Oxytocin

MOA - Uterotonic Action - uterine contraction

Breast milk ejections - by simulation of myoepithelial cells
Anti-diuretic action - causes water retention
Supraoptic and Paraventricular nuclei of hypothalamus
Comes in Ampule - 1ML each ml contains 5 units

Route - IV Infusion or IM. Direct IV bolus should not be given

Action starts in 20s - 30s

Half-life - 3 minutes
Intramyometrial injection can be given during C-Section

Uses - Induction of labor (Induction of labor is defined as the artificial process of initiating labor before
spontaneous onset, using mechanical or pharmacological methods)
• Augmentation of labor (the process of stimulating the uterus to increase the frequency,
duration and intensity of contractions after the onset of spontaneous labor.)
• Uterine inertia- Atonic PPH (Failure of the UTERUS to contract with normal strength,
duration, and intervals during childbirth)
• Oxytocin challenge test (*The oxytocin challenge test (OCT) is a form of antenatal fetal
monitoring that is being utilized by obstetricians to assess fetal well-being)
• Evacuation of vesicular mole (Hydatidiform mole (HM) is a rare mass or growth that forms
inside the womb (uterus) at the beginning of a pregnancy)
• After evacuation, making uterus to retract
• Treatment of breast engorgement
• Treatment of incomplete abortion

C/I - Precautionary in Multi Parous

• Obstructed labor (when the baby does not exit the pelvis during childbirth due to being
physically blocked, despite the uterus contracting normally)
• Previous scarred uterus
• Fetal distress
• Fluid overload in cardiac patients
• Antidiuretic action causes fluid retention
• Previous history of anaphylactic shock

Side effect - Hyperstimulation

• rupture of uterus
 • amniotic fluid embolism (Amniotic fluid embolism is a rare but serious condition that
occurs when amniotic fluid or fetal material, such as fetal cells, enters the mother's
bloodstream)
• Fetal distress
• Fluid retention

caution - unfavorable or unripe cervix

• breach presentation
• polyhydramnios
• multiple pregnancy

Methergine
(Uterotonic drug) 0.2mg Methyl ergometrine

MOA - Cause powerful, sustained tetanic contraction of upper and lower uterine segments

Route - IM(4-7min), IV (40 sec) or Oral(10 min)

Uses - Prophylactic and treatment of Atonic PPH - 0.2mg IM or IV after delivery of plac
cut short 3rd stage of labor after delivery of ant. shoulder
In 1st trimester MTP after blunt curettage of incomplete or missed abortion

C/I - Not be given before delivery of shoulder

• Before 2nd twin is born
• Heart disease in pregnancy
• In PIH or chronic HTN
• Rh Negative pregnancy

Side effects - Nausea, Vomiting, HTN due to vasoconstriction, Chest pain due to acute coronary spasm
Rarely periphery vasoconstriction leading to Gangrene
Misoprostol
(Prostaglandin E1)
Inexpensive, easy to store, stable, rapidly absorbed

MOA - Binds to Myometrial cells to cause strong myometrial contractions leading to expulsion of tissues
also causes cervical ripening with cervical dilatation and softening
Route - Orally (rapidly absorbed 15-30 minutes peak serum level, terminal Half-life 30 min), Vaginally
(Lasts for 4 hours), Per rectal

C/I - heart disease

Glaucoma
Hypersensitivity to Prostaglandin

Side effects - Nausea, Vomiting, Diarrhea

Fever with chills and shivering

Uses - Medical induction of first trimester abortion,

As a single agent or adjuvant
Adjuvant along with mifepristone
Misoprostol along with Methotrexate
Misoprostol as a single agent in 1st trimester MTP can be used up to gestational ae of 70 days
Dose 200mcg to 800mcg vaginally
Misoprostol with mifepristone can be used for gestational age of 63 days
Misoprostol for Medical induction of 2nd trimester abortion. dosage depends on gestational age
400mcg vaginally every 4 hourly is safe up to 20 weeks.
Between 20 - 24 weeks, safe dose 200mcg vaginally every 6-12 hourly
cervical ripening before surgical abortion 400-600mcg can't be kept vaginally approx. 3-4 hours
before surgical procedure
Treatment of incomplete abortion or missed abortion by giving 400-600mcg misoprostol orally or
vaginally
Used in induction for Intra uterine fetal death in 2nd and 3rrd trimester
Induction of Labor
Active management of 3rd stage of labor
Prevention and treatment of post-partum hemorrhage
Carboprost [Prostaglandin F2 Alpha)
Ampule 1 ml - 250mc of carboprost

Uses - Prophylaxis of Atonic PPH after delivery of ant. shoulder of baby or delivery of placenta
Treatment of Atonic PPH, 250mcg IM or Intramymetrium during C section.
Repeated after 30 minutes, Max 8 injections can be given
2nd trimester MTP - Injected IM every 3 hours till abortion occurs. Most effective
in 2nd trimester.
In first trimester, 1ampule it is given 30 minutes, IM, before Suction evacuation for cervical
softening and easy dilatation of cervix.

Side effects - Bronchoconstriction

C/I in Bronchial asthma
Hyperstimulation of Uterus and Uterine rupture

Cervi prime Gel (Prostaglandin E2)

0.5mg Dinoprost
should be stored in refrigerator at 2-to-8-degree Celsius

Uses - Used for cervical ripening and dilatation of cervix

C/I - Membranes should be intact so not used in

Patients with leaking PV
Patients with heart disease, Asthma, Glaucoma
 Patients who are hypersensitive to prostaglandins

Method of introduction - Catheter introduced into the cervical canal not beyond the internal OS
Entire content introduced into the cervix. After instillation patient must lie
in bed for 30 minutes. Reassessment should be done after 6 to 8 hours.
If after 1sdt dose, bishop score is poor, then 2nd dose can be instilled after 8 hours,
maximum 3 doses can be instilled at 8-hour interval

Precaution - don't introduce catheter into lower uterine segment

Side effect - Hyperstimulation of uterus

Failure of ripening of cervix
Nausea, Vomiting, Diarrhea

Clomiphene Citrate
Medication used to treat Infertility

MOA - Works by stimulating an increase in the amount of hormones that support the growth and
release of a mature egg

C/I - Ovarian failure

Pregnancy
Hepatic Failure
Unexplained Abnormal Vaginal bleeding
Thyroid disorder
Ovarian cyst
hypersensitivity

Route - Orally 50Mg, for 5 days starting at the 5th day of menstrual period
Not to be taken for more than 3 ovulatory cycles
Side effects - Hypersensitivity
Ovarian Hyperstimulation syndrome_ Stomach pain, bloating
Nausea, vomiting, diarrhea
Oliguria, anuria
Palpitations, Pain while breathing
Flushing
Breast tenderness and pain
Headache
Pelvic Inflammatory disease
Photophobia
Heavy vaginal bleeding

Betamethasone
Between 34 and 37 weeks of gestation at risk of preterm birth within 7 days
For fetal lung maturity

Iron Preparation oral

Pregnancy requirement 1000mg
To prevent and treat Anemia
To be taken empty stomach without PPI and not along with milk, tea
Side effects - Nausea, Vomiting, Bloating, GI irritation
So usually given post dinner
Isoxsurprine(tocolytic)
Reduces frequency and intensity of uterine contraction
Indication - Preterm labor
Tetanic uterine contraction
Acceleration of labor at term
Beta - sympathomimetic drug
Side effects - IV and IM route
Flushing
Tachycardia
Hypotension

For preterm labor 40-60mg in 500ml NS at 0.3 to 0.5mg/min

For tetanic, use IV or IM

MgSO4
Used in Eclampsia
MOA - Cerebral vessel dilatation
Reduction in free cytokines, oxygen free radical, inhibition of calcium influx into the cell
Peripheral action on NMJ is responsible for control in neuro muscular junction

It has fetal neuroprotective action

Uses - Treatment of Pre-eclampsia

Control of seizures in Eclampsia
Neuroprotection in preterm labor
Available in 50%% and 20% preparation

C/I - renal disease

Heart block
Myasthenia Gravis
 Not to be given along with calcium channel blocker like Amlodipine, Nifedipine, Verapamil

Pritchard's regime - loading dose IV 4Mg MGSO4 over 10 min

5mg IM in each buttock

Tranexamic acid
Antifibrinolytic agent used to prevent bleeding

MOA - Inhibit plasmin activity by inhibiting conversion of plasminogen to plasmin

6 to 10 times More potent than E amino caproic acid

C/I - Sever renal insufficiency, hematuria

abnormal uterine bleeding
IUCD induced bleeding
Prevention of bleeding after surgery or trauma
Treatment of acute fibrinolytic stage of acute DIC especially in case of abruptio placenta

Side effects - Nausea, Vomiting and Diarrhea

Methyldopa

MOA - Converted to methyl norepinephrine centrally to decrease the adrenergic outflow by alpha-2
agonist
action from CNS leading to reduced total peripheral resistance and decreased systemic BP
Use - Pregnancy induced Hypertension
Pre - Eclampsia

Side effects - Drowsiness

Headache
Lack of Energy
Weakness
Dizziness
Lightheadedness
Fainting
Nausea or vomiting

Labetalol
Anti-Hypertensive non selective beta blocker, blocks both alpha and beta receptors
Uses - Used in treatment of HTN in pregnancy, pre-eclampsia, eclampsia, chronic HTN, as effective as
methyldopa

MOA - decreases peripheral vascular resistance

Cardiac output not affected, has no effect on utero placental blood flow

Preparations - Tablet 100mg, ampule 2ml, vial 20ml (5mg/ml)

Dose - 100 to 200mg every 8-12 hourly, Max amount is 2400mg

Injectable labetalol used for Hypertensive crisis
Initial does of 20mg IV and BP monitored every 10 minutes
If BP not under control, then next does 40 mg after 10 minutes
If BP not under control, then next does 80 mg after 10 minutes until BP is under control

C/I - Sever Tachycardia

Pulmonary HTN
Bronchospasm
allergy

Side effects - postural HTN

 headache
dryness of mouth
Angina

Nifedipine
MOA - Calcium channel blocker
causes peripheral vasodilation and decrease in vascular resistance

Use - Long term treatment of HTN in pregnancy as a single agent or in combination with others
it has no side effects on utero placental circulation

Preparation - Oral 10mg, 5mg

Dose - 10 to 30mg/ day to a max of 120mg/ day

C/I - should not be used sublingual as it can lead to dangerous fall in BP

Side effects - Flushing

Headache
Exaggerated Hypotension
Vomiting
Constipation

In patients with DM, CCB have a Reno protective nature and are the drug of choice in such cases
MEDROXYPROGESTERONE
1st Gen - Norgestrel
2nd Gen - Levonorgestrel
3rd Gen - Desogestrel
4th Gen - Dosperidone, Dinogest
Uses - AUB, ovulatory bleeding, post-menopausal syndrome
Side effect - nausea, constipation, weight gain, fluid retention, acne, Hypertension
C/I - Hypersensitivity

Combined OC
Most effective reversible method of contraception
Mala- D (gov supplied) - Contains Levonorgestrel 0.15mg and Ethynyl Estradiol 30mcg
21 tablets of the combination and 7 iron tablets

Mala - N (not supplied by gov) - Levonorgestrel 0.15mg and Ethynyl Estradiol 30mcg

MOA - Inhibits ovulation

causes endometrial hyperplasia, inhibits plantation
causes change in cervical mucous
alters tubal transport
C/I - Circulatory disease
h/o arterial or venous disease
h/o stroke
DM with vascular complications
h/o migraine
smoker over the age of 35 years
undiagnosed genital tract bleeding
breast feeding women
Estrogen dependent neoplasia like breast cancer
Before major surgery as it increases risk of thrombosis
 Sickle cell disease

depot-medroxyprogesterone acetate DMPA

Injectable contraceptive