GOVERNMENT COLLEGE OF NURSING

C .R.P LINE , INDORE M. P.

SUB :MIDWIFERY & OBSTRETIC NURSING

TOPIC: “DRUG USE IN LABOUR ROOM”

DATE : 17-12-2021

SUBMITTED TO: - SUBMITTED BY:-

RESPECTED
MRS. A. RAM MS. BHUMIKA CHOUHAN
MRS. M. AUCHAT M.SC NURSING PREVIOUS YR
MRS. K.VINCIENT GOVT. COLLEGE OF NURSING

COLLEGE OF NURSING, INDORE

 PRACTICE TEACHING: EVALUATION PROFORMA (MSC NURSING)
Name of the Student …………………………………… Group ……………………………
Topic …………………………………………………………… Place ………………………………
Name of the Evaluator………………………………… Date and Time…………………..
S.N. Criteria Max. Marks Obtained
Marks
1 Lesson Plan
 General Objectives stated clearly
 Specific Objectives 10
 Lesson Followed in sequence
 Bibliography up to date Complete
2 Learning Environment
 Physical setup of classroom
 Classroom light –adequate 5
 Well ventilated
 Motivates Students
3. PRESENTATION
 Coverage of subject matter
 Integration of subject matter
 Speech Clear ,audible ,well modulated 10
 Explanation and clarification
 Use of Current Literature
 Time Limit
4. USE OF AUDIO VISUAL AIDS
 Relevant ,Clear and visible
 Creativity 10
 Shares used effectively at the right time
5. QUESTIONING TECHNIQUE
 Equally addressed to all
 Well worded questions no ambiguity 05
 Sufficient time allowed for answering
 Questions relevant
6. ASSIGNMENT
 Appropriate to the lesson
 Clear and motivating 05
 Explained to the Students (time and date)
7. PERSONALITY OF PRESENTER
 Grooming
 Confidence 05
 Mannerisms
TOTAL MARKS 50

REMARKS :

SIGNATURE OF THE SUPERVISOR SIGNATURE OF THE STUDENT

 “DRUG USE IN LABOUR ROOM”

 INTRODUCTION:

The midwife should have through knowledge of the indications, actions and side
effects of these drugs as well as the nursing considerations related to each of them in
order to plan and implement effective nursing process. Drugs used in obstetrics have a
huge impact on the outcome of both mother and baby.

 DEFENITION:
Drug is any substance or product that is used intended to be used to modify or explore
physiological system or pathological status for the benefits of recipient.
 Purpose: The practice of administrating medication involves providing the
patient with a substance prescribed and intended for the diagnosis, treatment, or
prevention of a medical illness or condition.

 Rights of medication administration :

 There are various drugs in obstetrics which are used during

pregnancy, labour, puerperium & for newborn.

1. Drug use in pregnancy:

2. Drug use in labour:

 Here are the drugs used in labor are: -
1. Oxytocin
2. Analgesics
3. Anticonvulsant
4. Anticoagulant

1. 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 :-
A. Oxytocin
B. Ergot derivatives
C. Prostaglandins 

A. OXYTOCIN :

 Brand Name: American oxytocin, black oxytocin, European oxytocin, low

oxytocin, mossberry, Oxycoccus macrocarpus, trailing swamp
oxytocin, Vaccinium edule, Vaccinium erythrocarpum, vaccinium
macrocarpon, Vaccinium occycoccus, Vaccinium vitis
 Generic Name: oxytocin
 Drug Class: Urology, Herbals
 Oxytocin is available under the following different brand names: Pitocin.

 Mode of Action:

 Acts directly on pregnant within 1 min. If injected IV, within 2 min. If injected
IM and its action lasts for 30 min. This cause initation & increase in
frequency, strenght & duration of uterine contraction. These are more effective
in the advacement of pregnancy.
 Oxytocin promotes contractions by increasing the intracellular Ca2+.
Oxytocin has specific receptors in the myometrium and the receptor
concentration increases greatly during pregnancy, reaching a maximum in
early labor at term.
 The two main actions of oxytocin in the body are contraction of the womb
(uterus) during childbirth and lactation. Oxytocin stimulates the uterine
muscles to contract and also increases production of prostaglandins, which
increase the contractions further.
 What is oxytocin?

Oxytocin is a hormone that is 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.
Oxytocin may also be used for purposes not listed in this medication guide.

 WHAT ARE DOSAGES OF OXYTOCIN(Preparations) ?

Dosages of Oxytocin:

 Dosage Forms and Strengths

 Injectable solution 10 units/mL.

Dosage Considerations – Should be Given as Follows:

 Postpartum Hemorrhage
 10 unit intramuscularly (IM) after delivery of the placenta
 Add 10-40 units; not to exceed 40 units; to 1000 mL of non-
hydrating intravenous (IV) solution and infuse at the necessary rate to control
uterine atony.

 Labor Induction
 0.5-1 mUnit/min IV, titrate 1-2 mUnit/min q15-60min until contraction pattern
reached that is similar to normal labor (usually 6 mUnits/min); may decrease dose
after the desired frequency of contraction reached and labor has progressed to 5-
6 cm dilation.

 Incomplete or Inevitable Abortion
 10-20 mUnit/min; not to exceed 30 units/12 hours.

 Monitor
 Intrauterine pressure, fetal heart rate

 Indications :

 Pregnancy :

1. To induce abortion, labour.

2. To expedite expulsion of hydatidiform mole.
3. For oxytocin challenge test
4. To stop bleeding following evacuation.

 Labour :

1. To augment labour, in uterine inertia.

2. to prevent & treat postpartum hemorrhage.

 Postpartum :
1.To initiate milk let-down in breast engorgement. 

 Contraindications :

 In late pregnancy :
1. Grand multipara.
2. Contracted pelvis.
3. History of LSCS or hysterectomy.
4. Malpresentation.

 During labour :
1. All contraindications mentioned in pregnancy.
2. Obstructed labour.
3. Incoordinate uterine action.

 Anytime :
1. Hypovolemic state, cardiac disease.

 Adverse effects\ Side effects :

 Slow heart rate.
 Fast heart rate.
 Premature ventricular complexes and other irregular heartbeats (arrhythmias).
 Permanent central nervous system (CNS) or brain damage.
 Neonatal seizure.
 Neonatal yellowing of skin or eyes (jaundice).
 Fetal death.
 Low Apgar score (5 minutes).
 Severe decreases in maternal systolic and diastolic blood pressure, increases in
heart rate, systemic venous return and cardiac output, and arrhythmia.
 Nursing considerations :
1. Assess Patient I/O Ratio, Uterine contraction, BP, pulse & respiration.
2. Administer By IV infusion After having crash cart available in the ward.
3. Evaluate patient Length & duration of contractions and Notify physician of
contractions lasting over one minute or absence of contractions.

B. ERGOT DERIVATIVES
 WHAT IS ERGOT?

 Despite serious safety concerns, ergot has been used as medicine. People use
ergot for excessive bleeding during menstrual periods, to
expel placenta after childbirth, and many other conditions, but there is no good
scientific evidence to support these uses.
 Certain chemicals in ergot are used in prescription medicines.

 How does it work ?

 Ergot contains chemicals that can help reduce bleeding by causing a narrowing of
the blood vessels.

 Mode of Action :

 Ergometrine acts directly on the myometrium. It stimulates uterine

contractions for last 2-4 hours & decreases bleeding.
 Ergot alkaloids have structures similar to the biogenic amines
norepinephrine, serotonin and dopamine. Vasoconstriction is produced by
an agonist activity and this effect varies with different vascular beds.
Hyperthermia and uterine stimulation are other effects.
 Acts primarily on alpha-adrenergic receptors on uterine and vascular smooth
muscle, increasing uterine tone and causing vasoconstriction.
 Dihydroergotamine and ergotamine belong to the group of medicines
known as ergot alkaloids. They are used to treat severe, throbbing headaches,
such as migraine and cluster headaches. Dihydroergotamine and ergotamine
are not ordinary pain relivers.

 Preparations:
 The appropriate dose of ergot depends on several factors such as the user's age,
health, and several other conditions. At this time there is not enough scientific
information to determine an appropriate range of doses for ergot. Keep in mind
that natural products are not always necessarily safe and dosages can be
important. Be sure to follow relevant directions on product labels and consult
your pharmacist or physician or other healthcare professional before using.

 Ergometrine- 0.25mg/ 0.5mg.

 ampoules & 0.5-1mg tablets.
 Methergine - 0.2 mg ampoules & 0.5-1mg tablets.
 Misoprostal- 100\200 MG Tablet.
 Syntometrine Ergometrine - 0.5 mg+ syntocinon 5.0 units ampoules.

 Dosage and routes of administration :

 For 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.

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.  

 Indication :
 Therapeutic :
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. 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.

 Nursing considerations :
1. Assess patient BP, pulse, respiration, signs of hemorrhage.
2. Administer Orally/IM deep, have emergency cart readily available.
3. Evaluate for decrease blood loss.
4. Advised patient to report for increased blood loss, abdominal cramps, headache,
sweating, nausea, vomiting/ dyspnea.

C. PROSTAGLANDINS :
Prostaglandins 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 & amniotic membrane.

 Mode of Action :
Both 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.
Initiation & \or stimulate of uterine contraction at anystage of pregnancy.
Prostaglandin E2 binds to G protein-coupled receptors (GPCRs) EP1, EP2, EP3, and
EP4 to cause various downstream effects to cause direct contractions in the
myometrium.
 In addition, PGE2 inhibits Na+ absorption within the Thick Ascending Limb (TAL)
of the Loop of Henle and ADH-mediated water transport in collecting tubules. As a
result, blockage of PGE2 synthesis with NSAIDs can limit the efficacy of
loop diuretics.
 

 Preparations :

Tablet- 0.5mg.

1. 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 250mcg.
3. PGE1 – Misoprostol Tablet-100mcg,200mcg,600mcg

 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.
 Indications :
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 :
1. Hypersensitivity.
2. Uterine fibroids.
3. Cervical stenosis.
4. PID
 Side effects :
1. Headache.
2. Dizziness.
3. Hypertension.
4. leg cramps.
5. Joint swelling.
6. Vomiting.
7. Nausea.
8. Diarrhoea.

 Nursing considerations :
1. Assess patient RR, rhythm & depth, vaginal discharge, itching/ irritation.
2. Administer Antiemetic/ antidiarrheal preparations prior to giving 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. Advised patient to remain supine for 10-15 minutes after vaginal insertion.

2 .Analgesics:

 What is an Analgesic?

Analgesics reduce the effect of pain without causing any mental confusion, paralysis
or any other disturbances in the nervous system so that you actually get rid of the pain
without any imbalance in the nervous system. The analgesic drugs can act in many
ways on the peripheral or central nervous system,  but they do not eliminate the
sensation of pain as in the case of anaesthetics.

 Types of Analgesics:
Analgesics can be broadly classified into two categories:
1. Non-narcotic (non-addictive) analgesics.
2. Narcotic analgesics.

A. Epidosin:

 Cervical spasmolytic.

 Preparation :
 Inj-1amp-8mg/ml.
 Dosage and routes of administration :
Inj-8mg deep IM. It may be repeated after 4 hours if necessary.  

 Mode of Action :

 It is both central and peripheral antimuscarininc agent, which is a competitive

inhibitor of acetylcholine at the muscarinic receptor.
 Epidosin Injection is an anticholinergic medication. It works by blocking the
effect of a chemical messenger (acetylcholine), thereby relaxing the smooth
muscles of cervix and intestine.
 EPIDOSIN 8MG INJECTION 1ML reduces the spasms associated with
various conditions. It works by relaxing the smooth muscles by inhibiting the
action of acetylcholine (a chemical that causes spasms or muscle contractions).
 Epidosin Injection is an antispasmodic agent used for the treatment of
gastrointestinal tract spasm, ureteric and biliary colic.

 Indication :
1. Cervical dilatation in the first stage of labor.
2. Symptomatic relief of GI tract and ureteric colic.

 Contraindications :
1. Paralytic ileus
2. Myasthemia Gravis.
3. Hypertension.
4. Ulcerative colitis.
5. Closed angle glaucoma.
6. CVS disorders.

 Adverse effects :
1. Dryness of mouth.
2. Thirst.
3. Dilatation of pupil.
4. Palpitations.
5. Giddiness.

 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.

B. Tramadol hydrochloride :
 Preparation:
 Inj-1amp=50mg.
 Tablet-50mg,100mg,200mg.

 Dosage and routes of administration:

 50 to 100mg IM 6hrly or as required.  

 Mode of Action:

 Bind to opioid receptor and inhibit re-uptake of norepinephrine and serotonin.

 Tramadol modulates the descending pain pathways within the central nervous
system through the binding of parent and M1 metabolite to μ-opioid receptors
and the weak inhibition of the reuptake of norepinephrine and serotonin.
 Tramadol is a centrally acting analgesic with a multimode of action. It acts
on serotonergic and noradrenergic nociception, while its metabolite O-
desmethyltramadol acts on the µ-opioid receptor. Its analgesic potency is
claimed to be about one tenth that of morphine.

 Indications:
1. Moderate to moderately severe pain.
2. Safe given during labor as it does not cause depression to fetal respiratory centre
and hence safe for baby.

 Contraindications:
1. Breast feeding mothers.
2. Hypersensitiviy.
3. Hepatic impairment.
4. Increased ICP.

 Adverse effects :
1. Dizziness.
2. Headache.
3. Malaise.
4. Hypertonia.
5. Nausea or vomiting.

 Nursing considerations:
1. Monitor patient CV and respiratory status.
2. Monitor patient at risk for seizure.
3. Monitor patient bowel and bladder function.

3 .Anticonvulsant :

A. MAGNESIUM SULPHATE :
 Magnesium sulfate, or mag for short, is used in pregnancy to prevent seizures due
to worsening preeclampsia, to slow or stop preterm labor, and to prevent injuries
to a preterm baby's brain.
 Magnesium sulfate is given as an intravenous infusion or intramuscular injection
in the hospital over 12 to 48 hours. It relaxes smooth muscle tissues, which helps
to prevent seizures and slow uterine contractions.

 Preparation :

 Inj- 1amp=2ml contains 1gm Mgso4.

 Tablet-64mg.

Dosage & routes of administration :

 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/L.
 4gm IV slowly over 10 min, followed by 2 gm/hr and then 1gm/ hr in drip of 5%
dextrose for tocolytic effect.

 Mode of 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.
 The mechanism of action of magnesium sulfate is not as well described as that of
calcium channel blockers, but it appears to function in a similar manner by
competitively blocking intracellular calcium channels, decreasing calcium
availability and thus inhibiting smooth muscle contractility.
 Magnesium is the second most plentiful cation of the intracellular fluids. It is
essential for the activity of many enzyme systems and plays an important role
with regard to neurochemical transmission and muscular excitability. Magnesium
sulfate reduces striated muscle contractions and blocks peripheral neuromuscular
transmission by reducing acetylcholine release at the myoneural junction.
Additionally, Magnesium inhibits Ca2+ influx through dihydropyridine-sensitive,
 voltage-dependent channels. This accounts for much of its relaxant action on
vascular smooth muscle.

 Indications:
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 :
1. Heart block.
2. Impaired renal function.
3. Pregnant women actively progressing labor.  

 Adverse effects :

•Maternal :
1. Severe CNS depression.
2. Evidence of muscular paresis

•Fetal :
1. Tachycardia.
2. Hypoglycemia.

 Nursing considerations :
1. Assess patients Vital signs 15 min after IV dose, do not exceed 150 mg/min.

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. Using infusion pump/monitor carefully, IV at less than 150mg/min ,circulatory

collapse may occur.

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.
B. Phenytoin(Dilantin):

 Uses:
 Phenytoin is used to prevent and control seizures (also called an anticonvulsant or
antiepileptic drug). It works by reducing the spread of seizure activity in
the brain.

 Mode of action:

 Phenytoin is believed to protect against seizures by causing voltage-dependent

block of voltage gated sodium channels. This blocks sustained high frequency
repetitive firing of action potentials.
 Although phenytoin first appeared in the literature in 1946, it has taken decades
for the mechanism of action to be more specifically elucidated.Although several
scientists were convinced that phenytoin altered sodium permeability, it wasn’t
until the 1980’s that this phenomenon was linked to voltage-gated sodium
channels.
 Phenytoin is often described as a non-specific sodium channel blocker and targets
almost all voltage-gated sodium channel subtypes. More specifically, phenytoin
prevents seizures by inhibiting the positive feedback loop that results in neuronal
propagation of high frequency action potentials.

 DOSAGES OF PHENYTOIN:

 Dosages of Phenytoin:
 Dosage Forms and Strengths
 Capsule, immediate-release
 30 mg
 100 mg

 Capsule, extended-release
 100 mg
 200 mg
 300 mg

 Tablet, chewable
 50 mg

 Oral suspension
 125 mg/5mL

 Injectable solution
 50 mg/mL.

 SIDE EFFECTS:
Common side effects of Phenytoin include:
 Drowsiness
 Fatigue
 Loss of control of bodily movements
 Loss of balance or coordination
 Irritability
 Headache
 Restlessness
 Nervousness
 Dizziness
 Diarrhea
 Nursing considerations :
 Assess patients Vital signs 15 min after IV dose, do not exceed 150 mg/min.

 Monitor magnesium level If using during labour, time of contractions, determine

intensity.

 Urine output should remain 30 ml/hr or more if less notify physician.

 Examine patient Reflexes-knee jerk, patellar reflex.

 Administer Only after calcium gluconate is available for treating magnesium

toxicity.

 Using infusion pump/monitor carefully, IV at less than 150mg/min ,circulatory

collapse may occur.

 Provide Seizure precautions: place client in single room with decreased stimuli,
padded side rails.

4 .Anticoagulant :

Vitamin K(phytonadione):
 At birth, the newborn does not have bacteria in the colon that necessary for
synthesizing fat soluble vitamin k. Therefore newborns have decreased level of
Prothrombin during the first 5 to 8 days of life.

 Preparation:
 INJ- 2ml vial=2mg/ml.

 Mode of Action:

 It promotes the hepatic formation of the clotting factors II,VII,IX and X.

 Vitamin K is the blood-clotting vitamin. The mechanism of action of vitamin K is
discussed in terms of a new carbanion model that mimics the proton abstraction
from the gamma position of protein-bound glutamate. This is the essential step
leading to carboxylation and activation of the blood-clotting proteins.
 Vitamin K refers to structurally similar, fat-soluble vitamers found in foods and
marketed as dietary supplements.[1] The human body requires vitamin K for
post-synthesis modification of certain proteins that are required for blood
coagulation (K from koagulation, Danish for "coagulation") or for controlling
binding of calcium in bones and other tissues.[2] The complete synthesis involves
final modification of these so-called "Gla proteins" by the enzyme gamma-
glutamyl carboxylase that uses vitamin K as a cofactor.
 Vitamin K is used in the liver as the intermediate VKH2 to deprotonate a
glutamate residue and then is reprocessed into vitamin K through a vitamin K
oxide intermediate.[3] The presence of uncarboxylated proteins indicates a
vitamin K deficiency. Carboxylation allows them to bind (chelate) calcium ions,
which they cannot do otherwise.[4] Without vitamin K, blood coagulation is
seriously impaired, and uncontrolled bleeding occurs.

 Indication:
1. It is used to treat or prevent certain bleeding problems.
2. It helps liver to produce blood clotting factors.

 Contraindications :
 Hypersensitivity

 Adverse effects:
1. Pain and edema may occur at injection site.
2. Allergic reaction such as rash and urticarial may occur.
3. Hyperbilirubinemia.

 Dosage and routes of administration:

 0.5mg IM within 1 hour of birth.  

 Nursing considerations:
1. Document the giving of the medication to newborn to prevent an accidental
doubling.
2. Observe for bleeding usually occurs on 2nd and 3rd day.
3. Observe for jaundice.
4. Observe for local inflammation.

3 .Drug use in 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.

 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.

 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.

 Roles & responsibility of nurse midwives :

 Know and comply with the state laws and regulations regarding
prescribing of medication.
 Limit telephone refiles to one prescription and require the patient to
come in and be seen before providing additional telephone refills.
 Avoid refilling narcotics and pain medication by telephone and
outside of regular office hours.
 Maintain drugs in safe area with limited access and if appropriate or
required by law, under lock and key.
 Store drugs at manufacturer's recommended temperature.
 Store drugs in separate location away from food or other materials or
supplies.
 Avoid storing similar looking drugs near one another.
 Avoid keeping drugs with similar sounding names of the formulary,
but if such similarities do occur, provide adequate additional warning
on packaging.
 Regularly check drug expiry dates and properly discard/destroy
expired drugs prescribing medication.

CONCLUSION

I have conducting the class on “drug use in labour room” today’s

discussion is introduction, definition including drugs used in labour in
detail here are the drug is Oxytocin,
Analgesics,Anticonvulsant,Anticoagulant we discussed in brief detail &
Roles & responsibility of nurse midwives.

The drug that are used daily in obstetric can have a huge impact on the
outcome of both mother & child. Therefore obstetric provider need to
have a very clear understating of mechanism of action, doses & side
effect of 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) A.K Debdas “Drug handbook in Obstetrics”,3rd

edition.Jaypee brothers and medical publishers private limited, New
Delhi.
 3) Bhaskar nima (2019) “Midwifery & gynaecological nursing”
3 ed. Emmess publisher.
rd

4) Datta D.C. (2004),’’Text book of obstetrics’’,6th ed .New

central book agency (P) LTD New Delhi.

5) D.C.Dutta’s “Textbooks of Obstetrics” 7th edition. New

Central Book Agency (P) Ltd page no.666.

6) Jacob Annamma,(2019) ‘’Acomprehensive textbook of

midwifery & gynecological nursing”5th ed. Jaypee brothers medical
publishers New delhi.

7) J.B.Sharma (2015).” Midwifery & gynaecological nursing “

1 ed. Avichal publishing company New delhi
st

8) Kumara neelam, shivani Sharma (2017)”A textbook of

midwifery & gynecological nursing”4th ed. S. Vikas and company
(medical publisher)