The document discusses drugs used in pregnancy, labor, and the postpartum period. It provides details on common drugs like folic acid, iron, calcium, antihypertensives, tocolytics, oxytocics, analgesics, and anticonvulsants. For each drug, it lists preparations, mechanisms of action, indications, contraindications, adverse effects, dosages, and nursing considerations. The document aims to give midwives thorough knowledge of pharmacotherapeutics in obstetrics.

1. PHARMACOTHERAPEUTICS IN
OBSTETRICS
Mrs. U SREEVIDYA,
Msc. NURSING,
Associate Professor,
Apollo college of
nursing, CHITTOOR

2. DRUGS USED IN PREGNANCY,
LABOUR AND PUERPERIUM

3. INTRODUCTION
The midwife should have thorough
knowledge of the indications, actions
and side effects of drugs used in
obstetrics as well as the nursing
considerations related to each of them.

4. INTRODUCTION
• Drugs used in obstetrics have a huge impact
on the outcome of both mother and baby.
• Drugs used during first trimester can produce
congenital malformation and the period of
greatest risk is from the third to eleven weeks
of pregnancy
• During second and third trimester drugs can
affect the growth and functional development
of the fetus or they can have toxic effect on
fetus tissues.

5. EFFECTS OF DRUGS IN
PREGNANCY

10. DRUGS USED IN PREGNANCY
List of drugs used in pregnancy are:-
• Folic acid
• Iron
• Calcium
• Anti -hypertensive drugs
•Diuretics
•Tocolytic agents

12. FOLIC ACID
Preparation
•Injection- 10ml vial (5mg/ml with 1.5% benzyl
alchoal)
•Tablet- 0.4mg , o.8mg , 1mg
Action
Stimulates normal erythropoiesis and
nucleoprotein synthesis.

13. Indications
1.Megaloblastic or macrocytic anemia
during pregnancy to prevent fetal damage
2.Prevent fetal neural tube defect during
pregnancy
Contraindications
1. untreated vitamin B12 deficiency.

14. Adverse effects
1. Abdominal cramps
2. Diarrhoea
3. Rash
4. Irritability
5. nausea or bloating
Dosage and route of administration
0.4mg or 400mcg OD orally
0.4-0.8mg IM Or subcutaneously daily.

15. Nursing consideration
1.Patient with H/O fetal neural tube defect
in pregnancy should increase folic acid
intake 1 month before and 3 months after
conception.
2.Patient with intestinal malabsorption
may need parentral administration.

16. IRON (ferrous fumarate)
Preparation
Each 100mg provides 33mg of elemental iron.
Tablet- 90mg,200mg,300mg,325mg,350mg
Action
Provides elemental iron, an essential component
in the formation of haemoglobin.

17. Indications
1. Iron deficiency
2. As a supplement during pregnancy
Contraindications
1. Primary haemolytic anemia
2. Peptic ulcer disease
3. Ulcerative colitis
4. Repeated blood transfusions

18. Adverse effects
1. Metallic taste
2. Temporary stained teeth
3. Nausea or vomiting
4. GI irritation
5. Black stools
Dosage and routes of administration
30mg OD orally
Injection- 20mg elemental iron/ml in 5ml and 10ml
single dose vial (iron sucrose )
Dose-15mg/kg body weight or max 1000mg in single Inj
IM Or diluted with 100ml of NS for IV.

19. Nursing considerations
1.Advised patient to avoid taking tablet with
milk or along with antacids.
2. Caution patient to crush tablet
3.Caution patient not to substitute one iron salt
for another because amount of elemental iron
may vary.
4.Advised patient to report for constipation or
change in stool colour

20. Calcium (calcium citrate)
Preparation
each tablet contains 211mg or 10.6meq of
elemental calcium
tablet- 250mg, 500mg
Action
Replaces calcium and maintain calcium level
Indication
supplement

21. containdications
1. Cancer patients with bone metastasis
2.Hypercalcemia
3.Hypophosphatemia
4.Renal calculi
Adverse effects
1. Headache
2.Irritability
3.Hypercalcemia
4.Chalky taste
5. Nausea or vomitings
Dosage and route of administration
500mg OD orally.

22. Nursing considerations
1.Advise patient to take oral calcium 1 or
1.5 hours after meals if GI upset occurs
2.Monitor calcium level if the patient is
having mild renal impairment.
3.Advise patient to report for any kind of
abdominal pain, vomiting or nausea occurs.

23. ANTIHYPERTENSIVE DRUGS
Here are the choice of drugs given during
pregnancy are:-
1.Alpha and Beta blockers- Labetalol
hydrochloride
2.calcium channel blockers-Nifedipine
3.alpha blockers-Methyldopa
4.vasodilators-Hydralazine hydrochloride

24. Anti hypertensive drugs
contraindicated in pregnancy
These drugs should be avoided because they
may cause poor fetal renal function,
malformation or can cause IUGR
1.ACE inhibitors
2. Minoxidil
3. Sodium Nitoprusside
4. Diltiazem
5.Atenolol
6.Propranolol

25. Labetalol Hydrochloride
Preparation
Injection-5mg/ml in 20ml vial
Tablets- 100mg,200mg ,300mg
Action
Reduced peripheral vascular resistance as a
result of alpha and beta blockage.

26. Indications
1.Hypertension 2.Hypertensive
emergencies
Contraindications
1.Hypersensitive to drug or its component.
2.Bronchial asthma
3.Hepatic or heart failure
4.Prolonged hypotension
5.Severe bradycardia

27. Adverse effects
1. Dizziness
2. Fatigue
3. Nausea or vomiting
4. Headache
5. Vertigo
Dosage and route of administration
50mg or 100mg tablet OD orally
20mg/20ml Inj IV bolus wait for 10min if no response
then give 40mg slow bolus.

28. Nursing considerations
1.Advised patient to remain in supine position
for 3hrs after infusion.
2. Monitor BP frequently
3.In diabetic patient monitor glucose level
closely.
4.Advised patient that dizziness can be
minimized by rising slowly and avoiding sudden
position change

29. NIFEDIPINE
Preparations
Capsule-10mg,20mg
Tablet-20mg,30mg,60mg,90mg
Action
Thought to inhibit calcium ion reflex across
cardiac and smooth muscle cells, decreasing
contractility and oxygen demand and also dilates
arteries and arterioles.

30. Indications
1. Hypertension
2. Classic chronic stable angina pectoris.
Contraindications
1.Heart failure
2. Hypotension
3. Severe GI narrowing
Adverse effects
1. Dizziness
2. Syncope
3. Heart failure
4. Muscle cramps
5. Peripheral edema

31. Dosage and route of administrations
5-20mg OD orally.
Nursing considerations
1. Monitor BP & HR regularly
2.Advise patient to avoid taking this drug with
grapefruit juice.
3. Watch for symptoms for heart failure.
4.Advise patient if chest pain worsen
immediately report to doctor.

32. METHYLDOPA
Preparations
Tablet-250mg,500mg
Inj-50mg/ml
Action
Inhibit the central vasomotor centre, decreasing
sympathetic outflow to the heart, kidney and
peripheral vasculature.

33. Indications
1. Hypertension
2. Hypertensive crisis
Contraindications
1. Hepatic disease or liver cirrhosis
2. Lactating mother
Adverse effects
1. Decrease mental acuity
2. Sedation
3. Headache or depression
4. Bradycardia
5. Hepatic necrosis
6. Hepatitis

34. Dosage and routes of administration
250mg BD or TDS max 2g daily titrated by BP
Nursing considerations
1. Monitor BP regularly.
2. Monitor patient coomb’s test result.
3. Report for involuntary movements.
4.Tell patient to check weight daily and notify if she
gains 2 or more pounds in a week

35. Hydralazine Hydrochloride
Preparation
Inj-20mg/ml in 1ml vial
Tablet-10mg,25g,50mg,100mg
Action
Direct acting peripheral vasodilator that relexes
arteriolar smooth muscle.
Indications
1. Hypertension
2. Severe essential hypertension

36. contraindications
1. Coronary artery disease
2. Rheumatic heart disease
3. Stroke
4. Severe renal impairment
Adverse effects
1. Neutropenia
2.Leukopenia
3.Thrombocytopenia
4. Orthostatic hypotension

37. Dosage and route of administration
• 25mg tablet BD and if necessary may increase to
50mg BD
• 5mg diluted in 10ml of NS slow IV at 15-
20minutes interval.
Nursing considerations
1. Monitor patient BP, pulse rate, body weight frequently.
2.Monitor patient for muscle and joint pain, fever or
throat pain.
3.Advised patient to take drug after food to increase
absorption

38. DIURETICS
a
Diuretics are used in the following conditions
during pregnancy:
1. PIH with massive edema
2. Eclampsia with pulmonary edem
3. Severe anemia in pregnancy with heart failure
4. Prior to blood transfusion in severe anemia
5.As an adjunct to certain antihypertensive
drugs.

39. FUROSEMIDE (LASIX)
Preparation
Inj-10mg/ml
Tablets-20mg,40mg,80mg,500mg
Action
Inhibits sodium and chloride reabsorption at proximal
and distal tubules and loop of Henle.
Indications
1. Acute pulmonary edema
2. Edema
3. Hypertension

40. Contraindications
1. Anuria
2. Hepatic cirrhosis
3. Allergic to sulfonamides
Adverse effects
1. Maternal: Weakness, fatigue, muscle cramps, hypokalemia
2.Fetal: May occur due to decreased leading to fetal compromise,
hyponatremia.
Dosage and routes of administration
40 mg tablet, daily followingbreakfast.
 In acute conditions, the drug is administered parenterally in
doses of 40-120 mg daily.

41. Nursing considerations
1.Monitor weight, BP and pulse rate routinely
for long term use.
2. Monitor patient I/O chart.
3.Watch the signs for hypokalemia such as
muscle weakness and cramps.
4. Monitor uric acid if patient is having gout.
5.Advise the patient to take drug in the morning
after food.
6.Advised patient to avoid direct sunlight to
prevent photosensitivity reactions.

42. TOCOLYTIC AGENTS
These drugs can inhibit uterine contractions &
used to prolonged the pregnancy. In women
who develop premature uterine contractions, in
addition to putting them to absolute bed rest &
sedating, Tocolytic drugs are administered in
an attempt to inhibit uterine contraction.
Here are the drugs used are:-
1. Isoxsuprine Hydrochloride
2. Ritodrine hydrochloride

43. Isoxsuprine hydrochloride
(Duvadilan)
Preparation
Tablet -10mg
Inj-10mg/ml
Action
Acts directly on vascular smooth muscle, causes cardiac
stimulation & uterine relaxation And thus causing relaxing the veins
and arteries and making them wider to increase the blood flow to
certain parts of the body.
Indication
1. Prevent Preterm labour
2. Inhibit uterine contractions.

44. Contraindications
1. Hypersensitivity
2. Postpartum
Adverse effects
1. Hypotension
2. Tachycardia
3. Nausea or vomiting
4. Pulmonary edema
5. Cardiac arrhythmias
6. Hyperglycemia or hypokalemia

45. Dosage & routes of administration
Initial: IV drip 100 mg in 5% dextrose
@Rate0.2ug/minute.
To continue at least 2 hours after the contractions
cease
Maintenance: IM 10mg 6 hourly for 24 hrs or tab
10mg 6- 8hrly.
Nursing considerations
1. Assess patient BP, pulse during treatment
2.Take BP lying & standing as orthostatic hypotension
is common
3.Monitor for Intensity & length of uterine contractions
and FHS.
4.Advise patient to make position changes slowly
as fainting may occur.

46. Ritodrine hydrochloride (yutopar)
Preparation
Inj-5ml amp-10mg/ml=50mg per amp.
Tablet-10mg
Action
Acts directly on vascular smooth muscle, causes cardiac stimulation &
uterine relaxant.
Indications
Prevent preterm labour
Contraindications
1. Hypersensitivity
2. Eclampsia
3. Hypertension
4. Dysrhythmias

47. Adverse effects
1.Hyperglycemia
2. Headache
3. Restlessness or sweating
4. Chills and drowsiness
5. Nausea or vomiting
6. Altered maternal & fetal heart tone & palpitations.
Dosage and routes of administration
Initial: IV drip 100 mg in 5% dextrose @ 0.1 mg/minute gradually
increased by 0.05mg/min ,To continue for at least 2 hrs after
contractions cease.
Maintenance -Tab 10mg 6-8 hourly PO 10 mg given half hour
before termination of iv, then 10 mg q2 hr x 24 hrs, then 10-20 mg
q4th, not to exceed 120 mg/day

48. Nursing considerations
1.Assess Maternal & fetal heart tones during infusion
and also Intensity & length of uterine contractions
2.Monitor Fluid intake to prevent fluid overload,
discontinue if this occurs.
3.Administer only clear solutions after dilution 150 mg
in 500 ml D5W or NS, give at 0.3 mg/ml By Using
infusion pumps/monitor carefully
4.Positioning of patient in left lateral recumbent
position to decrease hypotension & increase renal
blood flow.
5. Advise patient to remain in bed during infusion.

53. Other drugs such as,
Thyroid Drugs – Levothyroxine
Proton Pump Inhibitors –
Lansoprazole
Oral Diabetic Drugs – Metformin
Anti Coagulants – Warfarin
Anti pyretics - Paracetamol

54. DRUGS USED
IN LABOUR

55. DRUGS USED IN LABOR
Here are the drugs used in labor are:-
1.Oxytocics
2. Analgesics
3. Anticonvulsants
4. Anticoagulants

56. OXYTOCICS
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 :-
1. Oxytocin
2. Ergot derivatives
3. Prostaglandins

57. OXYTOCIN
&
Oxytocin is an octapeptide synthesized in the hypothalamus and
stored in the posterior pituitary.
Preparations
Synthetic oxytocin available for parenteral use includes:-
•Syntocinon : 5units/ml in ampoules of 1 ml
•Pitocin 10 units/ml in ampoule of 0.5 ml
•Syntometrine : A combination of syntocinon on 5 units &
ergometrine 0.5mg
•Oxytocin nasal solution 40 unit/ml
Actions
Acts directly on myofibrils producing uterine contractions
stimulates milk ejection by the breasts.

58. 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.

59. Contraindications
In late pregnancy
1. Grand multipara
2. Contracted pelvis
3. History of LSCS or hysterotomy
4. Malpresentations
During labour
1. All contraindications mentioned in pregnancy
2. Obstructed labour
3. Incoordinate uterine action
Anytime
1. Hypovolemic state, cardiac disease

60. Adverse effects
1. Hypertonic uterine activity
2. Fetal distress & fetal death
3. Uterine rupture
4. Hypotension
5. Neonatal jaundice
6. Water retention & water intoxication
Dosage & routes of administration
Controlled IV infusion ( 10 units of oxytocin in 1 L of
RL/5% Dextrose in water)
Nasal spray for milk let- down

61. Nursing considerations
1.Assess Patient I/O Ratio, Uterine
contractions, BP, pulse & respiration
2.Administer By IV infusion with appropriate
drop rate.
3.Evaluate patient Length & duration of
contractions and Notify physician of
contractions lasting over one minute or absence
of contractions.

62. ERGOT DERIVATIVES
Ergot alkaloids are either natural or semi
synthetic
Preparations
Ergometrine- 0.25mg/ 0.5mg
ampoules & 0.5-1mg tablets
Methergine - 0.2 mg ampoules & 0.5-1mg tablets
Syntometrine Ergometrine - 0.5 mg+ syntocinon
5.0 units ampoules.

63. 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
Mode of Action
Ergometrine acts directly on the myometrium. It
stimulates uterine contractions & decreases
bleeding.

64. Indications
Therapeutic
1.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. Organic cardiac disease
3. Severe Pre-eclampsia & Eclampsia

65. 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.
Dosage and routes of administration
• For active management of 3rdstage oflabour
-0.2mg(1 amp) to be given IM.
• For control of atonic PPH -1 amp slowly over
60 seconds, may be repeated after 2hrs.
• For excessive lochia and subinvolution-
1 Tablet(0.125mg)TDS for 3 days.

66. Nursing considerations
1.Assess patient BP, pulse, respiration, signs
of hemorrhage
2.Administer Orally/IM deep, assess for any
emergencies.
3. Evaluate for decreased blood loss.
4.Advise patient to report for increased blood
loss, abdominal cramps, headache, sweating,
nausea, vomiting/ dyspnea

67. PROSTAGLANDINS
Prostaglandins are synthesized from one of
the essential fatty acids, which is widely
distributed throughout the body. In the
female, these are identified in the menstrual
fluid, endometrium, decidua & amniotic
membrane.

68. 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
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.

69. Indications
1.For induction of abortion during 2ndtrimester &
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

70. Side effects
1. Headache
2. Dizziness
3. Hypertension
4. leg cramps
5. Joint swelling
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 F2alpha
5mg/ml Misoprostol 50mg given 4 hourly by oral, vaginal/
rectal route for induction of labour

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

72. ANTICONVULSANTS
MAGNESIUM SULPHATE
Preparation
• Inj- 1amp=2ml contains 1gm Mgso4.
• Tab-64mg
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

73. 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

75. Dosage & routes of administration
1.For control of seizures, 8 ml, (4gm) IV slowly in 3-4
mins, to be followed immediately by 10gm 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
2.4gm IV slowly over 10 min, followed by 2 gm/hr
and then 1gm/ hr in drip of 5% dextrose for tocolytic
effect

76. Nursing considerations
1.Assess patients Vital signs 15 min after IV dose.
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

77. 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.
9.Discontinue infusion if respirations are below
12/min, reflexes severely hypotonic, urine output
below 30ml/hr or in the event of mental confusion/
lethargy/ fetal distress.

78. ANALGESICS
valethamate bromide (epidosin)
Cervical spasmolytic (to treat pain associated with smooth muscle
spasm)
Preparation
Inj-1amp-8mg/ml
Action
Relieves smooth muscle pain, stiffness or spasm, thereby
improving muscle movement. It helps relieve pain due to periods
(menstrual pain), pain in labour which enables cervical dilatation.
Indication
1. Cervical dilatation in the first stage of labor.
2. Symptomatic relief of GI tract and ureteric colic.

79. Contraindications
1. Paralytic ileus
2. Myasthenia 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

80. Dosage and routes of administration
Inj-8mg deep IM. It may be repeated after 4
hours if necessary.
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.

81. Tramadol hydrochloride
Preparation
• Inj-1amp=50mg
• Tablet-50mg,100mg,200mg
Action
Bind to opioid receptor and inhibit reuptake
of norepinephrine and serotonin
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.

82. Contraindications
1. Breast feeding mothers
2. Hypersensitiviy
3. Hepatic impairment
4.Increased ICP
Adverse effects
5. Dizziness
6. Headache
7. Malaise
8. Hypertonia
9. Nausea or vomiting

83. Dosage and routes of administration
50 to 100mg IM 6hrly or asrequired.
Nursing considerations
1. Monitor patient CV and respiratory status.
2. Monitor patient at risk for seizure.
3. Monitor patient bowel and bladder function.

84. COAGULANTS
Vitamin K 1 (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

85. Action
It promotes the hepatic formation of the clotting factors
II,VII,IX and X.
Indications
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 urticaria may
occur.
3. Hyperbilirubinemia

86. t
o
Dosage and routes of administration
0.5mg IM within 1 hour of birth.
Nursing considerations
1.Document the given medication to the
newborn to prevent an accidental
doubling.
2.Observe for bleeding from cord usually
occurs on 2ndand 3rdday.
3. Observe for jaundice
4. Observe for local inflammation.

87. DRUGS USED
IN
PUERPERIUM

88. DRUGS GIVEN DURING
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.

89. Acetaminophen (paracetamol)
eptors.
Preparation
• Tablet-80mg,160mg,500mg
• Suppository-80mg,120mg
• Oral solution-16mg/ml, 80mg/ml
Action
Produce analgesia by inhibiting prostaglandins and other
substances that sensitizes pain receptors.
Indications
1. Mild to moderate pain
2. Fever

90. Contraindications
1. Liver disease
2. Hypersensitivity
Adverse effects
1. Neutropenia
2. Hemolytic anemia
3. Hypoglycemia
4. Urticaria

91. Dosage and routes of administration
500mg tablet thrice a day for 5 days
Nursing considerations
1.Advise the patient not to exceed the
prescribed dose.
2.Advise the patient that drug is only for
short term use and avoid taking without
prescription.
3.Advise patient to take tablet after meal to
prevent GI symptoms.

92. Lactation suppressants
(Bromocriptine mesylate)
Preparation
• Tablet-0.8mg, 2.5mg
Action
It blocks the release of a prolactin from the pituitary
gland.
Indications
1. Suppression of lactation
2. Pregnancy with prolactinoma
3.Infertility
4.Amenorrhoea

93. Adverse effects
1.Dizziness or lightheadedness especially when getting
up from lying position.
2. Confusion
3. Hallucinations
4. Hypertension
5. Seizures
6. Myocardial infarction
Dosage and routes of administration
• 2.5mg tablet orally once in a day.

94. Nursing considerations
1. Monitor patient for adverse reactions
2.Drug may lead to early post partum
conception . After menses resumes, test for
pregnancy every 4 weeks or as soon as period
is missed.
3.Assess orthostatic vital signs before initiation
of the therapy.
4.Instruct the patient to take drug with meal.

95. 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

96. 5.From 2ndtrimester transfer of drugs takes
place through the utero-placental
circulation due to lowered serum albumin
concentration which results from
haemodilution
6.As the albumin binding capacity of the
drugs is decreased, more free drug is
available for placental transfer

97. 7. The metabolism of the drug may be hampered
by the increase in plasma steroids, increased
utero-placental blood flow, increased placental
surface area & decreased thickness of placental
membrane. These are the additional causes for
increased drug transfer.
8. Fetotoxic/ teratogenic drugs are prescribed
only when the benefits out weigh the potential
risks.
9. Prior councelling is mandatory & minimum
therapeutic dosage is used for shortest possible
duration.

98. Maternal medications with
established teratogenic properties
& their effects
1.Cytotoxic drugs: multiple fetal malformations &
abortion
2.Androgenic steroids, hydroxy progesterone:
masculinization of the female offspring
3.Lithium: increased congenital malformations when
used in the 1st trimester, neonatal goitre, hypotonia &
cynosis
4.Diethyl stillbestrol: vaginal stenosis, cervical hoods
uterine hypoplasia in female foetuses.

99. drug Teratogenic effect
Cytotoxic drugs
-Diethyl stilbestrol
-androgenic steroids
-lithium
-anticonvulsants
Phenytoin
Valproate
-aspirin
multiple fetal malformations and abortion.
vaginal adenosis, cervical hoods, uterine hypoplasia of
the female offspring.
masculinization of the female offspring.
cardiovascular anomalies, neonatal goitre, hypotonia and
cyanosis.
benefits of treatment outweigh the risks to the fetus.
Polytherapy should be avoided.
Increase risk of neural tube defects, neonatal bleeding.
high doses in the last few weeks cause premature
closure of ductus arteriosus. Persistent pulmonary
hypertension and kernicterus in newborn.

100. drug Tertogenic effect
antimalarials
-corticosteroids
-aminoglycosides
-chloramphenicol
-tetracycline
-quinolones
-long acting
sulphonamides
-nitrofurantoin
chloroquine, quinine- no evidence of fetal toxicity in therapeutic
doses; benefits outweighs the risk.
high doses[ >10 mg prednisolone daily] may produce fetal and
neonatal adrenal suppression.
Auditory or vestibular damage.
Gray baby syndrome [peripheral vascular collapse].
Dental discolouration [yellowish] and deformity.
Inhibition of bony growth- should be avoided.
Arthropathy in animal studies
Neonatal hemolysis, jaundice and kernicterus.
Hemolysis in newborn, if used at term

101. drugs
-metronidazole
-ACE inhibitors
-vitamin K[large dose]
-all live viral vaccines
-narcotics
-anaesthetic agents
antidepressants
[imipramine]
-benzodiazapines
Teratogenic effect
o No evidence of fetal or neonatal toxicity,
high doses regimens should not be used.
o IUGR, fetal and neonatal renal failure.
o Hyperbilirubinemia and kernicterus.
o Potentially dangerous to the fetus.
o Depression of CNS-apnoea, bradycardia
and hypothermia.
acidosis,o Convulsion, bradycardia,
hypoxia, and hypertonia.
o cardiovascular abnormalities.
o Growth restriction, CNS dysfunction.

102. Maternal drug intake & breastfeeding
Maternal drug intake of nursing mothers have adverse
effects on lactation & also on the baby as it may be
present on the breast milk.
Transfer of drugs through breast milk depends on the
following factors:
•Chemical properties
•Molecular weight
•Degree of protein binding
•Ionic dissociation
•Lipid solubility
•Tissue pH
•Drug concentration
•Exposure time

103. 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

104. • Anticoagulants: hemorrhagic tendency
• Isoniazid: anti-DNA activity &
hepatotoxicity
• Antithyroid drugs & radioactive iodine:
hypothyroidism & goiter
• Diazepam, opiates, phenobarbitone:
sedation effect with poor sucking reflex.

105. USE OF SELECTED LIFE SAVING DRUGS IN
OBSTETRICAL EMERGENCIES APPROVED BY THE
MOHFW, INDIA
PRINCIPLES:
 The principle of safe medication management is essential for all nurses,
midwives and health agencies involved in the care of patient, antenatal
mothers, and clients.
 Before administering any drug and before implementing any therapy,
including those includes in standing orders, must use sound judgment in
determining whether the interventions are correct and appropriate.
 Based on these, in the non-availability of doctor, the nurse and midwives
can provide treatment to patient at home, hospital or in the community.

106. Objectives
• To maintain the continuity of the treatment of the patient.
• To protect the life of the patient.
• To create feeling of responsibility in the members of health
team.

107. DRUGS PERMITTED TO BE USED BY NURSE
MIDWIVES BY GOVT. OF INDIA IN ANTENATAL
PERIOD
Iron and folic acid tablets
Calcium tablets
Inj. TD
Inj. Magnesium Sulphate
Antenatal corticosteroids (DEXAMETHOSONE)
IV fluids for stabilization of the woman

108. DRUGS PERMITTED TO BE USED BY NURSE
MIDWIVES BY GOVT. OF INDIA IN INTRANATAL
PERIOD
Inj. Magnesium Sulphate
Inj. Oxytocin – 10 IU, IM
Tab. Misoprostol
Inj. Oxytocin – 20 IU in 500 ml RL, IV for PPH
IV administration of fluids for stabilization of
the woman

109. DRUGS PERMITTED TO BE USED BY NURSE MIDWIVES BY
GOVT. OF INDIA IN POSTNATAL PERIOD
Inj. Oxytocin – 10 IU, IM
Inj. Oxytocin – 20 IU in 500 ml RL, IV for PPH
Antibiotics for Puerperal sepsis
o Ampicillin 1 gm – 6 hourly, oral / Ampicillin 1 gm – 6
hourly, IV
o Metronidazole 400mg – 8 hourly, oral / Metronidazole
500mg – IV, 8 hourly
o Gentamycin 80mg, BD, IM

110. DRUGS PERMITTED TO BE USED BY NURSE MIDWIVES BY
GOVT. OF INDIA IN NEWBORN CARE
Inj. Vitamin-K
Immunization – Vaccines
Antibiotics for sepsis –
o Inj. Gentamycin – 5mg/Kg/dose, OD
o Inj. Amoxicillin – 25mg/kg/dose, TDS
Anti-Retroviral prophylaxis – Neviripine syrup for 6
weeks

111. S.N
o
Name of
Drug
Dosage Indication Contraindication Special considerations
and precautions
1 Inj.
Dexamethasone
6mg, IM, 12
hourly (4
Doses)
Preterm labour between 24-
34 weeks gestation to the
mother for fetal lung
maturity
1. True preterm labour
2. Following conditions that
lead to imminent delivery:
• Antepartum hemorrhage
• Preterm premature
rupture of membranes
• Severe pre-eclampsia
Frank chorioamnionitis
is an absolute
contraindication for
using antenatal
corticosteroids.
Following signs and
symptoms in the
mother suggests Frank
amnionitis:
1. History of fever and
lower abdominal pain
2. On examination: Foul
smelling vaginal
discharge, tachycardia,
and uterine tenderness
3. Fetal tachycardia
Should NOT be used if:
• Previous corticosteroid
course for fetal lung
maturity in current
pregnancy
• Maternal diabetes (i.e.,
gestational diabetes,
preexisting diabetes)
• Expected to deliver in <
12 hours (e.g., cervical
dilation ≥ 8 cm)
• Chorioamnionitis
• Multiple gestation
• Maternal chronic steroid
use during pregnancy

112. 4 Tab.
Misoprostol
Prophylaxis:
600 mcg Per
oral within 1
minute of
delivery
o As an alternate to
oxytocin in third
stage of labour for
uterine tonicity
o Post-partum
hemorrhage to
control bleeding
- Contraindications
include pelvic infection
or sepsis,
hemodynamic
instability or shock,
allergy to misoprostol,
known bleeding disord
er, and confirmed or
suspected ectopic or
molar pregnancy.
- Not to be used in
patients with previous
cesarean delivery or
major uterine surgery
- Use caution if
prophylactic dose
already given and
adverse effects present
or observed
- Use only in settings
where oxytocin not
available

113. CONCLUSION
• No drug should be administered to a woman during
pregnancy, labor and birth, unless the woman is fully
informed of the known risks.
• Uuncertainty regarding the effects of the drug on the
physiologic and neurologic development of the woman or her
baby leads to dangers.
• The drugs that are used daily in obstetric care have a huge
impact on the outcome of both mother and child.
Therefore, obstetric providers need
to have a very clear understanding of the mechanism of action,
doses and side-effects of the most commonly used drugs.

114. BIBLIOGRAPHY
2.D.C.Dutta’s “Textbooks of Obstetrics” 7th edition. New Central
Book Agency (P) Ltd page no.666.
3.A.K Debdas “Drug handbook in Obstetrics”,3rd edition.Jaypee
brothers and medical publishers private limited, New Delhi.
4.wolter Kluwer “Drug handbook”32 edition.lippincot William
&Wilkinson publisher ,London.
1. Annamma Jacob “ A Comprehensive Textbook of Midwifery &
Gynecological Nursing” 3rd edition. Jaypee Brothers Medical
Publishers (P) Ltd, page no. 604-619
www.medicine.tcd.ie/pharmacology_therapeutics/....Obs&
Gyn.pd