This document summarizes common drugs used in gynecology. It discusses prostaglandins and oxytocics like oxytocin, ergometrine, and prostaglandins which are used to induce labor, abortion and minimize postpartum bleeding. It also discusses mifepristone, myometrial relaxants, opioid analgesics like pethidine, magnesium sulfate and calcium gluconate. It provides details on indications, contraindications, side effects and dosing for these various drugs. The document also discusses contraception methods like combined oral contraceptives and progestogen-only contraceptives.

1. DRUGS USED IN
GYNAECOLOGY
BY COSAM BANDA
EN/EM/RN WITH BSCN CHN MAJOR

2. COMMON DRUGS
 Prostaglandins and Oxytocics
 Mifepristone
 Myometrial relaxants
 Opioid analgesics – Pethidine (Controlled drug)
 Magnesium Sulphate (MgSO4)
 Calcium gluconate

3. PROSTAGLANDINS AND
OXYTOCICS
• Prostaglandins and oxytocics are used to
induce abortion , induce and augment labour and
to minimise blood loss from the placental site. T

4. a.Oxytocin
b.Ergometrine
c.Prostaglandins

5. OXYTOCIN
• Oxytocin is a peptide hormone of the posterior pituitary gland.
• It stimulates the contractions of the pregnant uterus, which becomes
much more sensitive to it at term.
• Oxytocin is reflexly released from the pituitary following suckling
[and manual stimulation] and causes almost immediate contraction of
the myoepithelium of the breast
• it can be used to enhance milk ejection.

6. • The only other clinically important effect is on
the blood pressure which may fall if an overdose
is given.
• Synthetic oxytocin [Syntometrine®] is pure
and is not contaminated with vasopressin as is
the natural product, which is obsolete

7. INDICATIONS
1.induction for medical reasons or stimulation of
labour in hypotonic uterine inertia
2.Prevention of post partum haemorrhage, after
delivery of placenta.
3.Treatment of post partum haemorrhage.
4.Incomplete, inevitable or missed abortion

8. CONTRAINDICATIONS
 Hypertonic uterine contraction
 Mechanical obstruction to delivery
 Fetal distress
 Any condition where spontaneous labor or vaginal delivery is
inadvisable (e.g significant cephalopelvic disproportion,
malpresentation, placenta preavia, vasa preavia placental abruption,
cord presentation or prolapse, predisposition to uterine rupture as in
multiple pregnancy, polyhydramnios, grand multiparity and presence of
uterine scar from major sugery- including ceasarean section .
 Avoid prolonged administration in oxytocin-resistant uterine inertia,
severe pre-eclamptic toxeamia or severe cardiovascular disease.

9. SIDE EFFECTS
 Uterine spasm (may occur at low doses)
 Uterine hyper stimulation (with excessive doses- may cause fetal distress,
asphyxia and death, or may lead to hyper tonicity, titanic contractions, soft
tissue damage or uterine rupture
 Water intoxication and hyponaetreamia associated with high doses with
large infusion volumes of electrolyte- free fluid
 Nausea, vomiting, arrhythmias.
 Rashes and anaphylactic reactions( with dyspnoea, hypotension or shock)
• Placental abruption and amniotic fluid embolism also reported on overdose

10. DOSE
Induction of labour for medical reasons or stimulation of
labour in hypotonic
• Uterine inertia;
By intravenous infusion, initially 0.001 – 002units/minute
increased at intervals of at least 30 minutes until a maximum of
3 – 4 contractions occur every 10 minutes [0.012 units/minute
is often adequate]

11. recommendations
• Oxytocin should be used in standard dilutions
of 10 units/500ml [Infusion 3ml/hour delivers
0.001 unit/minute]
• for higher doses, 30 units/500ml [infusing
1ml/hour delivers 0.001 units/minute]

12. NURSING IMPLICATION
• careful monitoring of fetal heart rate and
uterine motility essential for dose titration( never
give intravenous bolus injection during labour);
• discontinue immediately in uterine
hyperactivity or fetal distress.

13. DOSE PER CONDITION
a)Prevention of post partum haemorrhage,after delivery of
placenta;
• By slow I.V injection, 5 units(if infusion used
for induction or enhancement of labour,
increase rate during third stage and for the
next few hours).

14. a)Treatment of post partum haemorrhage ;
• By slow IV injection, 5 – 10 units followed in severe
cases by IV infusion of
• 5 – 30 units in 500ml infusion at a rate sufficient to
control uterine atony
a)Incomplete, inevitable, or missed abortion, by slow IV Infusion,
0.02 – 0.04 units/minute or faster.
b)Ceasarean section, by slow iv injection immediately after delivery,
5units.

15. ERGOMETRINE
• Ergometrine and Oxytocin differ in their actions on the uterus.
• In moderate doses, oxytocin produces slow generalized contractions
with full relaxation in between;
• Ergometrine produces faster contractions superimposed on tonic
contractions.
• Thus, oxytocin is more suited in induction of labour and ergometrine
to the prevention and treatment of post partum haemorrhage.

16. INDICATION
 Prevention and treatment of haemorrhage

17. CONTRAINDICATION
 Induction of labour, first and second stage of labour
 Vascular disease
 Severe cardiac disease
 Impaired pulmonary function
 Severe hepatic and renal impairment,
 Sepsis
• Severe hypertension, eclampsia

18. SIDE EFFECTS
a.Nausea, vomiting, headache, dizziness,
tinnitus,
b. chest pain, Palpitation, Dyspnoea, bradycardia
c. Transient hypertension, vasoconstriction, stroke,
myocardial infarction and pulmonary oedema also
reported

19. DOSAGE
a. Orally – 0.5 – 1mg, when action begins in about 8 minutes and last
about 1 hour.
b. Intravenously – 100 – 500 micrograms [µg]; onset of action about 1
minute used as treatment of established post partumhaemorrhage.
c. Intramuscularly – 200 - 500µg;
action begins in about 6 minutes; the onset is speeded by mixing the
injection with hyaluronidase [1500], which enhances tissue permeation
and so speeds absorption.

20. PROSTAGLANDINS
• Prostaglandins that soften the uterine cervix
[by an action on collagen] and have a powerful
oxytocic effect include;
 Carboprost
 Dinoprostone
 Gemeprost

21. DINOPROSTONE
INDICATION
• They are used to induce labour and to
terminate pregnancy, including missed or
partial abortion and in the treatment of
hydatiform mole;

22. CONTRAINDICATIONS
• Active cardiac, pulmonary, renal or hepatic
disease
• Placenta praevia or unexplained vaginal
bleeding during pregnancy, ruptured
membranes
• Fetal malpresentation

23.  History of caesarian section or major uterine
surgery
 Untreated pelvic infection
 Fetal distress
 Grand multiparas and multiple pregnancy

24. SIDE EFFECTS
 Nausea, vomiting, diarrhea;
 Uterine hypertonus
 Severe uterine contractions
 Pulmonary or amniotic fluid embolism
 Abruption placenta
 Fetal distress
 Maternal hypertension
 Bronchospasm, etc

25. DOSE
• By vagina, cervical ripening and induction of labour at term,
 1 pessary inserted high into posterior fornix; if cervical ripening
insufficient, remove pessary 8 - 12 hours later and replace with a
second pessary [which should also be removed not more than 12
hours later]; max. 2 consecutive pessaries.
• By mouth, induction of labour,
 500 micrograms, followed by 0.5 – 1mg [max. 1.5mg] at hourly
intervals.

26. CARBOPROST
• Indications
 Postpartum haemorrhage due to uterine atony
in patients unresponsive to ergometrine and
oxytocin.

27. Contraindications
 Untreated pelvic infections
 Cardiac, renal, pulmonary, or hepatic disease.
Side effects
 Nausea, vomiting and diarrhea
 Hyperthermia and flushing,
 Bronchospasm

28. Dose
• By deep intramuscular injection 250
micrograms repeated if necessary at intervals of
11/2 hours.
• Total dose should not exceed 2mg [8 doses]

29. Misoprostol [Cytotec®]
– is given by mouth or by vaginal administration to
induce medical abortion [unlicensed indication];
intravaginal use ripens the cervix before surgical
abortion

30. Gemeprost
– is used intravaginally to soften the cervix
before operative procedures in the first trimester
of pregnancy and for abortion alone and in
combination with an anti progestogen
[Mifeprostone]

31. ANTIPROGESTOGENS
• MIFEPROSTONE
• Mifepristone, an antiprogestogen steroid used for the termination of
pregnancy.
• For medical termination it is given in combination with Gemeprost;
it is also used for softening and dilating the cervix before surgical
termination.
• Although the licensed dose of mifepristone is 600mg, there is
evidence that lower doses are effective for medical abortion in
pregnancy of up to 20 weeks gestation

32. CONTRAINDICATION
 Suspected ectopic pregnancy
 Chronic adrenal failure
 Long term corticosteroid therapy
 Haemorrhagic disorders and anticoagulant therapy
 smoking

33. DOSE
• Medical termination of intra uterine pregnancy up to 63
days of gestation,
 by mouth, Mifepristone 600mg as a single dose in presence
of doctor and observed for at least 2 hours followed 36 – 48
hours later [unless abortion already complete] by
Gemeprost 1mg by vagina and observed for at least 6 hours
with follow up visit 8 – 12 days later to verify complete
expulsion

34. MYOMETRIAL RELAXANT
• Β2 agonists relax uterine muscle and are used
in selected cases to inhibit premature delivery.
• Β2 agonists are indicated for the inhibition of
uncomplicated premature labour between 24 and
33 weeks of gestation and they may permit a
delay in delivery of at least 48 hours.

35. • Examples
 Atosiban [oxytocin receptor antagonist]
 Ritoride Hydrochloride
 TerbutalineSulphate
 Salbutamol

36. SALBUTAMOL
• INDICATION
a.Uncomplicated premature labour
b.Asthma

37. CONTRAINDICATIONS
a)Cardiac disease
b)Eclampsia and severe pre-eclampsia
c)Intra uterine fetal death
d)Ante partum haemorrhage [requires immediate
delivery]
e)Placenta praevia
f) Cord compression

38. SIDE EFFECTS
 Nausea, vomiting
 Tremor, hypokalemia, Tachycardia, Palpitations
and hypotension
 Uterine bleeding
 Pulmonary oedema
 Chest pain or tightness
• Liver function abnormalities

39. DOSE
• By intravenous infusion 10µg/min, rate increased
gradually according to response at 10 minute intervals
until contractions diminish the increase rate slowly until
contractions cease [Max rate 45µg/min; maintain rate for
1 hour after contractions have stopped, then gradually
reduce by 50% every 6 hours, then by mouth 4mg every 6
– 8 hours.

40. OPIOID ANALGESICS
• PETHIDINE
• INDICATION
 Moderate to severe pain
 Obstetric analgesia
 Peri-operative analgesia

41. CONTRAINDICATIONS
 Avoid in acute respiratory depression, acute
alcoholism and where risk of paralytic ileus;
 Also avoid in raised intracranial pressure or
head injury
 Avoid injection in phaechromocytoma (tumor
of the kidney)

42. SIDE EFFECTS
 Nausea and vomiting
 Constipation
 Drowsiness
 Large doses produce respiratory depression and hypotension
 difficult with micturition, ureteric or billiary spasm
 Dry mouth, sweating, headache, facial flushing, vertigo
 Decreased libido or potency
 hallucinations
 Dependence etc

43. DOSE
• Obstetric analgesia, by subcutaneous or intramuscular
injection, 50 – 100mg, repeated
• 1 – 3 hours later if necessary; max. 400mg in 24 hours.
• Postoperative pain, by subcutaneous or intramuscular
injection, 25 – 100mg, every 2-3 hours if necessary;
CHILD, by intramuscular injection, 0.5-2mg/kg

44. ANTIMALARIAL
• Intermittent Presumptive Treatment (IPT)
• In pregnancy give 3 doses (three tablets per dose) of
Sulphadoxine + Pyrimethamine (Fansidar®) during the
2nd and 3rd trimesters, at least one month apart.
• Fansidar should be avoided in the 1st trimester.
• NB. Quinine can be give for the treatment of malaria in
all the three trimesters

45. Pregnant Women and HIV
• HIV testing should be provided on an opt-out basis for all women presenting to
their first antenatal clinic visit. Women who test negative at the first visit should be
retested every 3 months at subsequent antenatal visits, when presenting in labour, and
during the breastfeeding period (e.g., at the 6 week postnatal visit)
 Diagnosing and treating pregnant women with ARV therapy to prevent transmitting
the virus to the foetus is a priority.
 Pregnant, HIV positive women will either be offered
o HAART to both prevent MTCT of HIV and treat maternal disease or
o short-term ARV therapy to prevent mother-to-child transmission only
•

46. • HAART for PMTCT of HIV and Maternal Treatment of HIV
 HAART provides maternal treatment for pregnant women who are
eligible
 HAART is also associated with the lowest rates of mother-to-child
transmission (1-2%)
• What Do You Do If a Woman Becomes Pregnant While On
HAART

47. CONTRACEPTION
• The process of contraception is achieved by
preventing ovulation [oestrogens] and also by
causing the thickening of cervical mucus
[progestogens] which then impedes entry of the
sperms into the uterus and interferes with
implantation.

48. • Contraceptives
a)Combined oral contraceptives
b)Progestogen-only contraceptives
c)Spermicidal contraceptives
d)Contraceptive devices

49. COMBINED ORAL
CONTRACEPTIVES
• Oral contraceptives containing oestrogen and a
progestogen are the most effective preparations
for general use.

50. Microgynon-30®
• [Levornogestrel 150µg/Ethinylestradiol 30 µg]

51. Advantages
a) Reliable and reversible
b) Reduced dysmenorrhoea and menorrhagia
c) Reduced incidence of premenstrual tension
d) Less symptomatic fibroids and functional ovaries cysts
e) Less benign breast disease
f) Reduced risk of ovarian and endometrial cancer
g) Reduced risk of pelvic inflammatory disease which
may be a risk with intra uterine device

52. • INDICATION
 Contraception
 Menstrual symptoms
•
• CONTRAINDICATIONS
 Pregnancy
 Personal history of venous of arterial thrombosis
 Heart disease associated with pulmonary hypertension or risk of embolus
 Migraine
 Liver disease
 Undiagnosed vaginal bleeding
 Breast feeding

53. SIDE EFFECTS
 Nausea, vomiting, headache
 Breast tenderness
 Changes in body weight
 Fluid retention
 Thrombosis
 Changes in libido
 Skin reactions
 Hypertension
 Impairment of liver function
• Reduced menstrual loss, ‘spotting’ in early cycles; Absence of withdrawal
bleeding

54. • DOSE
• Each tablet should be taken approximately
same time each day; if delayed by longer than 12
hours contraceptive protection may be lost.
• 1 tab od

55. PROGESTOGEN-ONLY CONTRACEPTIVES
a)Oral progestogen-only contraceptives
b)Parenteral
c)Intra uterine Progestogen-only contraceptive

56. ORAL PROGESTOGEN-ONLY
CONTRACEPTIVES
• Oral progestogen-only preparations may offer a suitable
alternative when oestrogens are contraindicated, but have a
higher failure rate than combined preparations.
• They are suitable for older women, for heavy smokers and
for those with hypertension, valvular heart disease, diabetes
mellitus and migraine.
• Menstrual irregularities [Oligomenorrhoea, menorrhagia]
are more common but tend to resolve on long term treatment

57. examples
• Norethisterone 350µg;
• Levornogestrel 30µg

58. • INDICATIONS
 Contraception
CONTRAINDICATION
 Pregnancy
 Undiagnosed vaginal bleeding
 Severe arterial disease
 Liver adenoma
 Porphyria
 After evacuation of hydatiform mole

59. SIDE EFFECTS
 Menstrual irregularities
 Nausea, vomiting
 Headache
 Dizziness
 Breast discomfort
 Depression
 Skin disorders
 Disturbance of appetite
 Weight changes
• Changes in libido

60. PARENTERAL PROGESTERON-
ONLY CONTRACEPTIVES
• Medroxyprogesterone acetate [Depoprovera®] is
a long acting progestogen given by intramuscular
injection;
• it is as effective as the combined oral preparations
but because of its prolonged action it should never
be given without full counseling backed by the
manufacturers approval leaflet.

61. • INTRA UTERINE PROGESTOGEN ONLY
DEVICE
• The progestogen-only intra uterine system,
releases levornogestrel directly into the uterine
cavity. It is licensed for use as a contraceptive
and for the treatment of primary menorrhagia

62. EMERGENCE
CONTRACEPTIVES
• Hormonal methods
• Hormonal methods for contraception involve the use of
either Levornogestrel or the combined preparation
containing ethinyloestradiol with Levornogestrel. Both are
effective if the first dose is taken within 72 hours [3 days]
of unprotected sex; taking the first dose as soon as
possible increases efficacy.

63. • Levornogestrel is taken as 1 tablet of 750
micrograms followed 12 hours later [and no
later than 16 hours] by a further tablet

64. • Advantages
 The levornogestrel-only emergence
contraceptive is more effective than the
combined hormonal emergence contraceptive.
 It has fewer side effects than the combined
hormonal emergence contraceptive

65. • The combined hormonal [Yuzpe] method involves taking 2 tablets,
each containing ethinylestradiol 50 micrograms and levornogestrel 250
micrograms, followed 12 hours later by a further 2 tablets.
• The combined method is not suitable for women with a history of
 thrombosis
 Active porphyria, or
• For those with focal migraine at the time of presentation

66. • SIDE EFFECTS
 Nausea, vomiting
 Headache
 Dizziness
 Breast discomfort, and
• Menstrual irregularities

67. ANTIBIOTICS
 Ampicillin
 Gentamycin
 Metronidazole
 BenzathinePenicillins
 Cloxacillin
 Amoxicillin
 Cefaloxycine
 Cotrimazole vaginal pessary
 Erythromycin
 Ciprofloxacin
 Tetracycline or doxicycline
 Tetracycline 1% eye ointment

68. • MISCELLANEOUS
 Lignocaine
 Adrenaline 1:1000
 Vitamin K
 Vitamin A
 Diazepam
 Ringers lactate
 Paracetamol
 Gentian violet

69.  Iron/Folic acid
 Mebendazole
 SulphadoxinePyrimethamine
 Niverapine
 Zidovudine
 Lamivudine
 Tetanus toxoid
 Normal saline
 Glucose
 Water for injection

70. HE WHO BELIEVES CAN DO IT,HE
DOES IT ALREADY IN HIS
MIND…SO YOU CAN DO IT!!!!!!!