PHARMACOTHERAPEUTIC

S IN OBSTETRICS
PRESENTED BY :
SAVITA S H
 DRUGS USED IN
PREGNANCY, LABOUR
AND PUERPERIUM
 INTRODUCTION

The midwife should have

thorough knowledge of the
indications, actions and side
effects of drugs used in
obstetrics as well as the nursing
considerations related to each
of them.
 INTRODUCTIO
N
• 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.
EFFECTS OF DRUGS
IN PREGNANCY
 DRUGS USED IN
PREGNANCY
List of drugs used in pregnancy are:-
• Folic acid
• Iron
• Calcium
• Anti -hypertensive drugs
•Diuretics
•Tocolytic agents
 FOLIC ACID

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

Dosage and route of administration

0.4mg or 400mcg OD orally
0.4-0.8mg IM Or subcutaneously daily.
 Nursing
consideration

1.Patient with H/O fetal neural tube defect

in pregnancy should increase folic acid
intake 1 month before and 3 months after
conception.

2.Patient with intestinal malabsorption

may need parentral administration.
 IRON (ferrous
fumarate)
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.
Indicati
ons
1. Iron deficiency
2. As a supplement during pregnancy

Contraindications
3. Primary haemolytic anemia
4. Peptic ulcer disease
5. Ulcerative colitis
6. Repeated blood transfusions
 Adverse
effects
1. Metallic taste
2. Temporary stained teeth
3. Nausea or vomiting
4. GI irritation
5. Black stools

Dosage and routes of administration

 30mg OD orally
 Injection- 20mg elemental iron/ml in 5ml and 10ml
single dose vial (iron sucrose )
 Dose-15mg/kg body weight or max 1000mg in single Inj
IM Or diluted with 100ml of NS for IV.
 Nursing
considerations

1.Advised patient to avoid taking tablet with

milk or along with antacids.
2. Caution patient to crush tablet
3.Caution patient not to substitute one iron salt
for another because amount of elemental iron
may vary.
4.Advised patient to report for constipation or
change in stool colour
 Calcium (calcium
Preparation citrate)
each tablet contains 211mg or 10.6meq of
elemental calcium
tablet- 250mg, 500mg

Action
Replaces calcium and maintain calcium
level

Indication
supplement
 containdicatio
ns
1. Cancer patients with bone metastasis
2.Hypercalcemia
3.Hypophosphatemi
a 4.Renal calculi

Adverse effects
3. Headache
4.Irritability
3.Hypercalcemia
4.Chalky taste
5. Nausea or
vomitings

Dosage and
route of
administratio
 Nursing
considerations
1.Advise patient to take oral calcium 1 or
1.5 hours after meals if GI upset occurs

2.Monitor calcium level if the patient is

having mild renal impairment.

3.Advise patient to report for any kind of

abdominal pain, vomiting or nausea occurs.
 ANTIHYPERTENSIVE
DRUGS
Here are the choice of drugs given during
pregnancy are:-

1.Alpha and Beta blockers- Labetalol

hydrochloride
2.calcium channel blockers-Nifedipine
3.alpha blockers-Methyldopa
4.vasodilators-Hydralazine hydrochloride
 Anti hypertensive
drugs contraindicated
in pregnancy
These drugs should be avoided because they
may cause poor fetal renal function,
malformation or can cause IUGR
1. ACE inhibitors
2. Minoxidil
3. Sodium Nitoprusside
4. Diltiazem
5.Atenolol
6.Propranolol
 Labetalol
Hydrochloride
Preparation
 Injection-5mg/ml in 20ml vial

 Tablets- 100mg,200mg ,300mg

Action
Reduced peripheral vascular resistance as a
result of alpha and beta blockage.
 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

Dosage and route of administration

50mg or 100mg tablet OD orally
20mg/20ml Inj IV bolus wait for 10min if no response
then give 40mg slow bolus.
 Nursing
considerations

1.Advised patient to remain in supine position

for 3hrs after infusion.
2. Monitor BP frequently
3.In diabetic patient monitor glucose level
closely.
4.Advised patient that dizziness can be
minimized by rising slowly and avoiding sudden
position change
 NIFEDIPIN
E
Preparations
Capsule-10mg,20mg
Tablet-20mg,30mg,60mg,90mg

Action
Thought to inhibit calcium ion reflex across
cardiac and smooth muscle cells, decreasing
contractility and oxygen demand and also dilates
arteries and arterioles.
 Indicatio
ns
1. Hypertension
2. Classic chronic stable angina pectoris.

Contraindications
3. Heart failure
4. Hypotension
5. Severe GI narrowing

Adverse effects
6. Dizziness
7. Syncope
8. Heart failure
9. Muscle cramps
10.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.
 METHYLDOP
A
Preparations
 Tablet-250mg,500mg

 Inj-50mg/ml

Action
Inhibit the central vasomotor centre, decreasing
sympathetic outflow to the heart, kidney and
peripheral vasculature.
Indicatio
ns
1. Hypertension
2. Hypertensive crisis

Contraindications
3. Hepatic disease or liver cirrhosis
4. Lactating mother

Adverse effects
5. Decrease mental acuity
6. Sedation
7. Headache or depression
8. Bradycardia
9. Hepatic necrosis
10.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 she
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
5. Neutropenia
6.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
 DIURETIC
S
Diuretics are used in the following conditions
during pregnancy:

1. PIH with massive edema

2. Eclampsia with pulmonary edem a
3. Severe anemia in pregnancy with heart
failure
4. Prior to blood transfusion in severe
anemia
5.As an adjunct to certain antihypertensive
 FUROSEMIDE
Preparation (LASIX)
 Inj-10mg/ml

Tablets-20mg,40mg,80mg,500mg

Action
Inhibits sodium and chloride reabsorption at proximal
and distal tubules and loop of Henle.

Indications
1. Acute pulmonary edema
2. Edema
3. Hypertension
Contraindicatio
ns
1. Anuria
2. Hepatic cirrhosis
3. Allergic to sulfonamides

Adverse effects
4. Maternal: Weakness, fatigue, muscle cramps, hypokalemia
5.Fetal: May occur due to decreased leading to fetal compromise,
hyponatremia.

Dosage and routes of administration

 4 0 mg tablet, daily following breakfast.
 In acute conditions, the drug is administered parenterally in
doses of 40-120 mg daily.
 Nursing
considerations
1.Monitor weight, BP and pulse rate routinely
for long term use.
2. Monitor patient I/O chart.
3.Watch the signs for hypokalemia such as
muscle weakness and cramps.
4. Monitor uric acid if patient is having
gout.
5.Advise the patient to take drug in the morning
after food.
6.Advised patient to avoid direct sunlight to
prevent photosensitivity reactions.
 TOCOLYTIC
AGENTS
These drugs can inhibit uterine contractions &
used to prolonged the pregnancy. In women
who develop premature uterine contractions, in
addition to putting them to absolute bed rest &
sedating, Tocolytic drugs are administered in
an attempt to inhibit uterine contraction.
Here are the drugs used are:-
1. Isoxsuprine Hydrochloride
2. Ritodrine hydrochloride
 Isoxsuprine
hydrochloride
Preparation (Duvadilan)
 Tablet -10mg

 Inj-10mg/ml

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.
Contraindicati
ons
1. Hypersensitivity
2. Postpartum

Adverse effects
3. Hypotension
4. Tachycardia
5. Nausea or vomiting
6. Pulmonary edema
7. Cardiac arrhythmias
8. 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
Preparation (yutopar)
 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
1.Assess Maternal & fetal heart tones during infusion
and also Intensity & length of uterine contractions
2.Monitor Fluid intake to prevent fluid overload,
discontinue if this occurs.
3.Administer only clear solutions after dilution 150 mg
in 500 ml D5W or NS, give at 0.3 mg/ml By Using
infusion pumps/monitor carefully
4.Positioning of patient in left lateral recumbent
position to decrease hypotension & increase renal
blood flow.
5. Advise patient to remain in bed during infusion.
Other drugs such as,

Thyroid Drugs – Levothyroxine

Proton Pump Inhibitors –
Lansoprazole
Oral Diabetic Drugs – Metformin
Anti Coagulants – Warfarin
Anti pyretics - Paracetamol
DRUGS USED
IN LABOUR
 DRUGS USED IN
LABOR
Here are the drugs used in labor are:-

1.Oxytocics
2. Analgesics
3. Anticonvulsants
4. Anticoagulants
 OXYTOCI
CS
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
 OXYTOCI
N
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.
Indicatio
ns
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
5. To augment labour, in uterine inertia
6. to prevent & treat postpartum hemorrhage

Postpartum
1.To initiate milk let-down in breast engorgement.
 Contraindicati
ons
In late pregnancy
1. Grand multipara
2. Contracted pelvis
3. History of LSCS or hysterotomy
4. Malpresentations

During labour
5. All contraindications mentioned in pregnancy
6. Obstructed labour
7. 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

1.Assess Patient I/O Ratio, Uterine

contractions, BP, pulse & respiration
2.Administer By IV infusion with appropriate
drop rate.
3.Evaluate patient Length & duration of
contractions and Notify physician of
contractions lasting over one minute or absence
of contractions.
 ERGOT
DERIVATIVES
Ergot alkaloids are either natural or semi
synthetic
Preparations
Ergometrine- 0.25mg/ 0.5mg
ampoules & 0.5-1mg
tablets
Methergine - 0.2 mg ampoules & 0.5-1mg tablets
Syntometrine Ergometrine - 0.5 mg+
syntocinon
5.0 units ampoules.
 NOTE
• Ergometrine & Methergine can be used parenterally
or orally. As the drug produces titanic uterine
contractions, it should only be used after delivery of
the anterior shoulder or following delivery of baby.
• It should not be used in induction of labor or
abortion.
• Syntometrine should always be administered IM

Mode of Action
Ergometrine acts directly on the myometrium. It
stimulates uterine contractions & decreases
bleeding.
 Indicatio
ns
Therapeutic
1.To stop the atonic uterine bleeding following delivery,
abortion/ expulsion of hydatidiform mole
Prophylactic
1. As a prophylaxis against excessive hemorrhage , it
may be administered after the delivery of the
anterior shoulder with crowing / following delivery of
baby.

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.

Dosage and routes of administration

• For active management of 3rdstage of labour
-0.2mg(1 amp) to be given IM.
• For control of atonic PPH -1 amp slowly over
60 seconds, may be repeated after 2hrs.
• For excessive lochia and subinvolution-
1 Tablet(0.125mg)TDS for 3 days.
 Nursing
considerations
1.Assess patient BP, pulse, respiration, signs
of hemorrhage
2.Administer Orally/IM deep, assess for any
emergencies.
3. Evaluate for decreased blood loss.
4.Advise patient to report for increased blood
loss, abdominal cramps, headache, sweating,
nausea, vomiting/ dyspnea
 PROSTAGLANDINS
Prostaglandins are synthesized from one of
the essential fatty acids, which is widely
distributed throughout the body. In the
female, these are identified in the menstrual
fluid, endometrium, decidua & amniotic
membrane.
Preparations
Tablet- 0.5mg
1. PG E2 –
Prostin E2
( Dinoprost
one)
Gel-0.5mg E2
in 2.5ml gel-
comes in pre
loaded
syringe.
2.PG F2 alpha- Prostin F2 alpha ( Dinoprostodine)
Inj- 125 and 250mcg
3. PGE1 – Misoprostol
Tablet-100mcg,200mcg,600mcg
 Indicatio
ns
1.For induction of abortion during 2nd trimester &
expulsion of hydatidiform mole
2. For induction of labor in IUD of fetus
3. In augmentation/ acceleration of labor
4.To stop bleeding from the open uterine sinuses as in
refractory cases of atonic PPH
5. Cervical ripening

Contraindications
6. Hypersensitivity
7. Uterine fibroids
8. Cervical stenosis
9. PID
 Side
effects
1. Headache
2. Dizziness
3. Hypertension
4. leg cramps
5. Joint swelling

Dosage & routes of administration

• Tablets: containing o.5 mg prostin E2
• Vaginal suppository: containing 20 mg PGE2 or 50 mg
PGF2 alpha
• Vaginal pessary: 3mg PGE2
• Injectable ampoules/vials of prostinE2
1 mg/ml prostin F2 alpha
5mg/ml Misoprostol 50mg given 4 hourly by oral,
vaginal/ rectal route for induction of labour
 Nursing
considerations
1.Assess patient RR, rhythm & depth, vaginal
discharge, itching/ irritation
2.Administer Antiemetic/ antidiarrheal preparations
prior to give this drug, high in vagina, after warming
the suppository by running warm water over package
3.Evaluate patient for length & duration of
contractions, notify physician of contractions lasting
over 1 minute or absence of contractions, fever &
chills
4.Advise patient to remain supine for 10-15 minutes
after vaginal insertion.
 ANTICONVULSAN
TS
MAGNESIUM SULPHATE
Preparation
• Inj- 1amp=2ml contains 1gm Mgso4.
• Tab-64mg
Action
Decreased acetylcholine in motor nerve terminals,
which is responsible for anticonvulsant properties,
thereby reduces neuromuscular irritability. It also
decreases intracranial edema & helps in diuresis. Its
peripheral vasodilatation effect improves the
uterine blood supply. Has depressant action on the
uterine muscles & CNS
 Indicatio
ns
1.It is a valuable drug lowering seizure threshold in women with
pregnancy- induced hypertension.
2. Used in preterm labor to decrease uterine activity.
Contraindications
3. Heart block
4. Impaired renal function .
5. Pregnant women actively progressing labor

Adverse effects
•Maternal
1. Severe CNS depression
2. Evidence of muscular paresis
•Fetal
1.Tachycardi
a
2.
Hypoglycemi
 Dosage & routes of
administration

1.For control of seizures, 8 ml, (4gm) IV slowly in 3-4

mins, to be followed immediately by 10gm of 50%
solution IM & continued 4 hourly till 24 hours
postpartum.
Repeat injections are given only if knee jerks are
present, urine output exceeds 100 ml in 4 hours &
respiration are more than 10/ minute. The therapeutic
level of serum magnesium is 4-7 mEq/L
2.4gm IV slowly over 10 min, followed by 2 gm/hr
and then 1gm/ hr in drip of 5% dextrose for
tocolytic effect
 Nursing
considerations

1.Assess patients Vital signs 15 min after IV dose.

2.Monitor magnesium level If using during labour, time
of contractions, determine intensity
3.Urine output should remain 30 ml/hr or more if
less notify physician
4. Examine patient Reflexes-knee jerk, patellar
reflex.
5.Administer Only after calcium gluconate is available
for treating magnesium toxicity
6.Provide Seizure precautions: place client in
single room with decreased stimuli, padded
side rails
7.Positioning of client in left lateral recumbent
position to decrease hypotension & increased
renal blood flow
8.Evaluate patient Mental status , sensorium,
memory , Respiratory status & Reflexes.
9.Discontinue infusion if respirations are below
12/min, reflexes severely hypotonic, urine output
below 30ml/hr or in the event of mental confusion/
lethargy/ fetal distress.
 ANALGESI
CS
valethamate bromide (epidosin)
Cervical spasmolytic (to treat pain associated with smooth
muscle spasm)
Preparation
Inj-1amp-8mg/ml

Action
Relieves smooth muscle pain, stiffness or spasm,
thereby improving muscle movement. It helps relieve
pain due to periods (menstrual pain), pain in labour
which enables cervical dilatation.
Indication
1. Cervical dilatation in the first stage of labor.
2. Symptomatic relief of GI tract and ureteric colic.
Contraindicati
ons
1. Paralytic ileus
2. Myasthenia Gravis
3. Hypertension
4. Ulcerative colitis
5. Closed angle glaucoma
6. CVS disorders
Adverse effects
7. Dryness of mouth
8. Thirst
9. Dilatation of pupil
10.Palpitations
11.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
5. Dizziness
6. Headache
7. Malaise
8. Hypertonia
9. Nausea or
vomiting
 Dosage and routes of
administration
5 0 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
S
Vitamin K 1 (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
3. Pain and
edema may
occur at
injection site.
4.Allergic reaction such as rash and urticaria may
occur.
Dosage and routes of administration
0.5mg IM within 1 hour of birth.

Nursing considerations
to
1.Document the given medication to the
newborn to prevent an accidental
doubling.
2.Observe for bleeding from cord usually
occurs on 2ndand 3rd day.
3. Observe for jaundice
4. Observe for local inflammation.
 DRUGS
USED IN
PUERPERIU
M
 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-16mg/ml, 80mg/ml
Action
Produce analgesia by inhibiting prostaglandins and other
substances that sensitizes pain receptors.
eptors
Indications .
1. Mild to moderate pain
2. Fever
Contraindications
1. Liver disease
2. Hypersensitivity

Adverse effects
3. Neutropenia
4. Hemolytic anemia
5. Hypoglycemia
6. Urticaria
 Dosage and routes of
administration 500mg tablet
thrice a day for 5 days

Nursing considerations
1.Advise the patient not to exceed the
prescribed dose.
2.Advise the patient that drug is only for short
term use and avoid taking without
prescription.
3.Advise patient to take tablet after meal to
prevent GI symptoms.
 Lactation suppressants
(Bromocriptine
Preparation mesylate)
• 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. Monitor patient for adverse reactions

2.Drug may lead to early post partum
conception . After menses resumes, test for
pregnancy every 4 weeks or as soon as period
is missed.
3.Assess orthostatic vital signs before initiation
of the therapy.
4.Instruct the patient to take drug with meal.
 EFFECTS OF MATERNAL
MEDICATIONS ON FETUS & BREAST
FEEDING INFANTS
1.During early embryogenesis, the drugs taken by the
mother reach the conceptus through the tubal/ uterine
secretions by diffusion.

2.The harmful effect on the blastocyst is usually death, in case

of survival there is chance of congenital anomalies

3.From 2nd-12th week (period of organogenesis) drugs can

cause serious damages

4.Gross congenital malformations & even death of the fetus may

result, depending on route, length of time & dose of exposure
5.From 2nd trimester transfer of drugs takes
place through the utero-placental
circulation due to lowered serum albumin
concentration which results from
haemodilution

6.As the albumin binding capacity of the

drugs is decreased, more free drug is
available for placental transfer
7. The metabolism of the drug may be hampered
by the increase in plasma steroids, increased
utero-placental blood flow, increased placental
surface area & decreased thickness of placental
membrane. These are the additional causes for
increased drug transfer.

8. Fetotoxic/ teratogenic drugs are prescribed

only when the benefits out weigh the potential
risks.

9. Prior councelling is mandatory & minimum

therapeutic dosage is used for shortest possible
duration.
 Maternal medications with
established teratogenic properties
& their effects

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 foetuses.
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.
drug Tertogenic effect

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

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

-aminoglycosides Auditory or vestibular damage.

-chloramphenicol Gray baby syndrome [peripheral vascular collapse].

-tetracycline Dental discolouration [yellowish] and deformity.

-quinolones Inhibition of bony growth- should be avoided.

Arthropathy in animal studies

-long acting
sulphonamides Neonatal hemolysis, jaundice and kernicterus.

-nitrofurantoin Hemolysis in newborn, if used at term

drug
Teratogenic effect
s
-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,
hypoxia, and hypertonia.
antidepressants o cardiovascular abnormalities.
[imipramine]

-benzodiazapines o Growth restriction, CNS dysfunction.

 Maternal drug intake &
Maternal
breastfeeding
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.
 USE OF SELECTED LIFE SAVING DRUGS IN
OBSTETRICAL EMERGENCIES APPROVED BY THE
MOHFW, INDIA
PRINCIPLES:
 The principle of safe medication management is essential for all nurses,
midwives and health agencies involved in the care of patient, antenatal
mothers, and clients.
 Before administering any drug and before implementing any therapy,
including those includes in standing orders, must use sound judgment in
determining whether the interventions are correct and appropriate.
 Based on these, in the non-availability of doctor, the nurse and midwives
can provide treatment to patient at home, hospital or in the community.
 Objectives
• To maintain the continuity of the treatment of the patient.

• To protect the life of the patient.

• To create feeling of responsibility in the members of health

team.
DRUGS PERMITTED TO BE USED BY NURSE
MIDWIVES BY GOVT. OF INDIA IN ANTENATAL
PERIOD

Iron and folic acid tablets

Calcium tablets
Inj. TD
Inj. Magnesium Sulphate
Antenatal corticosteroids (DEXAMETHOSONE)
IV fluids for stabilization of the woman
 DRUGS PERMITTED TO BE USED BY NURSE
MIDWIVES BY GOVT. OF INDIA IN INTRANATAL
PERIOD

Inj. Magnesium Sulphate

Inj. Oxytocin – 10 IU, IM
Tab. Misoprostol
Inj. Oxytocin – 20 IU in 500 ml RL, IV for PPH
IV administration of fluids for stabilization of
the woman
 DRUGS PERMITTED TO BE USED BY NURSE MIDWIVES BY
GOVT. OF INDIA IN POSTNATAL PERIOD

Inj. Oxytocin – 10 IU, IM

Inj. Oxytocin – 20 IU in 500 ml RL, IV for PPH

Antibiotics for Puerperal sepsis
o Ampicillin 1 gm – 6 hourly, oral / Ampicillin 1 gm – 6
hourly, IV
o Metronidazole 400mg – 8 hourly, oral / Metronidazole
500mg – IV, 8 hourly
o Gentamycin 80mg, BD, IM
 DRUGS PERMITTED TO BE USED BY NURSE MIDWIVES BY
GOVT. OF INDIA IN NEWBORN CARE

Inj. Vitamin-K
Immunization – Vaccines
Antibiotics for sepsis –
o Inj. Gentamycin – 5mg/Kg/dose, OD
o Inj. Amoxicillin – 25mg/kg/dose, TDS
Anti-Retroviral prophylaxis – Neviripine syrup for 6
weeks
S. Name of Dosage Indication Contraindication Special
No Drug considerations and
precautions
1 Inj. 6mg, IM, 12 Preterm labour Frank Should NOT be used
Dexamethas hourly (4 between 24-34 weeks chorioamnionitis is if:
one Doses) gestation to the an absolute
• Previous
mother for fetal lung contraindication
corticosteroid course
maturity for using antenatal
for fetal lung
corticosteroids.
maturity in current
Following signs pregnancy
1. True preterm
and symptoms in
labour • Maternal diabetes
the mother
(i.e., gestational
2. Following suggests Frank
diabetes, preexisting
conditions that lead amnionitis:
diabetes)
to imminent delivery:
1. History of fever
• Expected to deliver
• Antepartum and lower
in < 12 hours (e.g.,
hemorrhage abdominal pain
cervical dilation ≥ 8
• Preterm premature 2. On examination: cm)
rupture of Foul smelling
• Chorioamnionitis
4 Tab. Prophylax o As an - - Use caution if
Misopros is: 600 alternate to Contraindications prophylactic dose
tol mcg Per oxytocin in include pelvic already given and
oral third stage of infection or adverse effects
within 1 labour for sepsis, present or
minute of uterine hemodynamic observed
delivery tonicity instability or
- Use only in
o Post-partum shock, allergy to
settings where
hemorrhage to misoprostol,
oxytocin not
control known bleeding d
available
bleeding isorder, and
confirmed or
suspected ectopic
or molar
pregnancy.

- Not to be used
in patients with
previous cesarean
delivery or major
 CONCLUSIO
N

• No drug should be administered to a woman during

pregnancy, labor and birth, unless the woman is fully
informed of the known risks.
• Uuncertainty regarding the effects of the drug on the
physiologic and neurologic development of the woman or her
baby leads to dangers.
• The drugs that are used daily in obstetric care 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.
 BIBLIOGRAPH
Y
1. Annamma Jacob “ A Comprehensive Textbook of
Midwifery & Gynecological Nursing” 3rd edition.
Jaypee Brothers Medical Publishers (P) Ltd, page
2.D.C.Dutta’s
no. 604-619 “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
www.medicine.tcd.ie/pharmacology_therapeutics/....Obs&
publisher ,London.
Gyn.pd