at term- 25 ug orally every 3-4 hrs
Postpartum hemorrhage- 800mcg PR/PV
 Side effects: nausea,vomiting, diarrhoea, abdominal
pain
 Methotrexate

• Cinical use: Medical management of

ectopic pregnancy
• Dose 50mg per kg/m2

• Criteria- adenexal mass, non viable

pregnancy hCG< 3000U, haemoperitonuem
< 150ml

• Disadvantage : repeated hCG levels,

emergency surgery
• Advantage: Avoid surgery, tube preserved
 OXYCTOCICS IN OBSTETRICS

 OXYTOCIN

 ERGOT DERIVATIVES

 PROSTAGLANDINS
 OXYTOCIN

 It is synthesised in the supra-optic and para

ventricular nuclei of the hypothalamus.
 A half life of 3-4 minutes and duration
of action of approximately 20 minutes
 Mode of action

 Receptor and voltage mediated

calcium channels
 Amniotic and prostaglandin
decidual production
 OXYTOCIN

 Preparations used
 Synthetic oxytocin
 Syntometrine

 Desamino

oxytocin
 Oxytocin nasal

solution
 Effectiveness

 In later months of pregnancy and during

labour
 INDICATIONS
 THERAPEUTIC:
 Pregnancy:
Early:
• To accelerate abortion.
• To stop bleeding following evacuation of the
uterus.
• Used as an adjunct of abortion along with
other abortifacient agents.
Late:
• To induce labour.
• To facilitate cervical ripening for effective
induction.
• Augmentation of labour.
• Uterine intertia.
 INDICATIONS
 Labour:
 In active management of third stage of labour.
 Following expulsion of placenta.
 Pueperium:
 To minimize the blood loss and to control the PPH.
 DIAGNOSTIC:
 Contraction stress test
 Principles:

The test is based on the determination of

respitratory function of the feto placental unit
during induced contractions
 CST
 Candidates for CST:
 Intra uterine growth restriction.
 Postmaturity.
 Hypretensive disorders of pregnancy.
 Diabetes
 Contraindications:

 Compromised fetus.
 Previous history of caesarean section.
 Complications likely to produce preterm labour.
 APH.
 INTERPRETATION :CST
 Positive: persistent late deceleration of FHR following
50 % or more uterine contrations.
 Negative: no late deceleration or significant variable
deceleration.
 Suspicious: inconsistent but definite decelerations do
not persist with more uterine contractions.
 Unsatisfactory: poor quality of recording or adequate
uterine contraction is not achieved.
 Hyperstimultaion:
 Deceleration of FHR with uterine contraction lasting >
90 seconds or occurring more frequently than every
2 minutes.
 OXYTOCIN STIMULATION TEST
 Procedure
 Inference
 Contraindications of oxytocin:
 Pregnancy:
 Grand multipara.
 Contracted pelvis.
 History of caesarean or hysterotomy.
 Malpresentation.
 Labour:
 All the contraindications in pregnancy.
 Obstructed labour.
 Inco-ordinate uterine action.
 Fetal distress.
 Any time:
 Hypovolemic state.
 Cardiac disease.
 OXYTOCIN STIMULATION TEST
 Methods of administration:
Controlled intravenous infusion
 For induction in labour

 Use in labour

Intramuscular
 5-10 units after the birth of the baby
as an alternative to ergometrine
 ADVERSE EFFECTS
MATERNAL
 Uterine hyperstimulation

 Uterine rupture

 Water intoxication

 Hypotension

Anti-diuresis

FETAL
 Fetal
distress,
fetal
hypoxia and
 MONITORING DURING
OXYTOCIN USE
 Assess
 Intake output ratio.
 Uterine contractions and FHR.
 Blood pressure, pulse and respiration.
 Administer
 By IV infusion. Monitor drop rate.
 Make crash cart available.
 Evaluate
 Length and duration of contractions.
 Notify physician of contractions lasting over 1 minute or
absence of contrcations.
 Teach
 To report increased blood loss, abdominal cramps or
increased temperature.
 ERGOT DERIVATIVES
 Mode of action:
Ergometrine acts directly on the myometrium
 Effectiveness

It is highly effective in hemostasis

 Indications:

 Therapeutic:

To stop the atonic uterine bleeding following delivery,

abortion or expulsion of hydatidiform mole.
 Prophylactic:

Against excessive haemorrhage following delivery.

 ERGOT DERIVATIVES

CONTRAINDICATIONS:
Prophylactic:
 Suspected plural pregnancy.

 Organic cardiac diseases.

 Severe pre-eclampsia and eclampsia

 Rh- negative mother.

Therapeutic:
 Heart disease or severe hypertensive disorders
 ERGOT DERIVATIVES

Preparations Ampoules Tablet

Ergometrine[ergon 0.25 mg or 0.5 0.5 mg
ovine] mg

Methergin[methyl- 0.2 mg 0.5-1 mg

ergonovine]
Syntometrine[Sand 0.5 mg
oz] ergometrine
+
5 units of
syntometrine
 Onset of action
Routes Ergometrine Methergin
IV 45-60sec 5.min
IM 6 min 7 min
Oral 10 10 min
min
 ERGOT DERIVATIVES
Hazards:
 Common side effects are nausea and vomiting.

 Precipitate rise of blood pressure, myocardial

infarction, stroke and bronchospasm because of
vasoconstrictive effect.
 Prolonged use may result in gangrene formation of
the toes.
 Prolonged use in puerperium may interfere with
lactation.
 ERGOT DERIVATIVES
 Cautions:

Ergometrine should not be used during

pregnancy, first stage of labour, second
stage of labour, second stage prior to
crowning of the head and in breech delivery
prior to crowning
 ERGOT DERIVATIVES
Monitoring :
Assess
 Blood pressure, pulse and respiration.

 Watch for signs of haemorrhage.

Administer
 Orally or IM in deep muscle mass.

Have emergency cart readily available.

Evaluate
Therapeutic effect: decreased blood loss.

Teach
 To report increased blood loss,
abdominal cramps,
headache, sweating, nausea, vomiting or
 PROSTAGLANDINS
Source
 Arachidonic acid

Mechanism of action
 PGF2α promotes
myometrial contractility
 PGE2 helps cervical

maturation
 PROSTAGLANDINS
Use in obstetrics
 Induction of abortion.

 Termination of molar pregnancy.

 Induction of labour.

 Cervical ripening prior to the induction of abortion or

labour.
 Acceleration of labour.

 Management of atonic PPH.

 Medical management of tubal ectopic pregnancy.

 PROSTAGLANDINS
Contraindications:
 Hypersensitivity to the compound.

 Uterine scar.

Preparations
 Tablet.

 Vaginal suppository

 Vaginal pessry

 Prostin E2.

 Parentral
 PROSTAGLANDINS
Advantages:
 It has got a powerful oxytocic effect,
irrespective of period of pregnancy. As such
it can be used independently specially in
the induction of abortion with success.
 In later months it can be used for
acceleration of labour.
 It has got no anti diuretic effect.
 PROSTAGLANDINS
Drawbacks:
 It is costly.

 Unpleasant side effects on systemic use are

nausea, vomiting, diarrhoea, pyrexia or
bronchospasm.
 When used as abortifacient, extensive lacerations
may occur.
 Tachysystole.
 ANTI-HYPERTENSIVE THERAPY

1.Sympatho 1.Adrenergic 1.vasodilators 1.Calcium 1. ACEI

mimetics Receptor channel Inhibitors
blocking blockers
agent

Methyl Labetalol Hydralazine Nifedipine Captopril

dopa
Propanalol Prazocin Nicardia Lisinopril
Reserpine
Sodium
nitroprusside
 LABETALOL
Drug of first choice
Mechanism of action
 Combined alpha and beta adrenergic blocking agents.

Contraindication
 Hepatic disorders.

Dose
 Orally: 100mg TDS. May be increased upto 800 mg

daily.
 IV infusion [hypertensive crisis] 1-2 mg/min until

desired effect
Side effects
 Experience is less compared to methyl dopa. efficacy

and safety with short term use. Appear equal to methyl

dopa.
 METHYLDOPA

Mechanism of action
 Central and peripheral anti-adrenergic action
 Effective and safe for both mother and fetus.

Contraindications
 Hepatic disorders
 Psychic patients
 CCF

Dose
 Orally 250mg BD may be increased to 1 gm
TDS depending upon the response.
 IV infusion 250-500mg
 METHYLDOPA
Side effects
Maternal:
 Postural hypotension

 Haemolytic anemia

 Sodium retension

 Excessive sedation

 Coomb’s test may be

positive.
Fetal:
 Intestinal ileus
 PROPRANOLOL
Mechanism of action
 Beta adrenergic receptor blocker

Contraindication
 Bronchial asthma.

 Renal insufficiency.

 Diabetes.

 Cardiac failure

 The drug is better avoided for long term therapy

during pregnancy.
Dose
 Orally: 80-120 mg in divided doses
 PROPRANOLOL
Side effects
Maternal:
 Severe hypotension
 Sodium retension
 Bradycardia
 Bronchospasm
 CCF
 Hypoglycaemia.

fetal:
 Bradycardia and impaired fetal responses to hypoxia,
IUGR when began in I and II trimester.
Neonatal: hypoglycaemia
 PRAZOCIN
Mechanism of action
 Selective post synaptic blocker. Decrease plasma
renin activity.
 Reduces cardiac preload and after load.

Contraindication
 Low first dose, to avid hypotension and syncope.

Dose
 Orally 1 mg bd may be increased upto 20 mg/day

Side effects
 Hypotension
 Nasal congestion
 Fluid retension
 HYDRALAZINE

Mechanism of action
 Arteriolar vasodilator.

Contraindication
 Because of the variable sodium retention, diuretics should
be used.
Dose
 Orally: 100mg/day in 4 divided doses.
 IV : 5mg bolus followed by 25g in 200 ml NS at a rate of
2.5 mg/hr to be doubled every 30 mts.
Side effects
 Maternal: hypotension,tachycardia, arrhythmia,
palpitation, lupus like syndrome.
 Fetal: reasonably safe.
 Neonatal: thrombocytopenia
 NIFEDIPINE
Mode of action:
 Direct arteriolar vasodilation.

Dose:
 Orally 5-10 mg TID.

Contraindications:
 Simultaneous use of magnesium sulphate could
be hazardous due to synergic effect.
Side effects:
 Flushing
 Hypotension
 Head ache
 Tachycardia
 Inhibition of labour.
 SODIUM NITROPRUSSIDE
Mechanism of action:
 Direct vasodilator.

Dose:
 Orally 6.25 bid.

Side effects:
 Maternal
 Nausea
 Vomiting
 Fetal
 Oligohydramnios
 IUGR
 Fetal and neonatal renal failure.
 NITROGLYCERINE

Mechanism of action
 Release mainly venous but also arteriolar smooth
muscles.
Dose:
 Given as IV infusion 5µg/min. to be increased at
every 3-5 min. upto 100µg/min.
Side effects:
 Tachycardia

 Headache

 Methaemoglobinaemia
 DIURETICS
Diuretics are used in the following
conditions during pregnancy.
 Pregnancy induced hypertension with
massive edema.
 Eclampsia with pulmonary edema.

 Severe anemia in pregnancy with heart

failure.
 Prior to blood transfusions in severe
anemia.
 As as adjunct to certain antihypertensive
drugs, such as hydralazine or dioxide
 FUROSEMIDE

Mechanism of action
 Acts o loop of the Henle by increasing excretion of
sodium and chloride.
Dose
 40 mg tab, daily following breakfast for 5 days a
week. In acute conditions, parentrally 40-120 mg
daily.
Contraindications:
 Hypersensitivity
 FUROSEMIDE

Maternal fetal
 Weakness  fetal compromise due
 Fatigue to decreased placental
 muscle cramps perfusion.
 hypokalemia
 Thrombocytopenia
 hyponatremia
 Hyponatremia
 hypokalemia
 hypochloremic
alkalosis
 postural hypotension
 HYDROCLOROTHIAZIDE
Mechanism of action:
 Acts on distal tubule by increasing excretion of
water, sodium, chloride and potassium. It is used in
edema and hypertension.
Dose:
 PO 25-100 mg/day.

Side effects:
 Polyuria, glycosuria, frequency.

 Nausea, vomiting, anorexia.

 Rash,urticaria, fever.

 Increased creatinine, decreased electrolytes.

 TOCOLYTIC AGENTS

 Betamimetics
 Prostaglandin synthetase inhibitors

 Magnesium sulphate

 Calcium channel blockers

 Oxytocin receptor antagonists

 Nitric oxide donors

 Antibiotics.
 BETAMIMETICS
Commonly used drugs:
 Terbutaline

 Ritodrine

 Isoxurpine

Mechanism of action:
 Activation of the intracellular enzymes [adenylate
cyclase, cAMP, protein kinase] reduces intracellular
free calcium [Ca++] and inhibits the activation of
MLCK
 BETAMIMETICS
Dose:
 Ritodrine is given by IV infusion, 50µg/min and
increased by 50µg every 10 min until contractions
cease. Maximum dose of 350µg/ min may be given.
Infusion is continued for about 12 hours after
contraction cease.
 Terbutaline has longer half life and has fewer side
effects. Subcutaneous injection of 0.25 mg every 3-4
hours is given.
 Isoxurpine is given as IV drip 100 mg in 5D.
Rate 0.2
µg/minute. To continue for at least 2 hours after
contraction ceases. Maintenance is by IM 10mg six
hourly for 24 hours, tab 10 mg 6-8 hourly.
 BETAMIMETICS
Side effects:
Maternal:
 Headache
 Palpitation
 Tachycardia
 Pulmonary edema
 Hypotension
 Cardiac failure
 BETAMIMETICS
 Side effects
 Hyperglycemia

 ARDS

 Hyperinsulinemia

 Lactic academia

 Hypokalemia

 Even death

Neonatal:
 Hypoglycaemia

 Intraventricular haemorrhage
 INDOMETHACIN
Mechanism of action:
 Reduces synthesis of PGs thereby reduces intracellular
free Ca++, activation of MLCK and uterine contractions.
Dose:
 Loading dose , 50 mg P.O. or .P.R. followed by 25mg
every 6 hrs for 48 hours.
Side effects:
 Maternal
 Heart burn
 G.I. bleeding
 Asthma
 Thrombocytopenia
 Renal injury.
 CALCIUM CHANNEL BLOCKERS

 Nifedipine
 Nicardipine

Mechanism of action:
 Nifedipine blocks the entry of calcium inside the cell.
Compared to β- mimetics, effects are less. It is
equally effective to MgSO4.
Dose:
 Oral 10-20 mg every 6-8 hours.
CALCIUM CHANNEL BLOCKERS

Side effects:
 Maternal

 Hypotension

 Headache

 Flushing

 Nausea
 MAGNESIUM SULPHATE
Mechanism of action:
 Inhibition to calcium ion

Contraindications:
 Myasthenia gravis

 Impaired renal function

Dose:
 Loading dose: 4-6 gm I.V. over 20-30 min. followed
by an infusion of 1-2 gm/hr to continue tocolysis
for 12 hours after contarctions have stopped.
 MAGNESIUM SULPHATE
Side effects:
Maternal
 Flushing
 Perspiration
 Headache
 Muscle weakness
 Pulmonary edema rarely

Neonatal
 Lethargy
 Hypotonia
 Respiratory depression rarely.
 OXYTOCIN ANTAGONISTS
 Atosiban
Mechanism of action:
 It blocks myometrial oxytocin receptors.

Dose:
 I.V.infusion 300µg/min. initial bolus may be needed.

Side effects:
 Nausea

 Vomiting

 Chest pain
 ANTICONVULSANTS

1. MAGNESIUM SULPHATE:
 Mode of action:

 It decreases the acetylcholine release from the

nerve endings.
 Dose:

 IM – loading dose: 4 gm IV [20% solution] over 3-5

min. to follow 10 gm deep IM, 5gm in each
buttocks. Maintenance dose : 5gm deep IM on
alternate buttocks every 4 hrs.
 IV- loading dose: 4-6 gm IV over 15-20 min.
maintenance dose: 1-2 gm/hr IV infusion.
 MAGNESIUM SULPHATE

Side effects:
 MgSO4 is relatively safe and is the drug of choice.

Muscular paresis[ diminished knee jerks],

respiratory failure. Renal function to be monitored.
Antidote:
 Injection of calcium gluconate 10% 10 ml IV.
 DIAZEPAM
Mode of action:
 central muscle relaxant and anticonvulsant.

Dose:
 20-40 mg IV

Side effects:
Maternal:
 Hypotension

Fetal
 Respiratory depression
 Hypotonia
 Thermoregulatory problem
 PHENYTOIN
Mode of action:
 Centrally acting anticonvulsant

Dose:
 10 mg/ kg IV at the rate not more than 50 mg/ min
followed 2 hrs later by 5 mg/kg. In epilepsy 300-
400 mg daily orally in divided doses.
Side effects:
Maternal
 Hypotension
 Cardiac arrhythmias
 Phlebitis at injection site.

Fetal
 Fetal hydantoin syndrome
 ANTICOAGULANTS: HEPARIN
Mechanism of action:
 It inhibits action of thrombin

Dose:
 5000-10000 I.U. to be administered parenterally [SC or IV].

 Low molecular weight heparin is 2500 IU

Side effects:
Maternal:
 Haemorrhage

 Urticarial

 Thrombocytopenia

 Osteopenia.

Fetal
 It does not cross the placenta
 WARFARIN
Mechanism of action:
 Interferes with synthesis of vit K dependent factors.

Dose:
 10 mg orally

Side effects:
Maternal
 Haemorrhage

Fetal
 Contradi’s syndrome [skeletal and facial anomalies]

 Optic atropy

 Microcephaly

 Chondrodisplasia punctate.
ANALGESIA AND ANAESTHESIA
IN OBSTETRICS
SEDATIVES AND ANALGESICS

1. OPIOID ANALGESICS:
 PETHIDINE

Mechanism of action:
 Inhibits ascending pain pathways in CNS , increase
pain threshold and alters pain perception.
Indications:
 Moderate to severe pain in labour, postoperative pain,
abruption placentae, pulmonary edema.
Dose:
 Injectable preparations contains 50mg/ml can be
administered SC, IM,IV. Its dose is 50-100 mg IM
combined with promethazine.
 PETHIDINE
Contraindications:

Should not be used IV within 2 hrs and IM

within 3 hrs of expected time of delivery of the
baby, for fear of birth asphyxia. It should not
be used in cases of preterm labour and when
respiratory reserve of the mother is reduced
Side effects:
Maternal
 Drowsiness

 Dizziness

 Confusion

 Headache

 Sedation

 Nausea

 Vomiting

Fetal
 Respiratory depression

 Asphyxia
 FENTANYL

Mechanism of action:
 Inhbits ascending pathways in CNS, increases pain
threshold and alters pain perception.
Indications:
 Moderate to severe pain in labour, post operative
apin an dadjunct to general anaesthetic.
Dose:
 0.05 to 0.1 mg IM q1-2 hrs prn. Available in
injectable form, 0.05 mg/ml.
 Side effects:
 Dizziness

 Delirium

 Euphoria

 Nausea

 Vomiting

 Muscle rigidity

 Blurred vision
 PENTACOZIN

 Dose of 30-40 mg
 Naloxone is an efficient and reliable antagonist.

Adverse effects
 Neonate respiratory depression secondary to the
medication crossing the placenta and affecting the
fetus.
 Unsteady ambulation of the client.

 Inhibition of the mother’s ability to cope with the

pain of labor.
 TRANQUILIZERS
 DIAZEPAM:Usual dose is 5-10 mg.

 MIDAZOLAM:Dose of 0.05 mg/kg is given

intravenously

 COMBINATION OF NARCOTICS AND

TRANQUILIZERS

 BUTORPHANOL and NALBUPHINE

 INHALATIONAL METHODS
 Nitrous oxide and air

 Premixed nitrous oxide and oxygen

 Trichloroethylene

 Methoxyflurane, isoflurane, enflurane

 EPIDURAL AND SPINAL REGIONAL
ANALGESIA
Adverse effects
 Nausea and vomiting.

 Inhibition of bowel and bladder elimination

sensations.
 Bradycardia or tachycardia.

 Hypotension.

 Respiratory depression.

 Allergic reaction and pruritus.

 PUDENDAL BLOCK

 It consists of a local anesthetic such as

lidocaine(Xylocaine) or bupivacaine (Marcaine)
being administered transvaginally into the space in
front of the pudendal nerve.
 EPIDURAL ANAESTHESIA
 Epidural block consists of a local anesthetic
bupivacaine (Marcaine) along with an analgesic
morphine (Duramorph) or fentanyl (Sublimaze)
injected into the epidural space at the level of the
fourth of fifth vertebrae.
Adverse effects
 Maternal hypotension.

 Fetal bradycardia.

 Inability to feel the urge to void.

 Loss of the bearing down reflex.

 SPINAL BLOCK

 Spinal block consists of a local anaesthetic injected

into the subarachnoid space into the spinal fluid at
the third, fourth, or fifth lumbar interspace, alone or
in combination with an analgesic such as fentanyl .
Adverse effects
 Maternal hypotension.

 Fetal bradycardia.

 Loss of the bearing down reflex.

 PARACERVICAL BLOCK

 It consists of lidocaine (Xylocaine) being injected

into the cervical mucosa early in labor during the
first stage to block the pain of uterine contractions.
 Adverse effects include fetal bradycardia. Improper
technique can result in serious toxicity.
 GENERAL ANAESTHESIA

 100% oxygen is administered by tight mask fit for

more than 3 minutes. Induction of anaesthesia is
done with the injection of thiopentone sodium 200-
250 mg as a 2.5 % solution IV.,followed by
refrigerated suxamethonium 100 mg. the patient is
intubated with cuffed ET tube. Anaesthesia is
maintained with 50% NO2 , 50% oxygen and a trace
of halothane. Relaxation is maintained with non-
depolarizing muscle relaxant [ vecuronium 4 mg or
atracurium 25 mg].
 FETAL HAZARDS ON MATERNAL
MEDICATION DURING PREGNANCY

Mechanism of teratogenicity
 Folic acid deficiency.
 Epoxides or arena oxides

 Environmental and genes abnormalities.

 Maternal disease and drugs

 Homebox genes
Maternal-fetal drug transfer and the hazards:
 Before D 31:

Teratogen produces an all or none effect.

 D31-d71:

It is the critical period for organ formation.

 After D 71:

The development of other organs continues.

PLACENTAL TRANSFER OF DRUGS
The factors responsible for transfer are:
 Molecular weight [molecular wght more than 1000
Da do not cross the placenta].
 Concentration of free drug.

 Lipid solubility.

 Utero-placental blood flow.

 Placental solubility.
 GUIDELINES
 If the benefit outweighs the potential risks, only then
can the particular drugs be used with prior
counselling.
 Only, well tested and reputed drugs are to be
prescribed and that too using the minimum
therapeutic dosage for the shortest possible
duration.
CATEGORY DESCRIPTION EXAMPLE

A Adequate studies in pregnant woman have failed to show a risk to the fetus in Thyroid hormone
the first trimester of pregnancy; there is no evidence of risk in last trimester.

B Animal studies have shown an adverse effect on the fetus. But, there are no Insulin
adequate studies on humans. Pregnancy risk is unknown.

C Animal studies have shown an adverse effect on the fetus, but there are no Docusate-sodium
adequate studies on humans, or there are no adequate studies in animals or
humans. Pregnancy risk is unknown.

D There is evidence of risk to the human fetus, but potential benefits of use in Lithium acetate
pregnant woman may be acceptable despite potential risks.

X Studies in animals or humans show fetal abnormalities, or adverse reaction isotretinoin

reports indicate evidence of fetal risk. The risks involved clearly outweigh
potential benefits
drug Teratogenic effect

Cytotoxic drugs multiple fetal malformations and abortion.

-Diethyl stilbestrol vaginal adenosis, cervical hoods, uterine hypoplasia of
the female offspring.

Androgenic steroids masculinization of the female offspring.

Lithium cardiovascular anomalies, neonatal goitre, hypotonia and

cyanosis.

Anticonvulsants benefits of treatment outweigh the risks to the fetus.

Phenytoin Polytherapy should be avoided.

Valproat Increase risk of neural tube defects, neonatal bleeding.

e

Aspirin high doses in the last few weeks cause premature

closure of ductus arteriosus. Persistent
pulmonary hypertension and kernicterus in
newborn.
Paracetamol amount too small to be harmful.
drug Tertogenic effect

Antimalarials chloroquine, quinine- no evidence of fetal toxicity in therapeutic

doses; benefits outweighs the risk.
high doses[ >10 mg prednisolone daily] may produce fetal and
neonatal adrenal suppression.

Corticosteroids Auditory or vestibular damage.

Aminoglycosides Gray baby syndrome [peripheral vascular collapse].

Chloramphenicol Dental discolouration [yellowish] and deformity.

Tetracycline Inhibition of bony growth- should be avoided.

Quinolones Arthropathy in animal studies

Long acting Neonatal hemolysis, jaundice and kernicterus.

sulphonamides

Nitrofurantoin Hemolysis in newborn with G6 PD deficiency, if used at term

drugs Teratogenic effect

Metronidazole o No evidence of fetal or neonatal toxicity,

high doses regimens should not be used.

ACE inhibitors o IUGR, fetal and neonatal renal failure.

Vitamin K[large dose] o Hyperbilirubinemia and kernicterus.

All live viral vaccines o Potentially dangerous to the fetus.

Narcotics o Depression of CNS-apnoea, bradycardia

and hypothermia.
Anaesthetic agents o Convulsion, acidosis,
bradycardia,
Anticoagulant hypoxia, and hypertonia.
s [Warfarin] o Fetal bleeding and
Antidepressants anomalies.
o cardiovascular abnormalities.
[Imipramine]
Benzodiazapines o Growth restriction, CNS dysfunction.
 MATERNAL DRUG INTAKE AND
BREASTFEEDING
Transfer of drugs through breast milk depends on
following factors:
 Chemical properties

 Molecular weight

 Degree of protein binding

 Ionic dissociation

 Lipid solubility

 Tissue pH.

 Drug concentration.

 Exposure time.
 DRUGS IDENTIFIED AS HAVING EFFECT ON
LACTATION AND THE NEONATE
 Bromide: Rash. Drowsiness, and poor feeding.
 Iodides: Neonatal hypothyroidism
 Chloramohenicol: Bone marrow toxicity
 Oral pill: Suppression of lactation.
 Bromocriptine: Suppression of lactation.
 Ergot: Suppression of lactation.
 Metronidazole: Anorexia, blood dyscrasias, irritability, weakness,
neurotoxic disorders.
 Anticoagulants: Haemorrhagic tendency.
 Isoniazid: Anti-DNA activity and hepatotoxicity.
 Anti-thyroid drugs and radioactive iodine: Hypothyroidism and
goitre, agranulocytosis.
 Diazepam, opiates, phenobarbitone: Sedation effect with poor
sucking reflex.
THANK YOU……..