Labor Induction

reRipening Oxytocin (Pitocin) hormone produced by posterior pituitary, used to progress labor, discontinue if contraction frequency is more often than every 2 min, longer than 90 seconds, or contraction intensity is greater than 90 mmHg. Cervical Ripening, gel inserted into cervix Cervical Ripening, administered orally or gel inserted into cervix, not used as often

Prostaglandins (cervidil, Prepidil) Mixoprostol (Cytotec)

Tocolytic agents
Magnesium Sulfate

Contraindications: sever preeclampsia, vaginal bleeding, cardiac disease, cervical dilation beyond 6 cm, 34 weeks or greater 4 - 6 g loading dose, 2 - 4 g maintenance, side effects: flushing h/a, lehergy, n/v, decrease fetal HR variability, breathing and movement, hypocalcemia seen in neonate (symptoms similar to hypoglycemia), respiratory edema results from mag toxicity! this is from book. side effects: tachycardia, SOB, pulmonary edema, nervousness 2.5 to 5mg q 2 - 8 hours, Increases blood flow to uterus, side effects: tachycardia, palpations, cardiac arrhythmias, hypokalemia, pulmonary edema, fluid volume overload inhibits prostaglandin production, short term use, used before 32 weeks gestation 30 mg PO, additional 20 mg q 4 - 8 hours, Can delay longer time than others (gives you 48 to 72 hours), side effects: flushing, h/a, nausea, tachycardia, hypotension, decreased uterine blood flow, lack of variability, increases production of surfactant, given up to 34 weeks, pulmonary maturity if fetus isnt achieved until 37 weeks. Note: this isnt really a Tocolytic, the purpose if for fetal lung maturity only

Ritodrine (Yutopar) Terbutaline (Brethine)

Idomenthacin (NSAID) Nifedinpine (Procardia)

Betamethasone (12mg IM, two doses) Dexamethasone (6 mg IM, two doses)

Uterine Stimulants (post partum)

Oxytocin (IV) Methylergonovine (Methergine) (IM) Ergonovine Meleate (IM)

Note: this is for postpartum side effects: hyperstimulation, first line of defense with hemorrhage is oxytocin side effects: Hypertension, dizziness, h/a, flushing, palpatations, chest pain, vasoconstrictive effects side effects: Hypertension, dizziness, h/a, nausea, vomiting, vasoconstrictive effects

Prostaglandin (IM) Cytotec

side effects: Nausea, vomiting, h/a, flushing, bradycardia, bronchospasm, wheezing, cough given rectally

Pain Management
Sedatives barbiturates: secobarbital, pentobarbital, phenobarbital (Luminal)) meperidine hydrochloride (Demerol) fentanyl (Sublimaze) butorphanol (Stadol) nalbuphine (Nubain) promethazine (Phenergan) hydroxyzine (Vistaril) fentanyl (Sublimaza) sufentanil (Sufenta) lidocain (Xylocaine) bupivacaine (Marcaine) bupivacaine (Marcaine) usually given along with analgesics: morphine or fentanyl

note: Opioids and Epidural given in active phase, Spinal and Pudendal blocks given in Second stage used during latent phase to relieve anxiety and promote sleep. side effects: neonate respiratory depression, drowsiness, act on CNS to decrease perception of pain, IV route recommended, must be given in active phase of labor, never in transition, side effects: respiratory depression in neonate if given too close to birth, sedation, hypotension, decreased FHR controls nausea, vomiting, need to verify labor is well established (cervix at 4cm), careful not to slow progress of labor short acting opioids that are administered as a motor block with anesthesia, rapid pain relief, given in active phase administered transvaginally, no maternal or fetal systemic effects but provide local anesthsia to perineum, given in second stage injected into epidural space at fourth or fifth vertebrae, elimination of all sensation below umbilicus, side effects; maternal hypotension, fetal bradycardia, given during active phase of labor, IV bolus usually administered prior to block. eliminates all sensation from nipples to feet, this is not used in labor, to be given in second stage or before cesarean birth, watch for maternal hypotension, fetal bradycardia

Opioid analgesics

Phenothiazines

Epidural/ Spinal regional analgesics Puendal block

epidural block

Spinal block

anesthetic injected into subarachnoid space sometimes along with an analgesic