DRUGS USED IN PREGNANCY, LABOUR AND PUERPERIUM

PRESENTED BY:-MS LISA CHADHA

F.Y. MSC NURSINGBVCON, 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

List of drugs used in pregnancy are:-

• Folic acid

• Iron

• Calcium

• Anti -hypertensive drugs

•Diuretics

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 effects1. Abdominal cramps

2. Diarrhoea

3. Rash

4. Irritability

5. nausea or bloating

Dosage and route of administration0.4mg 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)

PreparationEach 100mg provides 33mg of elemental iron.

Tablet- 90mg,200mg,300mg,325mg,350mg

ActionProvides elemental iron, an essential component in the formation of haemoglobin.

Indications1. Iron deficiency2. As a supplement during pregnancy

Contraindications1. Primary haemolytic anemia2. Peptic ulcer disease3. Ulcerative colitis4. Repeated blood transfusions

Adverse effects1. Metallic taste2. Temporary stained teeth3. Nausea or vomiting4. GI irritation5. Black stools

Dosage and routes of administration30mg OD orallyInjection- 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 tablet3. 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 citrate)Preparation

each tablet contains 211mg or 10.6meq of elemental calcium

tablet- 250mg, 500mg

Action

Replaces calcium and maintain calcium level

Indication

supplement

containdications1. Cancer patients with bone metastasis2. Hypercalcemia3.Hypophosphatemia4.Renal calculi

Adverse effects1. Headache2. Irritability3.Hypercalcemia4.Chalky taste5. Nausea or vomitings

Dosage and route of administration500mg OD orally.

Nursing considerations

1.Advise patient to take oral calcium 1 or 1.5 hours after meals if GI upset occurs2. 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 can cause poor fetal renal function, malformation or can cause IUGR1.ACE inhibitors2. Minoxidil3. Sodium Nitoprusside4. Diltiazem5. Atenolol6.Propranolol

Labetalol Hydrochloride

PreparationInjection-5mg/ml in 2oml vialTablets- 100mg,2oomg ,300mg

Action

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

Indications1.Hypertension2.Hypertensive emergencies

Contraindications1.Hypersensitive to drug or its component.2.Bronchial asthma3.Hepatic or heart failure4.Prolonged hypotension5.Severe bradycardia

Adverse effects1. Dizziness2. Fatigue3. Nausea or vomiting4. Headache5. Vertigo

Dosage and route of administration 50mg or 100mg tablet OD orally20mg/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 frequently3. In diabetic patient monitor glucose level closely.4. Advised patient that dizziness can be minimized by rising slowly and avoiding sudden position change

NIFEDIPINE PreparationsCapsule-10mg,20mg

Tablet-20mg,30mg,60mg,90mg

ActionThought to inhibit calcium ion reflex across cardiac and smooth muscle cells, decreasing contractility and oxygen demand and also dilates arteries and arterioles.

Indications1. Hypertension2. Classic chronic stable angina pectoris.

Contraindications1.Heart failure2. Hypotension3. Severe GI narrowing

Adverse effects1. Dizziness2. Syncope3. Heart failure4. Muscle cramps5. Peripheral edema

Dosage and route of administrations

5-20mg OD orally.

Nursing considerations1. Monitor BP & HR regularly2. 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

PreparationsTablet-250mg,500mgInj-50mg/ml

ActionInhibit the central vasomotor centre, decreasing sympathetic outflow to the heart, kidney and peripheral vasculature.

Indications1. Hypertension2. Hypertensive crisis

Contraindications1. Hepatic disease or liver cirrhosis2. Lactating mother

Adverse effects1. Decrease mental acuity2. Sedation3. Headache or depression4. Bradycardia5. Hepatic necrosis6. Hepatitis

Dosage and routes of administration250mg BD or TDS max 2g daily titrated by BP 

Nursing considerations1. 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

PreparationInj-20mg/ml in 1ml vialTablet-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 administration25mg tablet BD and if necessary may increase to 50mg BD5mg diluted in 10ml of NS slow IV at 15-20minutes interval.

Nursing considerations1. 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:

1. PIH with massive edema

2. Eclampsia with pulmonary edema

3. Severe anemia in pregnancy with heart failure

4. Prior to blood transfusion in severe anemia

5. As an adjunct to certain antihypertensive drugs.

  FUROSEMIDE (LASIX)

PreparationInj-10mg/mlTablets-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

Contraindications1. Anuria2. Hepatic cirrhosis3. Allergic to sulfonamides 

Adverse effects1. Maternal: Weakness, fatigue, muscle cramps, hypokalemia2. Fetal: May occur due to decreased leading to fetal compromise, hyponatremia. 

Dosage and routes of administration40 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. Ritrodrine hydrochloride

Isoxsuprine hydrochloride (Duvadilan)

PreparationTablet -10mgInj-10mg/ml

ActionActs 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.

Indication1. Prevent Preterm labour

2. Inhibit uterine contractions.

Contraindications1. Hypersensitivity2. Postpartum 

Adverse effects1. Hypotension2. Tachycardia3. Nausea or vomiting4. Pulmonary edema5. Cardiac arrhythmias6. Hyperglycemia or hypokalemia

Dosage & routes of administrationInitial: IV drip 100 mg in 5% dextrose @Rate0.2ug/minute. To continue at least 2 hours after the contractions ceaseMaintenance: IM 10mg 6 hourly for 24 hrs or tab 10mg 6-8hrly.

Nursing considerations1. Assess patient BP, pulse during treatment2.Take BP lying & standing as orthostatic hypotension is common3. Monitor for Intensity & length of uterine contractions and FHS.4. Advise patient to make position changes slowly as fainting may occur.

Ritodrine hydrochloride (yutopar)PreparationInj-5ml amp-10mg/ml=50mg per amp.Tablet-10mg

ActionActs directly on vascular smooth muscle, causes cardiac stimulation & uterine relaxant.

 

IndicationsPrevent preterm labour

Contraindications1. Hypersensitivity

2. Eclampsia

3. Hypertension

4. Dysrhythmias

Adverse effects1.Hyperglycemia2. Headache3. Restlessness or sweating4. Chills and drowsiness5. Nausea or vomiting6. Altered maternal & fetal heart tone & palpitations.  

Dosage and routes of administrationInitial: 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 contractions2. 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 carefully4. Positioning of patient in left lateral recumbent position to decrease hypotension & increase renal blood flow.5. Advise patient to remain in bed during infusion.

DRUGS USED IN LABOR

Here are the drugs used in labor are:-

1.Oxytocics2. Analgesics3. Anticonvulsant4. 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 

OXYTOCINOxytocin is an octapeptide synthesized in the hypothalamus and stored in the posterior pituitary.

PreparationsSynthetic 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

ActionsActs directly on myofibrils producing uterine contractions & stimulates milk ejection by the breasts

Indications

Pregnancy1.To induce abortion, labour2.To expedite expulsion of hydatidiform mole3. For oxytocin challenge test4.To stop bleeding following evacuation.

Labour1.To augment labour, in uterine inertia2. to prevent & treat postpartum hemorrhage

Postpartum1.To initiate milk let-down in breast engorgement. 

Contraindications

In late pregnancy1. Grand multipara2. Contracted pelvis3. History of LSCS or hysterectomy4. Malpresentation During labour1. All contraindications mentioned in pregnancy2. Obstructed labour3. Incoordinate uterine action Anytime 1. Hypovolemic state, cardiac disease

Adverse effects1. Hypertonic uterine activity2. Fetal distress & fetal death3. Uterine rupture4. Hypotension5. Neonatal jaundice6. Water retention & water intoxication Dosage & routes of administrationControlled 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 contraction, BP, pulse & respiration2. Administer By IV infusion After having crash cart available in the ward3. 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.

NOTEErgometrine & 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 ActionErgometrine acts directly on the myometrium. It stimulates uterine contractions & decreases bleeding.

IndicationsTherapeutic1.To stop the atonic uterine bleeding following delivery, abortion/ expulsion of hydatidiform moleProphylactic1. As a prophylaxis against excessive hemorrhage , it may be administered after the delivery of the anterior shoulder with crowing / following delivery of baby.

Contraindications1. Suspected plural pregnancy2. Organic cardiac disease3. Severe Pre-eclampsia & Eclampsia

Adverse effects1. Rise of BP due to vasoconstriction action2. Prolonged use in puerperium may interfere by decrease concentration of prolactin & gangrene of toes due to vasoconstriction.

Dosage and routes of administrationFor active management of 3rd stage of labour -0.2mg(iamp) to be given IM.For control of atonic PPH -1amp 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 hemorrhage2. Administer Orally/IM deep, have emergency cart readily available3. Evaluate for decrease blood loss4. Advised patient to report for increased blood loss, abdominal cramps, headache, sweating, nausea, vomiting/ dyspnea

PROSTAGLANDINSProstaglandins are synthesized from one of the essential fatty acids, archidonic acid, which is widely distributed throughout the body. In the female, these are identified in the menstrual fluid, endometrium, decidua & amniotic membrane. 

PreparationsTablet- 0.5mg1. PG E2 – Prostin E2 ( Dinoprostone)Gel-0.5mg E2 in 2.5ml gel-comes in pre loaded syringe.2. PG F2 alpha- Prostin F2 alpha ( Dinoprostodine)Inj- 125 and 250mcg3. PGE1 – MisoprostolTablet-100mcg,200mcg,600mcgActionBoth PGE2 & PGF2 alpha have an oxytocic effect on the pregnant uterus. They also sensitize the myometrium to oxytocin. PGF2 alpha acts predominantly on the myometrium, while PGE2 acts mainly on the cervix.

Indications1. For induction of abortion during 2nd trimester & expulsion of hydatidiform mole2. For induction of labor in IUD of fetus3. In augmentation/ acceleration of labor4.To stop bleeding from the open uterine sinuses as in refractory cases of atonic PPH5. Cervical ripening Contraindications1. Hypersensitivity2. Uterine fibroids3. Cervical stenosis4. PID

Side effects1. Headache2. Dizziness3. Hypertension4. leg cramps5. Joint swelling

Dosage & routes of administrationTablets: containing o.5 mg prostin E2Vaginal suppository: containing 20 mg PGE2 or 50 mg PGF2 alphaVaginal pessary: 3mg PGE2Injectable ampoules/vials of prostinE2 1 mg/ml prostin F2 alpha5mg/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/ irritation2. Administer Antiemetic/ antidiarrheal preparations prior to giving this drug, high in vagina, after warming the suppository by running warm water over package3. Evaluate patient for length & duration of contractions, notify physician of contractions lasting over 1 minute or absence of contractions, fever & chills4. Advised patient to remain supine for 10-15 minutes after vaginal insertion.

ANTICONVULSANTS

MAGNESIUM SULPHATEPreparationInj- 1amp=2ml contains 1gm Mgso4.Tablet-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

Indications1. It is a valuable drug lowering seizure threshold in women with pregnancy- induced hypertension. 2. Used in preterm labor to decrease uterine activity.

Contraindications1. Heart block2. Impaired renal function3. Pregnant women actively progressing labor. 

Adverse effects•Maternal 1. Severe CNS depression2. Evidence of muscular paresis•Fetal 1.Tachycardia2. Hypoglycemia

Dosage & routes of administration

1. For control of seizures, 20 ml of 20% solution IV slowly in 3-4 mins, to be followed immediately by 10ml 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/L2. 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, do not exceed 150 mg/min2. Monitor magnesium level If using during labour, time of contractions, determine intensity3. Urine output should remain 30 ml/hr or more if less notify physician4. Examine patient Reflexes-knee jerk, patellar reflex.5. Administer Only after calcium gluconate is available for treating magnesium toxicity

6. Using infusion pump/monitor carefully, IV at less than 150mg/min ,circulatory collapse may occur 7. Provide Seizure precautions: place client in single room with decreased stimuli, padded side rails8. Positioning of client in left lateral recumbent position to decrease hypotension & increased renal blood flow9. Evaluate patient Mental status , sensorium, memory , Respiratory status & Reflexes.10. 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.

ANALGESICS

valethamate bromide (epidosin)Cervical spasmolytic

PreparationInj-1amp-8mg/ml

 

ActionIt is both central and peripheral antimuscarininc agent, which is a competitive inhibitor of acetylcholine at the muscarinic receptor.

Indication1. Cervical dilatation in the first stage of labor.

2. Symptomatic relief of GI tract and ureteric colic.

Contraindications1. Paralytic ileus2. Myasthemia Gravis3. Hypertension4. Ulcerative colitis5. Closed angle glaucoma6. CVS disorders 

Adverse effects1. Dryness of mouth2. Thirst3. Dilatation of pupil4. Palpitations5. Giddiness

Dosage and routes of administrationInj-8mg deep IM. It may be repeated after 4 hours if necessary. Nursing considerations1. 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 hydrochloridePreparationInj-1amp=50mgTablet-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.

Contraindications1. Breast feeding mothers2. Hypersensitiviy3. Hepatic impairment4. Increased ICPAdverse effects1. Dizziness2. Headache3. Malaise4. Hypertonia5. Nausea or vomiting

Dosage and routes of administration50 to 100mg IM 6hrly or as required. 

Nursing considerations1. Monitor patient CV and respiratory status.2. Monitor patient at risk for seizure.3. Monitor patient bowel and bladder function.

COAGULANT

Vitamin K(phytonadioneAt 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

ActionIt promotes the hepatic formation of the clotting factors II,VII,IX and X.Indications1. It is used to treat or prevent certain bleeding problems.2. It helps liver to produce blood clotting factors ContraindicationsHypersensitivity Adverse effects1. Pain and edema may occur at injection site.2. Allergic reaction such as rash and urticarial may occur.3. Hyperbilirubinemia

Dosage and routes of administration0.5mg IM within 1 hour of birth. Nursing considerations1. 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 jaundice4. Observe for local inflammation.

DRUGS GIVEN DURING PUERPERIUMHere are the drugs given during puperium are:-1.Iron2.Folic acid3.Calcium4.Acetaminophen(paracetamol)5.Lactation suppressant (in case of stillbirth, neonatal death, breast abscess or severe psychiatric illness.

Acetaminophen (paracetamol)PreparationTablet-80mg,160mg,500mgSuppository-80mg,120mgOral solution-16m/ml,80mg/ml

 

ActionProduce analgesia by inhibiting prostaglandins and other substances that sensitizes pain receptors.

 

Indications1. Mild to moderate pain

2. Fever

Contraindications1. Liver disease2. Hypersensitivity Adverse effects1. Neutropenia2. Hemolytic anemia3. Hypoglycemia4. Urticaria

Dosage and routes of administration500mg tablet thrice a day for 5 days 

Nursing considerations1. 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)

PreparationTablet-0.8mg,2.5mg ActionIt blocks the release of a prolactin from the pituitary gland. Indications1. Suppression of lactation2. Pregnancy with prolactinoma3. Infertility4.Amenorrhoea

Adverse effects1. Dizziness or lightheadedness especially when getting up from lying position.2. Confusion3. Hallucinations4. Hypertension5. Seizures6. Myocardial infarction Dosage and routes of administration2.5mg tablet orally once in a day. 

Nursing considerations

1. Monitor patient for adverse reactions2. Drug may lead to early post partum conception .after menses resumes, test for pregnancy every 4 weeks or as soon as period is missed3. 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 are the additional cause for increased drug transfer

8. Fetotoxic/ teratogenic drugs are prescribed only when the benefits out weigh the potential risks. 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 fetuses.

Maternal drug intake & breastfeedingMaternal 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.pdf 

• 6.www.elmmb.nhs.uk/formularies/joint-medicines-formulary/7/7-1/