Drugs Used During Labor and Delivery

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Prepared by: Ilona Rosabel G. Bitalac BSN 412

€ An

intravenous line is usually inserted into the woman's arm during labor in a hospital. This line is used to give the woman fluids to prevent dehydration and, if needed, to give drugs.

The aim of medication in preterm labor is to prevent delivery for as long as possible, with a focus on holding off delivery for at least 24 hours to allow time for lung-strengthening steroids to take effect on the baby. Depending on the pregnancy, the patient and the progression of the preterm labor, the following medications may be used: € Terbutaline: Used most commonly to treat asthma, terbutaline is thought to relax the muscles of the uterus.
€

€ While

most people think of drugs and pregnancy only in the context of pain relief, Dr. Blaskiewicz points out that there are other situations during pregnancy when a woman may be put on medication. Below is a list of some conditions that may require the use of drugs and what a doctor may prescribe:

This is estimated to affect up to 2 percent of pregnant women. Medications that can be prescribed include the following: € Zofran: This is an antiemetic that is effective against vomiting and nausea. Although it's a newer drug, preliminary studies indicate that it causes no harm to either Mother or Baby.
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Name of Drug Generic: Ondansetron hydrochloride Classification: Antiemetic Brand Name: Zofran

Indication Prophylaxis and prevention of nausea and vomiting

Contraindication Adverse Effect ‡Use with caution during lactation. ‡Under 3 years of age ‡Diarrhea ‡Abdominal pain ‡Malaise ‡Chest pain ‡Fatigue ‡Agitation ‡Blurred vision

Nursing Consideration A- document indication for therapy - assess for dehaydration P -report any rash/ diarrhea IMonitor vital signs stricly E-Prophylaxis and prevention of nausea and vomiting

Name of Drug Generic: Terbutaline sulfate Classification: Sympathomim etic direct acting Brand Name: Bricanyl

Indication relax the muscles of the uterus. Used for preterm labor

Contraindication Adverse Effect During lactation ‡Wheezing ‡Flushing ‡Sweating ‡Bad taste ‡CNS stimulation ‡Muscle cramps

Nursing Consideration ADocument type, onset, characteristics of symptoms PNotify provider immediately if labor resumes IIncrease fluid intake to help liquefy secretions Take medication with meals EInhibition of premature labor

Name of Drug Generic: Nifedipine Classification: Calcium channel blocker Brand Name: Procardia

Indication PID Premature labor

Contraindication Adverse Effect Hypersensitivity and lactation ‡Peripheral and pulmonary edema ‡Hypotension ‡Palpitations ‡Nausea ‡Constipation ‡Depresion ‡insomia

Nursing Consideration ADocument indication for therapy Note any pulmonary edema PMay take with or without food INote any hypotensive response Maintain fluid intake of 2-3L EDecrease BP Prevent premature labor

€ Indomethacin: Given

as a suppository in the short term. Delays premature labor by reducing uterine contractions through inhibition of prostaglandins. sulfate: Used to treat preeclampsia, eclampsia and preterm labor

€ Magnesium

Name of Drug Generic: Indomethacin

Indication

Contraindication Adverse Effect GI lesions Rectal bleeding Defects of coagulation ‡Parkinsonism ‡Epilepsy problems ‡Psychiatric problems

Nursing Consideration ANote disease onset, surgery and previous treatments PStore in amber colored containers ITake with foods or milk Withhold drug and report lack of response Record weight EDecrease pain and inflammation Reduce uterine contractions

. Delays premature labor by Classification: reducing NSAID uterine contractions Brand Name: through Indocin inhibition of prostaglandin s.

Name of Drug Generic: Magnesium sulfate

Indication For eclampsia

Contraindication Adverse Effect Heart block/ MI Patients with renal disease ‡Depression ‡Flushing ‡Hypotension ‡Sweating ‡Muscle paralysis ‡hypocalemia

Nursing Consideration AEvaluate cardiac status and ECG PContinually asses FHT intensity and contraction. IAdjust dose for CNS depressants Do not administer for 2 hr preceding delivery ETreatment of eclampsia and inhibits premature labor

Inhibits Classification: premature Anticonvulsan labor t, laxative, saline

€ : This

is often done for a variety of medical reasons and rarely just for convenience. A patient who is being induced will be watched carefully for rare side effects that are possible with the following medications:

€ Both

are administered as vaginal suppositories to ripen the cervix prior to delivery. This is the first step in preparing the cervix to respond to contractions. Cytotec, while very effective, has been implicated in some uterine ruptures and should not be used under certain circumstances.

Name of Drug Generic: Misoprostol Classification: Prostaglandin Brand name: Cytotec

Indication

Contraindication Adverse Effect ‡Diarrhea ‡N & V ‡Spotting ‡Vaginal bleeding ‡Headache ‡Flatus ‡contipation

Nursing Consideration ADocument any ulcer disease PDo not share medications IAvoid caffeine alcohol Report any abnormal bleeding E-Produce cervical ripening and labor induction

Produce Allergy to cervical prostaglandin ripening and lactation labor induction (used Po and vaginally)

€ : The

synthetic form of oxytocin, which is a natural hormone produced by a woman's body, Pitocin is used to start or improve contractions

Name of Drug Generic: Oxytocin Classification: Oxytocic drug Brand name: Pitocin

Indication Induction or stimulation of labor at term

Contraindication Adverse Effect Hypersensitivity to drug ‡N & V ‡Cardiac arrhytmia ‡Pelvic hematoma ‡Tachycardia ‡Edema ‡Anxiety ‡cyanosis

Nursing Consideration ADetermine fetal maturity PProvide continous observation. IRemain with the client during the induction Assess for water intoxication EInduction of labor with effective uterine contractions.

€ By

far the most common use of all drugs in active labor are for pain relief. Dr. Samuel Hughes, professor of clinical anesthesia and peri-operative says today's focus is on finding a balance between providing effective pain relief and allowing the mother to actively engage in the process.

€ Making

birth enjoyable (or at least bearable!) is the point of pain relief. These are some of the medications anesthesiologists and nurse anesthetists use to help patients in labor: € Narcotics: Marketed under various names, narcotics are used early in labor to take the edge off pain. They're generally administered by injection or intravenously. The drawbacks are that they do cross the placenta and should not be given if birth is imminent or if labor is progressing quickly.

€ Sedatives: Given

to ease anxiety, these are usually injected. They do not provide pain relief and are not commonly used unless the patient is in very early labor. € Nitrous oxide: This is used frequently in the United Kingdom, less so in the United States, mostly for reasons having to do with ventilation issues. This is an inhaled gas that can ease pain early in labor.

€ : Technically, these

are not medications, but they're important delivery methods for reg ional pain medications. Dilute local anesthetics and opiates are the most common drugs given this way. With a spinal block, the medication is given only once, by injection into the spinal fluid. This gives immediate relief from pain, but it can wear off before labor is done.

€ With

an epidural, the doctor has greater control over long-term pain relief and a greater variety of drug combinations and dosages. Sometimes both techniques are used in combination to provide both immediate and long-term pain relief. This combination is part of a trend to tailor analgesics to provide pain relief while maximizing the mother's mobility. Either of these techniques can be used in case of a Cesarean section.

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numbs the vagina and the tissues around its opening. Commonly, this area is numbed by injecting a local anesthetic through the wall of the vagina into the area around the nerve that supplies sensation to the lower genital area (pudendal nerve). This procedure, called a pudendal block, is used only late in the second stage of labor, when the baby's head is about to emerge from the vagina.

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