S. S.

AGRAWAL COLLEGE OF NURSING,

TRAINING COLLEGE AND RESEARCH
CENTRE, NAVSARI.

SUBJECT: OBSTETRIC AND GYNACOLOGICAL NURSING

TOPIC : DRUG BOOK

SUBMITTED TO SUBMITTED BY,

MS. KHYATI PATEL MS. BHANDARI SONAL

ASST.PROFESSOR F. Y M.SC NURSING

SS AGCON , NAVSARI SS AGCON, NAVSARI

SUBMITTED ON :
5/7/2024
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 .

DRUGS USED IN PREGNANCY,

LABOUR AND PUERPERIUM
FOLIC ACID

Preparation
•Injection- 10ml vial (5mg/ml with 1.5% benzyl alchoal)
•Tablet-0.4mg, 0.8mg, 1mg
Action
Stimulates normal erythropoiesis and nucleoprotein synthesis.
Indications
1.Megaloblastic or macrocytic anaemia during pregnancy to prevent fetal damage
2.Prevent fetal neural tube defect during pregnancy
Contraindications
1.untreated vitamin B12 deficiency.
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.
Nursing consideration
1.Patient with Hystory of 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.
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.
Indications
1. Iron deficiency
2. As a supplement during pregnancy
Contraindications
1. Primary haemolytic anaemia
2. Peptic ulcer disease
3. Ulcerative colitis
4. Repeated blood transfusions
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.

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

Calcium (calcium Gluconate)

Preparation :
each tablet contains 211mg or 10.6meq of elemental calcium
tablet- 250mg, 500mg
Action :
Replaces calcium and maintain calcium level
Indication :
supplement
Contraindications :
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.
Nursing considerations :
1.Advise patient to take oral calcium 1 or 1.5 hours after meals if Gl 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.
ANTI HYPERTENSIVE 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

Anti hypertensive drugs contraindicated in pregnancy

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

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 blockade.
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
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.
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
NIFEDIPINE

Preparation :
 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.
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
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.

METHYLDOPA

Preparations :
 Tablet-250mg,500mg
 Inj-50mg/ml
Action :
Inhibit the central vasomotor centre, decreasing sympathetic outflow to the heart, kidney and
peripheral vasculature.
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
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 he gains 2 or more pounds in a week

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
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
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
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. Ritrodrine hydrochloride

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.
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
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.

Ritodrine hydrochloride (vutopar)

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
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
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.
MAGNESIUM SULPHATE (MGSO4)
Use in obstetrics
Fetal neuroprotection
Tocolytics
Mechanism of action:
Cerebral vasodilatation thus reducing ischemia due to vasospasm.
Reduction in inflammatory cytokines and/or oxygen free radicals.
It inhibits platelet activation.
→ Peripheral vasodilatation, thus decreases systemic vascular resistance.
→ Dilates the orbital vessels, increases cardiac output, renal blood flow and utero placental
blood flow.
Contraindication:

❖ Impaired renal function.

→Heart block, myocardial damage.

❖ Myasthenia gravis.
→ Drug interaction: Nifedipine, anesthetic drugs.

Different Regimens of MgSO4* in Pre-eclampsia/Eclampsia

Combined IV/IM regimen
IV regimen

Combined IM and IV regimer

Loading dose: (total dose 9gm)
4g MgSO4 IV push over 20 min
And

2.5g (5ml of 50%) MgSO4 IM into each buttock

4g MgSO4 IV push over 20 mi

Add 8ml 50% MgSO4 (4g) in 100ml 0.9% saline or 5% glucose administer IV over 20min.
OR, if you have syringe-driver pump
Add 8ml 50% MgSO4 (4g) to 12ml 0.9% saline or 5% glicose and nfuse IV over 20 min at
0ml.h-1

2.5g ( 5ml of 50%)MGSO4 IM into each buttock

Combined IM and IV regimen

Maintenance dose:
 2.5 g (5ml-50%) MgSO4 IM 4 hourly using alternate buttocks.
 Continue for 24 hours after last convulsion or delivery.
For Recurrent Seizures
 Administer a further 2g MgSO4 IV.
 Draw 4ml (2g) of 50% MgSO4 into 10ml syringe and add 6ml 0.9% saline or 5%
glucose inject over 2min (5ml.min-1)
 If convulsions still continue, consider diazepam lorezapam 1mg (iv or im)
 Be aware of risk of respiratory depression.

Intravenous IV regimen
Loading Dose:
 Fill a paediatric infusion burette set with 22 ml 5% dextrose, Add 8 ml of 50 %
MgSO4 (4g).
 Administer the 20ml solution at 60ml/hr. o So the total dose will run over 30 min.
Maintenance Dose:
 Fill a paediatric infusion burette with 112ml 5% glucose, add 8ml 50% MgSO4 (4g)
making 120ml solution
 Administer at 30ml.h-1, the total will run over 4 hours (1g.h-1)
 Repeat the same hours after the last comvulsion or delivery

Intravenous IV regimen For Recurrent Seizures

 Administer a second loading dose or increase the infusion to 1.5 or 2g.h-1
10%MgSO4
Each ampoule: 1gm/10ml/over 5min
4 ampoule is 4 gm/40ml/over 20 min

1gm (10ml) over 5 min/hour Or

4gm (40ml) infusion pump at 10 ml/hour/4hour
Vasodilatation effect:
o Feeling of warmth
o Lethargy
o Facial flushing
o hypotension

Other side effects:

o Nausea, Vomiting, sweating
o Diminished reflexes
o Confusion
o Intense thirst

MgSO4 Toxicity
o Loss of patellar reflexes.
o Respiratory paralysis.
o Heart block.
o Collapse of circulatory system
o Death

Monitoring of patients on MgsO4 narrow therapeutic index (4-7mE

3 R parameters
o Respiratory rate should be 16 cycle per min or more
o 14-20 respirations in 1 minute
o 7 respirations in 30 seconds
Monitoring of patients on MgsO4
o Reflex of deep tendon should be present prior to initiating therapy.
o Renal output during treatment should be at least 30 ml/hr half the dose of the mag
should be given if less than 100m/4 hours.
MgSO4 Toxicity Antidote
o Calcium gluconate: 1g (10ml of 10% IV over 10 minutes. Repeat doses may be
necessary).
o Calcium chloride can also be used 500 mg of 10% calcium chloride IV given over 5-
10 minutes.
 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

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
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.
Contraindications
In late pregnancy
1. Grand multipara
2. Contracted pelvis
3. History of LSCS or hysterectomy
4. Malpresentation
During labour
1. All contraindications mentioned in pregnancy 2. Obstructed labour
3. Incoordinate uterine action
Anytime
1. Hypovolemic state, cardiac disease
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 ofRL/5% Dextrose in water)
 Nasal spray for milk let- down
Nursing considerations
1.Assess Patient I/O Ratio, Uterine contraction, BP, pulse & respiration
2.Administer By IV infusion After having crash cart available in the ward
3.Evaluate patient Length & duration of contractions and Notify physician of
contractions lasting over one minute or absence
of contractions.

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.
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.
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
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 3rd stage of labour -0.2mg(iamp) to be given IM.
For control of atonic PPH -1amp slowly over 60 seconds, may be repeated after 2hrs.
For excessive lochia and subinvolution-1 Tablet(0.125mg)TDS for 3 days.
Nursing considerations :
1.Assess patient BP, pulse, respiration, signs of hemorrhage
2.Administer Orally/IM deep, have emergency cart readily available
3. Evaluate for decrease blood loss
4.Advised patient to report for increased blood loss, abdominal cramps, headache, sweating,
nausea, vomiting/ dyspnea

PROSTAGLANDINS

Prostaglandins are synthesized from one of the essential fatty acids, archidonic acid, which is
widely distributed throughout the body. In the female, these are identified in the menstrual
fluid, endometrium, decidua & amniotic membrane.
vaginal insert
Сontains:
10 mg Dinoprostone in 241 mg hydrogel polymer
Misoprostol Tablets 100 mcg Misoprost-100
Misoprostol Tablets 200 mcg Misoprost-200
Misoprostol Tablets 25 mcg Misoprost-25
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.
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
Side effects
1. Headache
2. Dizziness
3. Hypertension
4. leg cramps
5. Joint swelling

Dosage & routes of administration

o Tablets: containing 0.5 mg prostin E2
o Prepidi Gel
o Vaginal suppository: containing 20 mg PGE2 or 50 mg Forz alpha
o Vaginal pessary: 3mg PGE2
o Injectable ampoules/vials of prostinE2
o 1 mg/ml prostin F2 alpha
o 5mg/ml Misoprostol 50mg given 4 hourly by oral, vaginal/ rectal route for induction
of labour
Nursing considerations :
1.Assess patient RR, rhythm & depth, vaginal discharge, itching/ irritation
2.Administer Antiemetic/ antidiarrheal preparations prior to giving 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.Advised patient to remain supine for 10-15 minutes after vaginal insertion.
valethamate bromide (epidosin)
Cervical spasmolytic

Preparation :
Inj-1amp-8mg/ml
Action :
VALETHAMATE BROMIDE INJECTION Epidosin
It is both central and peripheral antimuscarininc agent, which is a competitive inhibitor of
acetylcholine at the muscarinic receptor.
Indication:
1. Cervical dilatation in the first stage of labor.
2. Symptomatic relief of GI tract and ureteric colic.
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
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.
COAGULANT

Vitamin K(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
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 urticarial may occur.
3. Hyperbilirubinemia
Dosage and routes of administration :
0.5mg IM within 1 hour of birth.
Nursing considerations
1.Document the giving of the medication newborn to prevent an accidental doubling.
2.Observe for bleeding usually occurs on 2nd and 3rd day.
3. Observe for jaundice
4. Observe for local inflammation.

Tranexamic Acid

Brand name : Cyklokapron Lysteda

Generic Name :Tranexamic Acid

 Tranexamic acid is a synthetic derivative of lysine used as an antifibrinolytic in the

treatment and prevention of major bleeding. It possesses a similar mechanism of
action to aminocaproic acid but is approximately 10-fold more potent.6
 It was first patented in 19572 and received its initial US approval in 1986.
 Tranexamic acid is an antifibrinolytic that competitively inhibits the activation of
plasminogen to plasmin. At much higher concentrations it behaves as a
noncompetitive inhibitor of plasmin similar to aminocaproic acid, a similar
antifibrinolytic which is 10-fold less potent.

INDICATION
 Taken orally ,tranexamic acid is indicated for the treatment of hereditary
angioedema
 Cyclc heavy menstrual bleeding in premenopausal females and other instance of
significant bleeding in the context of hyperfibrinolysis
 Given intravenously , tranexamic acid is indicated for short term use (2-8days) in
patients with haemophilia to prevent or reduce bleeding following tooth
extaction4
CONTRAINDICATION
 In patients with subarachnoid hemorrhage, due to risk of cerebral edema and
cerebral infarction .
 In patients with active intravascular clotting .
 In patients with severe hypersensitivity reactions to tranexamic acid or any of the
ingredients
 It contraindicate in patient receiving thrombin due to increased risk of theombotic
complication

Dosage and routes of administration

3-4gm/day in thre divide doses for upto 4 or 5 days per cycle in menorrhagia.
0.5-1gm i.v during surgery or 0.5-2.5gm by i.v infusion each time as required.

mechanism of action
Tranexamic acid competitively and reversibly inhibits the activation of plasminogen via
binding at several distinct sites , including four or five low affinity sites and one high affinity
site , the latter of which is involved in its binding to fibrin . The biding of plasminogen to
fibrin induces fibrinolysis by occupying yhe necessary binding sites tranexamic acid prevent
this dissolution of fibrin , thereby stabilizing the clot and preventing haemorrhage.
toxicity

Reperted symptoms of tranexamic acid overdose include severe gastrointestinal symptoms ,

hypertension , thromboembolism visual impairment, convulsion , mental status changes and
rash

Nursing consideration

 Measurement of quatitative blood loss is essential for more accurate identification and
management of PPH.
 Administration of tranexamic acid is considered when PPH is not responsive to
uterotonic agents.
 Perinatal nurses must br familiar with the pharmacologic principles of TXA
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
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.
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.
CLOMIPHEN

Clomiphene is an FDA- approved selective estrogen receptor modulator indicated to treat

anovulatory or oligo-oulatory infertility to induce ovulation for patients desiring to
concevive.

Clomifene, also known as clomiphene, is a medication used to treat infertility in women who
do not ovulate, including those with polycystic ovary syndrome. It is taken by mouth.
Common side effects include pelvic pain and hot flashes.
Other names: Clomiphene; Chloramifene; Chloramiphene;

Routes AND DOSES of administration: By mouth

Dose for normal women 50-100mg/day
Less sensitivity upto 250mg/day
Extremely sensitive 5mg/day

Mechanism of action
By binding to the estrogen receptors, clomiphene blocks the negative feedback effect of
estrogens on the central nervous system and this leads to an increased secretion of GnRH and
gonadotrophins from the hypothalamus and the pituitary, respectively.

Indication
Clomiphene is used to induce ovulation (egg production) in women who do not produce ova
(eggs) but wish to become pregnant (infertility). Clomiphene is in a class of medications
called ovulatory stimulants. It works similarly to estrogen, a female hormone that causes eggs
to develop in the ovaries and be released.
Contraindication
 Hypersensitivity to clomiphene citrate or components of the formulation.
 Pregnancy.
 Breastfeeding.
 History of hepatic impairment.
 Hepatic disease.
 Abnormal uterine bleeding.
 Uncontrolled adrenal dysfunction.
 Non-PCOS-related ovarian cyst.

Side Effect
 Increase in the size of the ovaries
 Hot flushes
 Stomach discomfort , distention , bloating ,nausea,and vomiting
 Headche
 Abnormal vaginal bleeding , including spotting
 Vision problems

Nursing Consideration
 Screen patients for contraindications and potential risks associated with clomiphene
use.
 Implement clomiphene therapy according to established guidelines and protocols for
infertility management. Implement follow-up care and monitoring to ensure
continuity and successful outcomes in clomiphene therapy for infertility.
ANTI –D

Anti D is a medicine given by intramuscular injection that is used to prevent the

immunological condition known as Rh diseases.
The medicine is a solution of IgG Anti D antibiotic that out any fetal Rh D positive
erythrocyte which have entered he maternal blood stream from fetal circulation before the
maternal immune system can react to them.
Generic name: Anti D
Trade name: Rho GAM
Rho Phyloc
Win RhoSoF
Available Forms : Injection (im) -300mcg vial
50mcg vial
Injection(IV)-120mcg,300mcg,500mcg,1000mcg,3000mcg
Indication and dosage

 Rh exposure after abortion , miscarriage ,ectopic oregnancy or child birth.

 Blood bank determines fetal packed RBC volume entering patients blood one vial
1gm is given IM.
 To prevent Rh antibody formation after abortion or miscarriage.
 Consult transussion unit one 1GIM micro dose vial IM

Contraindication
 Contraindicated in Rho(D) positive or D positive patient and in the dose previously
immunized to Rho (D) blood factor.
 Patient anaphylactic or severe systemic reaction to human globulin.
 Use extreme caution when giving drug to patient with immunoglobulin A deficiency.
Mechanism of Action
Mechanism of action not completely known.
Suppress action of antibody response and formation of Anti D anti bodies in Rh-D negative.D
negative person expose to Rh negative.D negative person expose to Rh positive blood
.Rho(D) immunologlobulin IV may block platelet destruction in Rh (D) antigen positive
adults.

Nursing Consideration
 Patient with immunoglobulin A deficiency may develop immunoglobulin A
antibodies and have anaphylactic reaction prescribe must high benefit of treatment
against risk of hypersensitivity reaction before giving.
 Obtain history of allergies and reaction to immunization keep epinephrine 1:1000
ready to treat anaphylaxis.
 Immediately after delivery send a sample of neonates cord blood to laboratotry for
testing and cross matching confirm mother is Rho 9D) or D positive.
 This immune serum provide passive fetal blood during pregnancy and prevent
formation of mayernal antibody which would indanger future.
 Poatpan volination with live virus vaccine for 3 month after administration or Rho(D)
Ig.
BETAMETASON

Betamethasone is a corticosteroid that is available as a pill, by injection, and as an ointment,

cream, lotion, gel, or aerosol (spray) for the skin, and a foam for the scalp. When given by
injection, anti-inflammatory effects begin in around two hours and last for seven days.
Indication
Administration of betamethasone may be considered in pregnant women between 34 0/7
weeks and 36 6/7 weeks of gestation who are at risk of preterm birth within 7 days, and who
have not received a previous course of antenatal corticosteroids.
contraindication
 Taking betamethasone might affect your baby's growth. You may need extra scans
later on in your pregnancy to check that your baby is growing OK. If they're not well
treated, inflammatory conditions can affect your baby, causing premature birth and
growth problems.
 Systemic fungal infection.
 Hypersensitivity to betamethasone.
 Traumatic brain injury (high doses)
 Untreated serious infections.
 Administration of live, attenuated vaccines is contraindicated in patients receiving
immunosuppressive doses of corticosteroids.

Action
betamethasone is that it can help speed up lung development in preterm babies.
Betamethasone causes the release of surfactant, a substance that lubricates the lungs so that
they do not stick together when the infant breathes.
Route and Doses of Administration
4 to 20mg betamethasone (1 to 5ml) administered by slow intravenous injection over half to
one minute. This dose can be repeated three or four times in 24 hours ...

Adverse Efect
 Research has found that when given late in pregnancy and in small doses, the side
effects of betamethasone are minimal (1, 2, 8). Women at risk of delivering
prematurely used to be given multiple courses of steroids, but this was associated
with lower birth weights and smaller heads.
 Weight gain. Betamethasone can make you hungrier and retain water, so if you
take it for more than a few weeks it's likely that you'll put on weight. ...
 Indigestion. Take betamethasone tablets with food to reduce the chances of
stomach problems. ...
 Problems sleeping. ...
 Feeling restless. ...
 Sweating a lot.

Nuersing Consideration
Assess involved systems before and periodically during therapy. Assess patient for signs of
adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia,
lethargy, confusion, restlessness) before and periodically during therapy. Monitor intake and
output ratios and daily weights.
CONCLUSION
 No drug should be administered to a woman during pregnancy, labour and birth,
unless the woman is informed of the known risks and the relevant area uncertainty
regarding the effects of the drug on the physiologic and neurologic development of
the woman or her baby
 The drugs that are used daily in obstetric can 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.
BIBLIOGRAPHY
 Annamma Jacob “A Comprehensive Textbook of Midwifery & Gynecological
Nursing" 3 dedition. Jaypee Brothers Medical Publishers (P) Ltd
page no. 604-619
 D.C.Dutta's "Textbooks of Obstetrics" 7tedition. New Central Book Agency (P) Ltd
page no.666.
 A.K Debdas "Drug handbook in Obstetrics",3rd edition.Jaypee brothers and medical
publishers private limited, New Delhi.
 wolter Kluwer "Drug handbook"32 edition.lippincot William &Wilkinson publisher,
London.
 www.medicine.tcd.ie/pharmacology therapeutics/....Obs & Gyn.pd