UNIT-5

DRUGS USED FOR PREGNANT WOMEN

DURING ANTENATAL, LABOUR AND
POSTNATAL PERIOD
TETANUS PROPHYLAXIS
• Te t a n u s P r o p h y l a x i s d u r i n g
pregnancy is essential to protect
both the mother and the unborn
child.
COMPOSITION

• Tetanus Prophylaxis during pregnancy typically involves

administering the Tetanus toxoid vaccine.

• The vaccine can be given as part of Tdap (Tetanus,

Diptheria and Pertusis) vaccine.
ACTION

• The Tetanus toxoid vaccine stimulates

the mothers immune system to
produce antibodies.

• These antibodies are then passed on

the fetus, providing protection to the
newborn.
DOSE AND ROUTE
The first dose will be administered in the third trimester or around
the seventh month of pregnancy.

• The second dose of the vaccine will be administered after four

weeks from the first.

DOSE: 0.5ml.

• The vaccine is typically given intramuscularly (into a muscle),

often in the deltoid muscle of the upper arm.

• Tdap: 0.5ml -IM, 3 doses - 0,1,6 months duration

INDICATIONS:

• Tetanus prophylaxis during pregnancy is indicated to protect both the

mother and the newborn from tetanus infection.

CONTRAINDICATIONS:

• Contraindications may include a severe allergic reaction to a previous

dose of the vaccine or its components.
DRUG INTERACTIONS

• Tetanus toxoid vaccines generally do not have significant drug

interactions. However, it’s essential to inform healthcare providers about
any other vaccines or medications the pregnant women is taking.

SIDEEFFECTS:

• Common side effects are usually mild and include pain, swelling or
redness at the injection site. Some individuals may experience mild
fever,fatigue or headache.
ADVERSE EFFECTS:

• Severe adverse effects are extremely rare but can include

severe allergic reactions (anaphylaxis).

TOXICITY:

• There is no inherent toxicity associated with the tetanus toxoid

vaccine when administered according to standard protocols.
ROLE OF NURSE:

• Nurses play a crucial role in tetanus prophylaxis during

pregnancy by administering the vaccine, educating pregnant
women about its importance and monitoring for any adverse
reactions.

• They ensure that the vaccine is administered at the

appropriate time during pregnancy and that the mother and
newborn receive the necessary protection against tetanus.
IRON
COMPOSITION:
• Iron supplements during pregnancy typically contain
ferrous sulfate, ferrous gluconate or other iron salts.

ACTION:
• Iron is crucial during pregnancy to suport the increased
demand for hemoglobin and red blood cell production.
• Iron supplements prevent or treat iron deficiency anemia
in pregnant women.
DOSAGE AND ROUTE:

• The dosage and route of iron supplementation during pregnancy

can vary based on the severity of anemia and individual
patients needs.

• Common routes include oral (tablets or liquid).

Drug: Ferous Fumarate:
Dose:
• Each 100mg provides 33 mg of elemental iron.
• Tablets available in dose of 90mg, 200mg, 300mg, 325mg, 350mg.

Route:
Oral -30mg- OD
IV: 15-20mg depends on deficiency
INDICATIONS:
• Iron supplementation is indicated for pregnant women
and pregnant with iron-deficiency anemia, a common
condition during pregnancy due to increased blood
volume and the needs of the growing fetus.

CONTRAINDICATIONS:
• Contraindications may include a known allergy to iron
supplements or certain medical conditions like
hemochromatosis (excessive iron storage).
DRUG INTERACTIONS:
• Iron supplements can interact with other medications,
so it’s essential to inform healthcare providers about
any other drugs you’re taking to minimize interactions.

SIDE EFFECTS:
• Common side effects include gastrointestinal like
constipation, diarrhea or nausea.
• Iron supplements can also darken stool.
ADVERSE EFFECTS:
• Severe adverse effects are rare but can include severe
allergic reactions or iron toxicity if taken in excessive
amounts.

TOXICITY:
• Iron overdose can lead to Iron Poisoning, which can be
life-threatening.
• Its crucial to keep iron supplements out of reach of
children.
ROLE OF NURSE:

• Nurses play a role in educating pregnant women about

the importance of iron supplementation during
pregnancy.

• They monit or pregnant women f or si g n s o f i r o n

deficiency or iron overload and provide guidance on
managing common side effects.
VITAMIN-K
 Vitamin-K injection to newborns is commonly administered to
prevent a rare but serious bleeding disorder known as Vitamin-K
Deficiency Bleeding (VKDB).

COMPOSITION:

The injection typically contains phytomenadione, which is a

synthetic form of vitamin K1.
ACTION:

• Vitamin-K is essential for blood clotting. Newborns often

have low levels of Vitamin-K, which can put them at risk for
bleeding disorders.

• The injection helps ensure adequate levels of vitamin K for

normal blood clotting.
• DOSAGE: The standard dosage for newborns is usually 0.5 to 1
mg of Vitamin-K administered as a single intramuscular
injection.

• ROUTE: It is administered via intramuscular injection, often in

the thigh muscle.
INDICATIONS:
• The injection is indicated for all newborns to prevent
VKDB (Vitamin-K Deficiency Bleeding), as they are
born with insufficient vitamin K stores.

CONTRAINDICATIONS:
• There are few contraindications, but they may include
rare conditions where Vitamin-K metabolism is impaired
or if the baby is hypersensitive to the components of the
injection.
DRUG INTERACTION:
• There are no significant drug interactions associates
with vitamin K injections for newborns.

SIDE EFFECTS:
• Side effects are rarebut can include pain at the
injection site and very rarely, an allergic reaction.
ADVERSE EFFECTS:
• Adverse effects are also uncommon but may include skin
reactions or excessive bleeding at the injection site.

TOXICITY:
• Vi t a m i n K i s n o t t y p i c a l l y a s s o c i a t e d w i t h t o x i c i t y w h e n
administered as recommended.
• Excessive dosages can lead to condition called Vitamin-K
overdose, but this is extremely rare in newborns receiving
standard doses.
ROLE OF NURSE:

• Nurses play a crucial role in administration of Vitamin-K

injections to newborns.

• This includes verifying the prescription, explaining the

procedure to parents, ensuring proper injection technique,
monitoring for any immediate adverse reactions and
documenting the administration accurately.
OXYTOCIN

DR. BANDARI SRUJANA

ASSOCIATE PROFESSOR
• Oxytocin is a medication used in pregnancy for
various purposes, primarily to induce or augment
labor.
COMPOSTION:
• Oxytocin is a synthetic hormone that act like the natural
hormone oxytocin produced by the body.

ACTION:
• Oxytocin stimulates uterine contractions, helping to
initiate or strengthen labor.
• It also aids in the milk ejection reflex during
breastfeeding.
DOSE AND ROUTE:

• The dosage and route of administration of oxytocin can

vary widely depending on the specific medical
situation and the healthcare providers instructions.

DOSE:10UNITS/ML.
ROUTE: typically administered IV OR IM
INDICATIONS:

• Oxytocin is used to induce labor when it’s medically

necessary, such as in cases of post-term pregnancy or
certain medical conditions.

• It can also used to augment labor if contraindications

are not strong enough for progress.
CONTRAINDICATIONS:

• Contraindications are may include a history of uterine

surgery, certain medical conditions, fetal distress or
placental abnormalities.

• It should not be used in cases where vaginal delivery is

contraindicated.
DRUG INTERACTIONS:

• Oxytocin may interact with certain medications, so its

important to inform healthcare providers of all medications
being taken.
SIDE EFFECTS:

• Common side effects may include uterine hyperstimulation

(excessive contractions), nausea, vomiting and water retention.

• Maternal side effects can also include changes in blood pressure

and heart rate.
ADVERSE EFFECTS:
• Adverse effects can include uterine rupture, fetal
distress and postpartum hemorrhage if not used
carefully and monitored closely.

TOXICITY:
• Oxytocin can occur if the dosage is too high or if the
contractions become too frequent and intense.
• This can lead to oxygen deprivation for the fetus or
uterine rupture in the mother.
ROLE OF NURSE:
• Nurses play a critical role in the administration and monitoring of oxytocin
during labor.

• They are responsible for accurately preparing and administering the

medication as prescribed by the health care provider.

• Nurses closely monitor the mother’s vital signs, uterine contractions

and fetal heart rate during oxytocin administration.

• They also provide education and emotional support to the mother and
family throughout the labor process.
MISOPROSTOL
• Misoprostol is a meditation that is commonly used for
several medical purposes.

COMPOSITION:

• Misoprostol is a synthetic prostaglandin E1 (PGE1)

analogue.
ACTION:
Gastrointestinal protection:

• Misoprostol helps protect the stomach lining by reducing acid

production and increasing mucus production.

• This can prevent or treat ulcers caused by nonsteroidal anti-

inflammatory drugs (NSAIDs).

Cervical Ripening and Labor Induction:

In obstetrics, misoprostal can be used to include labor or ripen the

cervix.
DOSAGE AND ROUTE:

• Dosage and route of administration can vary depending

on the indication.
• For preventing NSAID-induced ulcers, its typically
taken orally in doses ranging from 200-800micrograms
per day, divided into 2-4 doses.
• For cervical ripening and labor induction, it’s often
administered intravaginally in specific doses under
medical supervision.
INDICATIONS:

• Prevention of NSAID - induced gastric ulcers.

• Cervical ripening and induction of labor (off-label use).
• Treatment of postpartum hemorrhage (off-label use).
CONTRAINDICATIONS:
Misoprostol should not be used in cases of:

• Allergy to misoprostol.
• Pregnancy (unless for labor induction under medical
supervision).
• History of uterine surgery or cesarean section scar (for
Cervical ripening).
• Severe cardiovascular, renal or hepatic disease.
DRUG INTERACTIONS:
• Misoprostol may interact with drugs like antacids,
magnesium-containing compounds and some
antidiarrheal medications, potentially reducing its
effectiveness.

SIDE EFFECTS:
• Common side effects include diarrhea, abdominal
pain, nausea and headache.
• These are usually mild and transient.
ADVERSE EFFECTS AND TOXICITY:

• In high doses, misoprostol can cause uterine

hyperstimulation, which can be dangerous for both
mother and fetus.

• Severe adverse effects are rare when used as

directed, but overdose or misuse can lead to
complications.
ROLE OF A NURSE:

Nurses play a crucial role in the administration and

monitoring of misoprostol. This includes:(MAP2C)

• Accurate medication administration.

• Monitoring for side effects and adverse reactions.

• Patient education on how to take the medication

properly.
• Providing information on potential risks and benefits.

• Collaborating with the healthcare team to ensure safe

and effective use, especially in obstetric settings.
METHYL PROSTAGLANDIN F2 ALPHA
• Methyl prostaglandin F2 alpha, commonly known as
carboprost tromethamine, is a medication used in
obstetrics and gynecology.

COMPOSITION:
• The active ingredient is Carboprost tromethamine.
• It may be formulated as an injection for intramuscular
administration.
ACTIONS:
• Carboprost tromethamine is a synthetic prostaglandin that acts
on the uterus to induce contractions.
• It is used to prevent or treat postpartum hemorrhage
(excessive bleeding after child birth).

DOSE AND ROUTE:

• 250mg in repeated dose at intervals of not less then
15minutes Dosage may vary depending on the specific indication
and patient condition.
• It is typically administered as an intramuscular injection.
INDICATIONS:
• Prevention and treatment of postpartum hemorrhage.
• I n d u c ti o n o f a b o r ti o n d u ri n g t h e s e c o n d tr i m e s te r o f
pregnancy.

CONTRAINDICATIONOS: (HAS)
• Hypersensitivity to carboprost or any of its components.
• Acute pelvic inflammatory disease.
• Severe hepatic, Renal or Pulmonary disease.
DRUG INTERACTIONS:
• There may be potential drug interactions with other
uterotonic agents or drugs that affect uterine
contractility.

SIDEEFFECTS:
• Common side effects include nausea, vomiting,
diarrhea, fever and chills.
• Uterine hypertonicity, which can lead to fetal distress.
ADVERSE EFFECTS:
• Adverse effects may include severe uterine hypertonicity,
uterine and cervical laceration.
• In rare cases, anaphylaxis or severe allergic reactions can
occur.

TOXICITY:
• Toxicity can manifest as excessive uterine contractions,
which may lead to uterine rupture and other severe
complications.
ROLE OF NURSE:

• Nurses play a crucial role in the administration of Carboprost

tromethamine.

• They should verify patient allergies, assess vital signs and

monitor uterine contractions during administration.

• Nurses should educate patients about potential side effects

and adverse reactions.
• Promptly report any signs of hypersensitivity or severe
adverse effects to the healthcare team.

• Ensure proper documentation of the medication

administration and its effects on the patient.
MAGNESIUM SULPHATE
COMPOSITION:

• Magnesium sulphate used during pregnancy is the same

chemical compound as magnesium sulfate in other
contexts.
• It consists of magnesium, sulfur and oxygen (MgSO4).
• In pregnancy, magnesium sulfate is primarily used as an
anticonvulsant to prevent or manage seizures in
conditions like preeclampsia and eclampsia.

• It works by relaxing smooth muscles and reducing

neuromuscular transmission.
DOSE AND ROUTE:

Common routes include Intravenous (IV) and

Intramuscular (IM) injections.
• The Intramuscular regimen is most commonly 4g IV
loading dose, immediately followed by 10g IM and
then by 5g IM every 4 hours in alternating buttocks.

• The Intravenous regimen is given as a 4g dose,

followed by a maintenance infusion of 1 to2 g/h.
INDICATION:

Magnesium sulphate is indicate during pregnancy for:

• Prevention and management of seizures in pre-

eclampsia and eclampsia.
• Tocolysis (to delay preterm labor) in certain cases.
CONTRAINDICATIONS:
Contraindications during pregnancy may include:

• Allergy or hypersensitivity to magnesium sulfate.

• Myasthenia gravis.
• Heart block or other cardiac conditions.
• Renal dysfunction
• Some Neuromuscular disorders.
DRUG INTERACTIONS:

• Healthcare providers should consider potential drug

interactions when administering magnesium sulfate
during pregnancy.

• It may interact with other medications used in pregnancy ,

so a thorough medication review is essential.
SIDE EFFECTS AND ADVERSE EFFECTS:

• Common side effects of magnesium sulfate during

pregnancy can include warmth, flushing and a feeling
of heaviness at the infection site.
• Adverse effects may include respiratory depression,
low blood pressure and rarely magnesium toxicity.
• Signs of magnesium toxicity should be closely
monitored, especially during prolonged use.
TOXICITY:

• Magnesium sulphate toxicity can be a concern, especially

if levels in the blood become too high.

• Signs of Magnesium toxicity include muscle weakness,

confusion and cardiac arrhythmias.

• Monitoring for these signs is crucial during

administration.
ROLE OF NURSE:

• Nurses have a critical role in the administration of

Magnesium sulphate during pregnancy.

• They closely monitor the patients vital signs, including

blood pressure, respiratory rate and fetal heart rate.

• They assess for signs of Magnesium toxicity and

promptly report any adverse reactions to the healthcare
team.
• Nurses educate pregnant patients about the importance
of compliance with the treatment regimen and inform
them about potential side effects.

• Ensuring that the medication is administered safely and

according to the prescribed dosage and route is a key
responsibility of nurses.
CALCIUM GLUCONATE
COMPOSITION:

• Calcium gluconate is a medication that contains calcium

in the form of glucose salt.

• It is available in various formulations including oral

tablets and Intravenous (IV) Solutions.
ACTIONS:

• Calcium gluconate is used to supplement calcium in the

body.

• Calcium is essential for various physiological functions,

including muscle contraction, nerve function and bone
health.
DOSAGE AND ROUTE:

• It can be taken orally as tables or administered intravenously .

• Tablet - 50mg.

• Injectable solution- 100mg/ml (10%)

INDICATIONS:

• Calcium gluconate is used to treat conditions characteized

by low blood calcium levels (hypocalcemia), such as in
cases of hypoparathyroidism, certain kidney disorder,
and acute management of hyperkalemia(elevated level
of potassium (K+) in the blood).
CONTRAINDICATIONS:

• Hypersensitivity to calcium gluconate or its components.

• Hypercalcemia (elevated blood calcium levels).

• Cardiac conditions like ventricular fibrillation

( abnormal heart rhythm) or digitalis toxicity (digoxin
poison).
DRUG INTERACTIONS:

Calcium gliconate may interact with certain medications,

such as:
• Tetracycline antibiotics: Calcium can interfere with their
absorption.
• Calcium channel blockers: Potential for increased risk
of side effects.
• Digoxin: Increased risk of toxicity when calcium levels
are elevated.
SIDE EFFECTS:

Common side effects of calcium gluconate may include:

• Nausea
• Vomiting
• Constipation
• Increased thirst
• Muscle weakness
ADVERSE EFFECTS AND TOXICITY:

• Excessive use of calcium gluconate can lead to

hypercalcemia, which can manifest as more severe
symptoms, including:
• Irregular heartbeats
• Confusion
• Coma
ROLE OF NURSE:

The nurse’s role in administering calcium gluconate

includes:

• Accurate dosage calculation and administration,

especially when given intravenously.

• Monitoring the patients vital signs and serum calcium

levels.
• Assessing for signs of hypersensitivity or adverse
effects.

• Providing patient education regarding medication use,

potential side effects and the important of compliance.

• Collaborating with the healthcare team to adjust the

dosage as needed.
ERGOMETRINE
• It is one of Ergot derivatives which act by stimulation of
Uterine activity.

ACTION:

As moderate doses of ergometrine cause contraction of

uterus as a whole i.e Fundus & Cervix with faster
contraction
DOSAGE:

Ergometrin is given Orally and parenterally.

• Orally- 0.5mg
• IM - 100-150 μg
• IV - 250-500 μg
INDICATION: CONTRAINDICATION:

v PPH-Post PartumHemorrhage. Ø Peripheral vascular diseases

Ø Heart disesae
v Post abortion.
Ø History of Hypertension

Ø Impaired hepatic or renal function

Ø Calcium deficiency
SIDE EFFECTS:

üNausea üChest pain

üVomiting üBradycardia
üAbdominal Pain üCardiac arrhythmias
üDiarrhea üDyspnea
üHeadache üRashes
üDizziness üShock
ADVERSE EFFECTS:

vItching and tingling of the skin

vRespiratory depression
vConfusion
vConvulsions
vComa
ROLE OF NURSE

The nurse’s role includes:

• Accurate dosage calculation and administration.

• Monitoring the patients vital signs.

• Observe & Asses for side effects and adverse effects.

• Provide patient education regarding medication use, potential side effects and the
important of compliance.

• Collaborating with the healthcare team to adjust the dosage as needed.

 REVISION

• TETANUS PROPHYLAXIS • METHYL PROSTAGLANDIN F2

• IRON ALPHA

• VITAMIN-K • MAGNESIUM SULPHATE

• OXYTOCIN • CALCIUM GLUCONATE

• MISOPROSTOL • ERGOMETRINE