OUTLINE

1. Oxytocin
2. Ergot
3. Prostaglandins
4. Antihypertensive drugs Methyldopa Labetalol
propranolol
5. Diuretics
6. Tocolytic agents  Ritodrine hydrochloride (yutopar)
7. Anticonvulsants  Magnesium sulphate
8. Anticoagulants (Heparin sodium)
9. Analgesics (Pethidine)
10.Effects of maternal medications on fetus
11. Maternal drug intake and breastfeeding
 OXYTOCIN (Pitocin)
• Definition:
• Oxytocin is a hormone secreted from
posterior pituitary gland used to help start or
continue labor and to control bleeding after
delivery. It is also sometimes used to help milk
secretion in breast-feeding. Types of oxytocics:
A) Syntocinon Syntocinon is a synthetic form
of the natural oxytocin produced by the
woman's anterior pituitary gland in the brain.
• It is the same drug given to induce labour or
augment a slow labour, but it is given in one
injection into the woman's thigh and in a
much higher dose for managing the 3rd stage
(rather than in gradual, small doses through a
drip in the vein when inducing or augmenting
the labour). Syntocinon makes the uterus
contract within 2 to 3 minutes after being
given as an intramuscular injection into the
woman's thigh and will last up to 5 to 10
minutes.
 ERGOMETRINE
• Ergometrine , known as 'Ergot' is an ergot alkaloid
medication. It became routine to use it to treat
postpartum haemorrhage (PPH). It is an uterotonic
drug that increases the tone of the uterine
muscles, causing stronger more frequent and
sometimes sustained contractions of the uterus.
Ergometrine takes about 5 to 7 minutes to start
working after being given as an intramuscular
injection into the thigh, stimulating the uterus to
contract almost continuously for up to 2 to 4 hours.
 SYNTOMETRINE
• Syntometrine is a mix of Syntocinon and
ergometrine, and became popular for routine
use during the 3rd stage of labour. It contains 5
units (5IU) of Syntocinon and 500 micrograms
(500 mg) of Ergometrine. If given
intramuscularly the Syntocinon will act within 2
to 3 minutes (lasting 5 to 10 minutes) and the
ergometrine within 6 to 7minutes (lasting 2 to 4
hours). When combined, their action makes the
uterus contract sooner and sustains more
intense contractions for a longer period of time
after the birth.
 PHARMACOLOGICAL EFFECTS OF
OXYTOCICS
1- Uterine stimulation
2- Milk ejection
3- Water retention
 INDICATION OF OXYTOCICS:
In Pregnancy:
• 1. To induce abortion (inevitable, missed).
• 2. To expedite expulsion of hydatidiform mole.
• 3. For oxytocin challenge test.
• 4. To stop bleeding following evacuation
• 5. To induce labor.
In Labor:
• 1. To augment labor
• 2. In uterine inertia.
In Postpartum Period:
• 1. To prevent and treat postpartum hemorrhage
• 2. To initiate milk let-down in breast engorgement.
 CONTRAINDICATIONS
• Oxytocin is contraindicated in any of the following
conditions:
• Significant cephalopelvic disproportion;
• Unfavorable fetal positions or presentations i.e., transverse
lies.
• In obstetrical emergencies where the benefit for either
the fetus or the mother favors surgical intervention.
• In cases of fetal distress.
• Hypertonic uterine patterns.
• Patients with hypersensitivity to the drug.
• Induction or augmentation of labor in those cases where
vaginal delivery is contraindicated, such as cord
presentation or prolapse, total placenta previa, and vasa
previa.
DOSAGE AND ROUTES OF ADMINISTRATION
• A) Dose for Induction: Initial dose: 0.5 to 1
milliunits IV infusion per hour.
• B) Dose for Postpartum Bleeding: 10 to 40
units IV infusion in 1000 mL at a rate sufficient
to control bleeding.10 units IM after delivery
of placenta.
• C) Dose for Abortion: After suction or sharp
curettage for an incomplete, inevitable or
elective abortion: 10 units in 500 mL IV
infusion. Adjust rate to assist uterus in
contraction.
 SIDE EFFECTS AND TOXIC EFFECTS
• Water intoxication may occur when large doses
of oxytocin have been infused for long periods.
• Allergic reactions may occur.
• Oxytocin can cause maternal death due to
uterine rupture.
• Hypotension
• Hypertensive crisis and cerebral hemorrhage.
• Pelvic hematomas, bradycardia, and
arrhythmias also occur. Arrhythmias may also
occur in the fetus, and fetal death.
Nursing intervention for women taken oxytocin
• Monitor FHR and uterine contraction for (frequency,
duration, intensity of contraction and resting tone).
• Check blood pressure and pulse.
• Once the desired frequency of contractions has been
reached labor has progressed to 6 cm dilatation,
oxytocin may be reduced by similar increment.
If hyper stimulation of the uterus occurs or a non-
reassuring FHR pattern occur, following action are taken:
• Turn off oxytocin.
• Change position (left lateral position).
• Give oxygen face mask.  Monitoring of fetal heart
rate.
 Pharmacologic effect of Ergot Alkaloids
A) Effects on the uterus:
• Ergot Alkaloids stimulate uterine contraction,
because contraction may be prolonged, Ergot
Alkaloids are not employed to induce labor
B) Effects on the cardiovascular system
• Ergot Alkaloids can cause constriction of arteries
and veins, vasoconstection may contribute to
treat postpartum hemorrhage. How does it
work? Ergot contains chemicals that can help
reduce bleeding by causing a narrowing of the
blood vessels. It is given IM injection or oral.
 Indications
• Treat excessive bleeding during menstrual
periods, at the start of menopause
• Before and after miscarriage.
• After childbirth to expel the placenta and
contract the uterus.
 Contraindications
• Coronary artery disease: Vasoconstriction or spasm of
coronary arteries may exacerbate symptoms and lead to
myocardial ischemia.
• Hypertension: The pressor effects of the ergots may
raise blood pressure, exacerbating hypertension.
• Peripheral vascular disease may lead to limb ischemia
because of vasoconstriction of stenotic arteries.
• Avoid using within 24 hours of triptans or other
vasoconstrictors because of additive vasoconstrictive
effects.
• Pregnancy: Ergots may cause fetal distress, or
miscarriage. Although not used during pregnancy, ergots
can be used during labor to control hemorrhage.
• Liver disease, kidney disease, toxemia.
 Side Effects
• Nausea and vomiting:Is likely a direct effect on
the vomiting center in the brain.
• Diarrhea: Activation of serotonin receptors in
the gut can enhance GI motility.
• Numbness and tingling of extremities are likely
caused by vasoconstriction of micro vessels
feeding nerves.  Angina is likely caused by
vasoconstriction or vasospasm of coronary
arteries.
• Hypertension is caused by vasoconstriction.
Nursing intervention for women taken Ergot
Assess
• Blood pressure pulse and respiration
• Watch for signs of hemorrhage Administer
• Orally or IM in deep muscle mass
• Have emergency cart readily available.
• Evaluate Therapeutic effect--- decreased blood
loss
• Teach Client To report increased blood loss,
abdominal cramps, headache, sweating
nausea, vomiting, dyspnea, chest pain).
 PROSTAGLANDINS
Mechanism of action
• Prostaglandins increase intramyometrial calcium concentration
and enhance uterine contraction. They act on the G protein-
coupled receptors and activate the calcium channels.
• Clinical uses (indications) include:
• Inducing labor.
• Terminating pregnancy.
• As a second-line agent in treating postpartum hemorrhage.
Dosage
• Misoprostol (PGE1) is cheap and easy to store. It is widely
used during termination of pregnancy. It has also been used
off label for the management of postpartum hemorrhage as a
second-line agent. The most reliable route is sublingual, but it
can also be used rectally or through the intravaginal route.
• The recommended dosage for postpartum
hemorrhage is 400-800 μg. However, higher doses
are associated with side-effects. Prostaglandin F2α
(PGF2α) produces contraction of the uterine
muscles, bronchial smooth muscles and
vasoconstriction. The recommended dose is 250
μg intramuscularly or 500 μg intramyometrially.
For induction and maintenance of labour PGE2
generally infused as 5 mg / litre [in 5% dextrose]
Start with 2-6 drops /min. Increase by 2-6 drops
every 2 hr [if no response]. Total maxis 600 μg
[normally 100 - 400 μg]
 Side-effects
• The side-effects of prostaglandins include
fever, diarrhea, nausea and vomiting, and an
increase in pulmonary and systemic pressure.
 Nursing intervention for women taken
Prostaglandins
Assess:
• Respiratory rate, rhythm and depth
• Vaginal discharge; itching or irritation
indicative of infection.
Administer: Antiemetic or antidiarrheal
preparations prior to giving this drug
Evaluate: Length and duration of contractions,
Fever and chills Teach the client to remain
supine for 10-15 min after vaginal insertion.
 ANTIHYPERTENSIVE DRUGS
Antihypertensive drugs are used in hypertensive
disorders of pregnancy.
The commonly used drugs are:
Methyldopa
Labetalol, propranolol
Vasodilators ------- Hydralazine
Nifedipine.
 Methyldopa
Brand names: (Aldomet, Dopamet).
Mechanism of action:
• Methyldopa affects the nerves that relax the walls of blood
vessels, causing the blood vessels to widen (dilate) and
reducing blood pressure. Indications: This medication is
used alone or with other medications to treat high blood
pressure (hypertension). Lowering high blood pressure helps
prevent strokes, heart attacks, and kidney problems
Contraindication
•  Patients with active hepatic disease, such as acute
hepatitis and active cirrhosis
•  Patients with liver disorders previously associated with
methyldopa therapy
•  Hypersensitivity to any component of these products.
• Side effects:
•  Sleepiness.
•  Dry mouth.
•  Headache, dizziness, or lightheadedness. 
Nausea and vomiting.
•  Diarrhea.
 Nursing Considerations

Assess
• Blood values-----platelets
• Renal studies----protein,creatinine
• Liver function tests
• Blood pressure before beginning treatment and
periodically there after.
• Decrease in blood pressure ( therapeutic
response)
• Allergic reaction--- Rash, Fever, Pruritis, urticaria
• Symptoms of congestive heart failure ( edema,
dyspnea)  Renal symptoms------polyuria,
oliguria, frequency.
Teach client
• To avoid hazardous activities
• Administer one hour before meals
• Not to discontinue drug abruptly or withdrawal
symptoms may occur
• Not to use over the counter (OTC) medications for
cough, cold or allergy, unless directed by physician.
• To rise slowly to sitting or standing position to
minimize orthostatic hypotension
• Not to skip or stop drug unless directed by
physician
• Notify physician of untoward signs and symptoms.
 DIURETICS
• Diuretics are drugs that increase the volume of urine
produced by promoting the excretion of salt and water
from the kidneys.
Therapeutic Uses (indications):
• 1. Hypertension: The efficacy of these drugs is derived
from their ability to reduce blood volume, cardiac output,
• 2. Heart failure The primary use for diuretics in heart
failure is to reduce pulmonary and/or systemic congestion
and edema, and associated clinical symptoms (e.g.,
shortness of breath - dyspnea).
• 3. Pulmonary and systemic edema Diuretics, by reducing
blood volume and venous pressure, lower capillary
hydrostatic pressure, which reduces net capillary fluid
filtration and tissue edema.
 Furosemide (lasix)

• Dosage:40 mg tab, daily following breakfast for

5days a week. In acute conditions, the drug is
administered parenterally in doses of 40- 120 mg
daily.
Adverse Side Effects Loop diuretics
• hypokalemia
• metabolic alkalosis
• hypomagnesemia
• hyperuricemia
• dehydration (hypovolemia), leading to hypotension
• dose-related hearing loss (ototoxicity)
 Nursing considerations
• Assess
•  Weight, intake and output daily to determine fluid
loss.  Respiration—rate,depth and rhythm
•  BP----Lying and standing.
•  Electrolytes----sodium, chloride, potassium, blood
sugar, CBC, serum creatinine
•  Glucose in urine, if patient is diabetic.
•  Administer with food, if nausea occurs. Evaluate:
•  Improvement in edema of feet, legs.
•  Signs of drowsiness, restlessness.
•  Signs of hypocalcemia, malaise, fatigue, tachycardia
and leg cramps.
•  Rashes and temperature elevation.
Teach patient
• To increased fluid intake 2-3 L\ day unless
contraindicated.
• To rise slowly from lying or sitting position
• To report adverse reactions, such as muscle
cramps, nausea, weakness, or dizziness.
• To take with food or milk.
• To take early in day to prevent nocturia
 TOCOLYTIC AGENTS
• Tocolytics (also called anti-contraction medications or labor
repressants) are medications used to suppress premature
labor. Eg. Ritodrine hydrochloride
Contraindications to tocolysis
• 1. Fetus is older than 34 weeks gestation
• 2. Fetus weighs less than 2500 grams or has intrauterine
growth restriction (IUGR) or placental insufficiency
• 3. Lethal congenital or chromosomal abnormalities
• 4. Cervical dilation is greater than 4 centimeters
• 5. Chorioamnionitis or intrauterine infection is present
• 6. Mother has severe pregnancy-induced hypertension,
eclampsia/preeclampsia, active vaginal bleeding, placental
abruption, a cardiac disease, or another condition which
indicates that the pregnancy should not continue.
• Tocolytic agents inhibit uterine contractions and suppress pre-term
labor. Tocolytics can delay labor and give more time for fetal
growth and for the fetal lungs to mature. They are most effective
when given early in premature labor.
Side effects
Maternal side effects
• Metabolic hyperglycemia,
• hyperinsulinemia,
• hypokalemia,
• antidiuresis,
• altered thyroid function,
• physiologic tremor,
• palpitations, nervousness,
• nausea or vomiting,
• fever,
• hallucinations
Fetal and neonatal side effects
• Neonatal tachycardia,
• hypoglycemia,
• hypocalcemia,
• hyperbilirubinemia,
• hypotension,
• intraventricular
• hemorrhage
 Nursing Considerations
Assess
• Maternal and fetal heart tones during infusion. 
Intensity and length of uterine contractions  Fluid
intake to prevent fluid overload, discontinue if this
occurs.
• Positioning of patient in left lateral recumbent position
to decrease hypotension and increase renal blood flow.
• Evaluate therapeutic response: length of contraction,
absence of preterm labor, decreased BP.
 ANTICONVULSANTS
• The commonly used anticonvulsant is magnesium
sulphate.
Mechanism of Action
• Depresses CNS, blocks peripheral neuromuscular
transmission, produces anticonvulsant effects; decreases
amount of acetylcholine released at end plate by motor
nerve impulse Slows rate of SA node impulse formation
in myocardium and prolongs conduction time Promotes
movement of calcium, potassium, and sodium in and
out of cells and stabilizes excitable membranes
Promotes osmotic retention of fluid in colon, causing
distention and increased peristaltic activity, which
subsequently results in bowel evacuation
 Indications
1. Convulsions (treatment) - Intravenous magnesium
sulfate injectionis indicated for immediate control of
life-threatening convulsions in the treatment of severe
toxemias (pre-eclampsia and eclampsia) of pregnancy.
2. Hypomagnesaemia (prophylaxis and treatment) -
Magnesium sulfate injection is indicated for
replacement therapy in magnesium deficiency,
especially in acute hypomagnesaemia, it is also used to
prevent or treat magnesium deficiency in patients
receiving total parenteral nutrition.
3. Preterm of Labor (treatment)- Magnesium sulfate
injection is indicated in uterine tetany as a myometrial
relaxant.
Magnesium sulfate Dose:
• Usual Adult Dose for Hypomagnesaemia: 1 g
IM every 6 hours for 4 doses (mild
hypomagnesaemia) or as much as 2 mEq/kg
(0.5 mL of a 50% solution) within 4 hours if
necessary (more severe hypomagnesaemia) or
5 g in 1 L IV fluid over 3 hours. Administration
should be discontinued as soon as the desired
clinical effect is achieved and the serum level
is normal.
• Usual Adult Dose for Seizure Prophylaxis:
Seizure Prevention in Preeclampsia/Eclampsia:
Initial: IM: 4 to 5 g of a 50% solution every 4
hours as necessary. IV: 4 g of a 10% to 20%
solution, not exceeding 1.5 mL/min of a 10%
solution. Maintenance: IV Infusion: 1 to 2
g/hour. Maximum dose should not exceed 30
to 40 g/day. Duration: Continuous
administration beyond 5 to 7 days can cause
fetal harm
• Side effects: Maternal side effects
• Flushing, lethargy, headache, muscle
weakness, diplopia, dry mouth, pulmonary
edema, cardiac arrest
• Fetal and neonatal side effects
Lethargy, hypotonia, respiratory depression,
demineralization with prolonged use
 Nursing considerations
Assessment Prior to administration:
• Obtain a complete health history including allergies, drug history,
and possible drug interactions.
• Assess respiratory status and deep tendon reflexes.
• Assess for the presence or history of malnutrition, hypomagnesia,
seizure activity, preeclampsia, and kidney disease.
• Obtain serum magnesium level and renal profile. During
administration
• Monitor renal function, blood pressure, respiratory rate, and deep
tendon reflex when magnesium sulfate is administered parenterally
• Report urine output of less than 100 ml/h to healthcare provider
• Observe symptoms of magnesium toxicity (nausea, muscle
weakness, loss of reflexes) occur during magnesium sulfate
treatment. The medicine calcium gluconate is given to treat the
problem.
 Client Education

• Instruct client that magnesium sulfate should

only be taken on the advice of a healthcare
provider.
• Instruct client to report any difficulty
breathing, low pulse rate, or dizziness.
• Instruct client to report problems with
urination or edema.
• Advise laboring mothers who are receiving
magnesium sulfate that the newborn will be
monitored closely after birth
 ANTICOAGULANTS (HEPARIN SODIUM)
Mechanism of action:
• Heparin inhibits reactions that lead to the clotting of blood
and the formation of fibrin clots
Indications:
• Heparin Sodium Injection is indicated for:
• Prophylaxis and treatment of venous thrombosis
• For prevention of postoperative deep venous thrombosis in
patients undergoing major abdominal surgery
• Prophylaxis and treatment of pulmonary embolism.
Contraindications:
• Patients with severe thrombocytopaenia
• Patients with an uncontrollable active bleeding state except
when this is due to disseminated intravascular coagulation.
 Side effects
• 1. Haemorrhage: Hemorrhage is the chief
complication that may result from heparin therapy
usually be controlled by withdrawing the drug
• 2. Local Irritation: Local irritation, erythema, mild
pain, hematoma or ulceration may follow deep
subcutaneous injection or intramuscular use.
• 3. Hypersensitivity: General hypersensitivity
reactions have been reported, with chills, fever
and urticaria as the most usual manifestations
• 4. Miscellaneous: As Osteoporosis following long
term administration of high doses of heparin or
cutaneous necrosis after systemic administration.
 Nursing considerations
Assess:
• Blood studies, prothrombin time, blood
pressure (signs of hypertension).
• Avoid all IM injections that may cause bleeding.
• Evaluate therapeutic response
• Bleeding gum, hematuria, fever skin rash,
urticaria.
• Teach patient: avoid use of drugs unless
prescribed by physicians, use soft toothbrush to
avoid bleeding gums.
 ANALGESICS (PETHIDINE)
Uses:
• Postoperative and obstetric analgesia.
• Dosage and administration Obstetric analgesia
• A dose of 1 mg/kg, repeated as needed. The last
dose should be administered, when possible, 1-3
hours prior to delivery in order to prevent
neonatal depression.
• Dosage should be reduced in elderly patients and
those with cardiorespiratory disease
 Contraindications
• Pethidine should not be used intravenously within 2
hours and intramuscularly within 3 hours of the
expected time of delivery of the baby, for fear of birth
asphyxia.
• It should not be used in cases of preterm labor and
when the respiratory reserve of the mother is reduced.
Side effects:
• Mother: drowsiness, dizziness, confusion, headache,
sedation, nausea and vomiting.
• Fetus: respiratory depression, asphyxia.
 Nursing considerations
Assess:
• Urinary output-----may cause urinary retention. 
Administer antiemetic to prevent nausea and vomiting.
• Storage in light—resistant container at room temperature
• Safety measures---Side rails, night light
• Evaluate therapeutic response-----decrease in pain.  CNS
changes------- dizziness, drowsiness
• Allergic reactions-------rash, urticaria.
• Teach patient to report symptoms of CNS changes,
allergic reactions.
 HEMATINIC DRUGS USED DURING
PRENANCY
Iron prophylaxis
• Prophylactic supplementation of all pregnant
women with 60 mg iron and 400 μg folic acid
daily, till term in pregnancy and continuation
of similar dose during lactation for 3 months in
countries where prevalence is >40% is
recommended by WHO
• Ministry of Health and Social Welfare
(MoHSW) guideline recommends 100 mg of
iron and 500 μg of folic acid daily at least for
100 days starting after the first trimester, at 14-
16 weeks of gestation, followed by the same
for 6 months in the post-partum period
• Treament of anaemia in pregnancy
• Mild anemia- 2 tablets/day-100 days
• Moderate anemia- IM iron therapy+oral folic
acid. Sometimes oral HB12 syrup is prescribed
• Severe anaemia- blood transfusion is required
 Drugs used in the prevention and
treatment of malaria in pregnancy
• Prevention
• Oral Sulfadoxine and pyrimethamine (fansidar)- given
at 16-24 weeks and repeated every month until
delivery. Maximum 5 doses
• Treatment
• First trimester- oral quinine plus clyndamicin
• Second and third trimester- arthemeter and
lumefantrine is used.
• In severe case- parental quinine or artesunate is given
until patient is able to tolerate oral coartem/quinine
DRUGS USE IN NEONATAL PERIOD
• Hepatitis vaccine: It protects neonates against
hepatitis B. A dose is given at birth and other three
doses are given at 6 weeks, 4 months and at 6
months. it’s given I.M
• Vitamin K: It is given to newborns to prevent a
serious disease call hemorrhagic disease of the
newborn. It’s given I.M
• Ampicillin: it is a bactericidal and a broad-spectrum
antibiotic active against gram-negative bacteria that
are resistant to penicillin G.
 CONT….
• Ampicillin is effective against infections caused by
klebsiella,pneumonia, E. Coli, enterococci,and Beta-
lactams. It’s contraindicated in renal disease.
• Gentamycin: it is an aminoglycoside use in the
treatment of bacterial infections. It kills by inhibiting
protein synthesis, but nephrotoxic. It’s combination
with Beta-lactams can treat sepsis, pneumonia, and
active against enterobacter and klebsiella.
Contraindicated in kidney disease and
hypocalcaemia. It’s drug reaction is furosemide.