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Drugs Used IN Pregnancy, Labour, Puerperium & Newborn
Drugs Used IN Pregnancy, Labour, Puerperium & Newborn
Drugs Used IN Pregnancy, Labour, Puerperium & Newborn
& NEWBORN-
There are various drugs in obstetrics which are used during pregnancy, labour,
puerperium & for newborn.
DRUGS
USED IN
PREGNANCY-
Oxytocin
Ergot derivatives- Ergometrine, Methergin
Prostaglandins- Misoprost, Carboprost, Dinoprostone
Antihypertensive- Methyldopa, Sodium Nitroprusside,
Labetalol, Nifedipine,
Prazocin, Propranol, Diuretics (Frusemide, Hydralazine Hydrochloride,
Spironolactone)
Tocolytic agents- Betamimetics(Terbutaline, Ritodrine &
Isoxsuprine), Nifedipine, Magnesium Sulphate, Indomethacin)
Anticonvulsant- Magnesium Sulphate, Diazepam, Phenytoin.
Anticoagulants- Heparin, Warfarin
LABOUR
Oxytocin
Ergot derivatives- Ergometrine, Methergin
Prostaglandins- Misoprost, Carboprost, Dinoprostone
Anticonvulsant- Magnesium Sulphate, Diazepam,
Phenytoin
PUERPERIUM
Oxytocin
Ergot derivatives- Ergometrine, Methergin
Prostaglandins- Misoprost, Carboprost, Dinoprostone
Rhogam
NEWBORN
Betamethason
e Vit. K
OXYTOCIC
S
Oxytocics are the drugs of varying chemical nature that can excite uterine
contractions of the uterine muscles. There are a number of drugs but the important
ones are
Oxytocin
Ergot derivatives
Prostaglandins
OXYTOCIN
INTRODUCTION:
& stimulate amniotic & decidual prostaglandin production & initiate myometrial
contractions
PREPARATIONS USED:
Synthetic oxytocin (pitocin): is widely used. It has got oxytocic effect without
any vasopressor action. It is available in ampoules containing 5I.U/ml
ROUTES OF ADMINISTERATION:
IV or IM
Buccal tablets
Nasal sprays
Calculation of dose delivered in miliunits (mU) & its correlation with drop
rate per minute
Units of oxytocin mixed in 500ml Drops per minute
Ringer solution 15 drops =1ml
( 1Unit = 1000 miliunits) 15 30 60
In terms of mU / minute
2 4 8
4 8 16
16 32 64
INDICATIONS:
It may be conveniently given in pregnancy, labour and puerperium. It is grouped as
Therapeuti
c
Diagnostic
THERAPE
UTIC
Pregnancy
Labour
Puerperiu
m
PREGNA
NCY:
1 To accelerate abortion
2 To stop bleeding
3 To induce labour
4 To facilitate cervical
ripening of labour
LABOUR
In active management of 3rd stage of labour
Expulsion of placenta as an alternative to ergometrine
PUERPERIUM
To minimize blood loss and to control PPH
Out of many ergot derivatives two are used as oxytocics.
DIAGNOSTIC:
Contractions Stress test
Oxytocin sensitivity test
CONTRAINDICATION
S PREGNANCY
Grand multipara
Contracted pelvis
History of caesarean
section or
hysterotomy
Malpresentation
LABOUR
Grand multipara
Contracted pelvis
History of caesarean
section or
hysterotomy
Malpresentation
Obstructed labour
Incoordinate uterine
action
Fetal distress
OTHER
Hypovolaemic state
Cardiac disease
DANGERS OF OXYTOCIN:
MATERNAL
1. Uterine hyper stimulation
2. Uterine rupture
FETAL
1. Fetal distress or fetal death
ERGOT DERIVATIVES
Out of many ergot derivatives two are used as oxytocics
Ergometrine
Methargin
MODE OF ACTION:
PREPARATIONS USED:
Ergometrine-
0.25mg in ampoules
0.5 mg ampoules
Methargin
0.2 mg in
ampoules 0.5-1mg
tablet
INDICATIONS:
Therapeutic
Prophylacti
c
THERAPE
UTIC
To stop the atonic uterine bleeding
Following delivery, abortion
Expulsion of hydatidiform mole
PROPHYLACTIC
Excessive heamorrhage following delivery
In active management of 3rd stage of labour
CONTRAINDICATIONS:
1 Suspected plural
pregnancy 2 Organic cardiac
diseases
3Severe eclampsia and preeclampsia
4 Heart disease and HTN
SIDE EFFECTS
Nausea & vomiting
Rise in blood pressure, stroke
Rarely gangrene of the toe
PROSTAGLANDIN
INTRODUCTION:
Prostaglandins are the derivatives of prostanoic acid they have the property of
acting as local hormone
preprations of
PROSTAGLANDINS
Vaginal suppository
Or Parentral
Tablet
Vaginal pessary
PROSTAGLANDIN
S
PGE1-
Misoprostol
PGE2-
Prostaglandins
Dinoprostone
PGE2α -
Carboprost
MISOPROSTOL
It is a methyl ester of PGE1
MECHANISM OF ACTION
INDICATIONS
1 Induction of abortion
2 Induction of labour
3 Acceleration of
labour
4 Management of
atonic postpartum
hemorrhage
CONTRAINDICATI
ONS
Hypersensitivity to drug
Uterine scar
Pelvic inflammatory disease
Hepatic & renal disorder
ADVERSE EFFECTS
Tacysystole (Hyperstimulation)
Meconium passage
DINOPROSTONE
It is a PGE2 Prostaglandin
MECHANISM OF ACTION
INDICATIONS
1 Induction of abortion
2 Induction of labour
3 Acceleration of
labour
4Management of atonic postpartum heamorrhage
5 Termination of molar pregnancy
6 Management of ectopic tubal pregnancy
CONTRAINDICATIONS
Hypersensitivity to drug
Uterine scar
Pelvic inflammatory disease
Hepatic & renal disorder
SIDE EFFECTS
Reproductive system:
uterine rupture
Vascular Disorders:
Hypotension
Pregnancy, Puerperium
and Perinatal Conditions:
Amniotic fluid embolism
CARBOPROST
MECHANISM OF ACTION
INDICATIONS
1 Induction of abortion
2 Induction of labour
3 Acceleration of
labour
4Management of atonic postpartum heamorrhage
5 Termination of molar pregnancy
6 Management of ectopic tubal pregnancy
CONTRAINDICATIONS
Hypersensitivity to drug
Uterine scar
SIDE EFFECT
ADVANTAGES OF
PROSTAGLANDIN
S OVER
OXYTOCIN
DISADVANTAGES OF
PROSTAGLANDINS
It is costly
Tachysystol
e Nausea
Vomiting
ANTIHYPERTENSIVE
S INTRODUCTION:
Antihypertensive drugs are given when B.P. is 160/110mm of Hg to protect
mother from cerebral haemorrhage, cardiac failure and placantal abruption. First
line therapy is methyldopa and second line of therapy is nifedipine.
Methyldopa
Labetalol
Prazosin
Antihypertensi
Nifedipin
ves
e
Propranol
Sodium
nitroprusside
Diuretics
METHYLDOPA
Drug of first choice during pregnancy, effective & safe for both mother & fetus.
MODE OF ACTION
Stimulates central α adrenergic receptors
INDICATIONS
Hypertension
Gestational hypertension (pregnancy-induced hypertension -PIH)
Pre-eclampsia
SIDE EFFECTS
MATERNAL-
Postural
hypotension
Haemolytic anaemia
Sodium retention
FETAL-
Intestinal ileus
CONTRAINDICA
TIONS
Hepatic disorders
Psychic patients
CCF
LABETALOL
Efficacy & safety
with short term
use
MECHANISM OF ACTION
INDICATIONS
Hypertension
Severe hypertension, hypertensive emergencies
DOSAGE
Orally -100mg t.i.d
I.V. Infusion- 1-2mg/min until desired effect
SIDE EFFECTS
MATERNAL-
Postural hypotension
Sodium retention
FETAL-
Intestinal ileus
CONTRAINDICA
TIONS
Hepatic disorders
PROPRANOL
Propranolol (INN)
is a sympatholytic
non-selective beta
blocker.
MECHANISM OF ACTION
DOSAGE
Orally – 80-240mg
INDICATIONS
Hypertension
SIDE EFFECTS
MATERNAL
Severe hypotension
Sodium retension
Bradicardia
Bronchospasm
Cardiac failure
Hypoglycemia
FETAL
Bradycardia
Impaired fetal
response to
hypoxia
IUGR when began in first & second trimester
Neonatal hypoglycemia
Contraindications
Bronchial asthma
Renal insufficiency
Diabetes
CONTRAINDICATIONS
Bronchial asthma
Cardiogenic shock
PRAZOSIN
It is a
sympatholytic
drug used to treat
high blood
pressure
DOSAGE
Orally -1mg b.i.d
INDICATIONS
Hypertension
SIDE EFFECTS
Hypotension
Nasal congestion
Fluid retention
CONTRAINDI
CATIONS
Hypotensio
n Syncope
NIFEDIPINE
It is a dihydropyridine calcium channel blocker
MODE OF ACTION
DOSE
ORALLY-5-10mg
INDICATIONS
Pre term labour
Hypertension
Chronic or
stable angina
SIDE EFFECTS
Flushing
Hypotension
Headache
Tachycardia a
Inhibition of labour
Bradycardia
Ankle edema
Constipation
Placental ischemia
Heart block
CONTRAINDIC
ATIONS
It could be hazardous due to its synergic effect
Bradycardia
Cardiogenic shock
Systolic pressure <
90mmhg Sick sinus
syndrome
Left ventricle dysfunction
SODIUM
NITROPRUSSIDE
Sodium nitroprusside is a
potent vasodilator
PREPARATIONS
Nipride
Nitropres
s
MECHA
NISM
OF
ACTION
D
i
r
e
c
t
l
y
r
e
l
a
x
e
s
a
r
t
e
r
i
o
l
a
r
v
e
n
o
ACTION
INDICATIONS
Pregnancy induced HTN
In eclampsia with pulmonary
edema
CONTRAINDICATIONS
Patient with anuria
Hypersensitive to drug
SIDE EFFECTS
MATERNAL-
Weaknes
s Fatigue
Muscle cramps
Postural
hypotension
Hypokalemia
Hyponatremia
FETAL-
Fetal compromise
HYDROCHLORO
THIAZIDE
It is a thiazide
diuretic.
PREPARATIONS
Esidrex, hydrodiuril , hydroozide
ACTION
Acts on distal tubule
INDICATIONS
Edema
Hypertensio
n
DOSAGE
AND
ROUTE
P.O.-25-
100mg/day
SIDE EFFECT
Polyuria, glycosuria, frequency
Nausea, vomiting, anorexia
Rash, urticaria, fever
Increased creatinine
CONTRAINDICATIONS
Hypersensitivity to thiazides
SPIRONOLACTONE
It is a potassium sparing
diuretic
MODE OF ACTION
DOSE
Tablets- 25mg, 50mg, 100mg
INDICATIONS
Edema
Hypertensio
n
CONTRAI
NDICATIO
NS
Hypersensiti
ve to drug
Acute or
progressive
renal
insufficiency
SIDE
EFFECTS
Hyperkalemi
a Weakness
Fatigue
Muscle
cramps
Postural
hypotension
Tocolytic
TOCOLYT agents
IC
AGENTS
Magnesium
Betamimetics Indomethacin Nifedipine
Preterm delivery can be delayed by drugs in order
Sulphate
to improve the perinatal
outcome.
BETAMIMETICS (TERBUTALINE, RITODRINE & ISOXSUPRINE)
ISOXSUPRINE
ACTION
DOSE
IV drip 100 mg in 5 percent dextrose
Rate 0.2 u.g. per minute
MAINTENANCE
I.M. 10 mg six hourly for 24 hours,
Tab 10 mg 6-8 hourly
INDICATIONS
Delaying preterm birth
Management of preterm labour
SIDE EFFECTS
Hypotensio
n
Tachycardia
Nausea
Vomitin
g
Pulmonary edema
Cardiac arrhythmias
Adult respiratory distress syndrome
Hyperglycemia
Hypocalcaemi
a Lactic
acidosis
RITODRINE
HYDROCHL
ORIDE
It is a tocolytic
drug, was used
to treat
premature
labour
ACTION
Uterine relaxant –acts directly on vascular smooth muscle
INDICATIONS
Delaying preterm birth
Management of preterm labour
SIDE EFFECTS
Hyperglycemia, headache, restlessness, sweating, chills, and drowsiness.
Nausea, vomiting, anorexia and malaise
Altered maternal and fetal heart tone and palpitations
CONTRAINDICATIONS
TERBUTALINE
DOSE
I.V-50mg/ml
INDICATIONS
Delaying preterm birth
Management of preterm labour
SIDE EFFECTS
MATERNAL-
Headache
Palpitations
Oedema
Hyperglycemi
a
FETAL-
Tachycardi
a Heart
INDOMETHACIN
failure
It is a cyclo–oxygenase inhibitor appropriate first-line tocolytic for the pregnant
patient
MODE OF ACTION
Reduces synthesis of PGs
DOSE
Loading dose25-50mg
INDICATIONS
In early preterm labor (< 30 wk)
Preterm labor associated with polyhydramnios
SIDE EFFECTS
MATERNAL-
Heart burn
G.I bleeding
Asthma
Thrombocytopeni
a Renal injury
MAGNESIUM SULPHATE
Magnesium sulfate is widely used as the primary tocolytic agent because it has
similar efficacy to terbutaline with far better tolerance.
MECHANISM OF ACTION
Competitive inhibition to calcium ion either at motor end plate or at the cell
membrane
Decreases acetylcholine release & its sensitivity at the motor end plate
INDICATIONS
Premature rupture of membranes
Active labor
Planned delivery within 24 hours
LOADING AND
MAINTENANCE DOSES
It should not normally exceed 6
g, 1-2 g/h, and 24 hours
SIDE EFFECTS
MATERNAL
Flushing
Nausea
Headache
Drowsiness
Blurred vision
FETAL
Respiratory Depression
Motor Depression
CONTRAINDICATI
ONS
Patients with Myasthenia
gravis & impaired renal
function
NIFEDIPINE
MECHANISM OF ACTION
CONTRAINDICATIONS
Allergy to nifedipine
Hypotension
Hepatic dysfunction
Concurrent use of
beta-mimetics or
mgso4 or other
antihypertensive
medication.
SIDE EFFECTS
MATERNAL
Tachycardi
a
Palpitations
Flushing
Headaches
Dizziness
Nausea
ANTICON
VULSANT
S
Anticonvulsants
Magnesium
Diazepam
Sulphate
MAGNESSIUM SULPHATE
MODE OF ACTION
DOSE
IM-4gm-
10gm I.V-4-
6gm
Regimen Loading dose Maintaince dose
Intramuscular 4gm I.V over 3-5 min 5gm I.M 4 hrly in
followed by 10gm deep alternate
I.M buttocks
INDICATIONS
Prevention or control of seizures in pre-eclampsia & eclampsia
Hypomagnesia
SIDE EFFECTS
MATERNAL
Muscular paresis
Respiratory
failure
FETAL
Respiratory
Depression Motor
Depression
CONTRAINDICATIONS
Patients with Myasthenia gravis & impaired renal function
Magnesium sulfate (magnesium sulfate injection should not be administered
parenterally in patients with heart block or myocardial damage
DIAZEPA
M ACTION
Depresses
sulbcortical
levels of
CNS,
antianxiety.
SIDE
EFFECTS
MOTHER:
Hypotensio
n Dizziness
Drowsiness
Headache
FETUS:
Respiratory
depression Birth
hypotonea
Thermoregulatory
problems in newborn
PHENYTOIN
It is a centrally acting
anticonvulsant
MECHANISM OF ACTION
INDICATIONS
ANTICOAGULANT
S HEPARIN
SODIUM
Prevents conversion of
fibrinogen to fibrin
INDICATIONS
Deep vein thrombosis
Thrombo-embolism
Disseminated intravasculation
coagulation Patients with prosthetic valves
in the heart
ACTION
Interferes with blood clotting by indirect
mean
DOSAGE AND
ROUTE
10-15mg orally daily for 2 days, followed by 2-10 mg at the same time each day
depending upon the prothrombin time
SIDE
EFFECTS
MATERNAL
Haemorrhage
FETAL
Skeletal & facial deformities
Optic atrophy
Microcephaly
RHOGAM
INTRODUCTION-
Prevention of anti Rh(d) antibody formation is most successful if the medication is
administered twice at 28 weeks of gestation and again within 72 hrs after delivery.
MECHANISM OF ACTION
DOSE:-
<13 wk gestation: 50 mcg IM
>13 wk gestation: 300 mcg IM
UTERINE BLEEDING
Give 300 ug per 30 ml fetal whole blood or 15 ml pRBC
NO UTERINE BLEEDING
Gestation under 13 weeks: Rhogam 50 ug IM
Gestation over 13 weeks: Rhogam 300 ug IM
ADMINISTRATION:
INDICATION
To prevent Iso-immunisation in Rh negative clients exposed to Rh positive, MTP,
abdominal trauma or bleeding during pregnancy
ADVERSE REACTIONS-
Elevated temperature
Tenderness
CONTRAINDICA
TIONS-
Rh positive woman
Patients with allergic
reactions
BETAMETHASONE
It is a glucocorticosteroid, It is similar as dexamethasone probably a little more
potent
MODE OF ACTION
OR
Alveoli are lined with two types of cells, the type 1 and type 2 pneumocytes
The type 1 pneumocyte is responsible for gas exchange in the alveoli, while the
type 2 pneumocyte is responsible for the production and secretion of surfactant
DOSE
Dosage-4-20mg IV or IM
CONTRAINDICATIONS-
Hypersensitivity and systemic infections
SIDE EFFECTS-
Cataract
Osteoporosi
s Peptic
ulcers
Hypertensio
n
VIT.
K(PHYTON
ADIONE)
ACTION
An ant hemorrhagic factor that promotes
INDICATIONS
Coagulation disorders due to decreased formation of phyton-
dependent factors II, VII, IX, and X
Anticoagulant induced hypoprothrombinemia
Prophylaxis & treatment of hemorrhagic disease of newborns
Reversal of warfarin anticoagulant effects
CONTRAINDICATIONS
Hypersensitivity
Avoid IM if bleeding, 3rd trimester pregnancy
SIDE EFFECTS
IV or IM use: Severe reactions, including fatalities, have occurred during and
immediately after IV administration, even when precautions have been taken
with proper dilution and avoiding rapid infusion
Severe reactions, including fatalities, also have been reported following IM
administration; typically, these severe reactions are hypersensitivity or
anaphylaxis in nature and include shock and cardiac or respiratory arrest
These reactions may occur with the first dose
DRUGS USED IN PREGNANCY,
LABOUR,
PUERPERIUM & NEWBORN-