Based on the BPH curriculum of TU and maternal health program of Nepal. All the drugs have not been discussed and remaining drugs will be discussed in subsequent classes

1. Drugs Used in
Maternal Health
For BPH 1st Year
Dr. Pravin Prasad
Resident 3rd Year
MD Clinical Pharmacology
Maharajgunj Medical Campus
18th June, 2017 (4th Ashar, 2074) Sunday

2. Maternal Health
Programmes in Nepal
Programmes Drugs/Medicines
Family Planning Hormonal Contraceptives
Antenatal Care Albendazole
Labour and
Delivery
Oxytocics
Postpartum Care Prevention of Post partum
Haemorrhage
Neonatal Care

3. Hormonal Contraceptions:
Types
Route Formulation
Oral • Compbined Pills
• Monphasic
• Phased
• Progestin-only pills
• Emergency pills
Injectables • Intramuscular (long acting
progestin only)
Implants • Subcutaenous
• Intra-uterine

4. Hormonal Contraception:
Mechanism of Action
Inhibition of
Gonadotrophin
release
Estrogen
decreases FSH
secretion
Progestin
decreases LH
pulse
Ovulation does
not occur

5. Hormonal Contraception:
Mechanism of Action
Thick cervical
mucous (p)
Hostile Endometrium:
Most important in case of
minipills and post coital pills
Uterine and
Tubal
Contractions
Postcoital pills may dislodge a just
implanted blastocyst or may interfere
with fertilization/implantation

6. Hormonal Contraception:
Indications
 Birth spacing/Family Planning
 Emergency Contraception
 Lowers risk of endometrial and ovarian
carcinoma (? Colorectal Ca)
 Reduced menstrual blood loss and
anaemia

7. Hormonal Contraception:
Indications
 Irregular menstrual cycles
 Premenstural Tensions, Dysmenorrhoea,
Menorrhagia
 Other Benefits:
Endometriosis & Pelvic Inflammatory
Disease
Fibrocystic breast disease & Ovarian
Cyst

8. Hormonal Contraception:
Adverse Effects
Serious Complications:
Leg vein Thrombosis and Pulmonary
Embolism (E)
Coronary and Cerebral Thrombosis
Rise in Blood Pressure (E+P)
Genital Carcinoma
Benign hepatoma
Gallstones (E)

9. Hormonal Contraception:
Adverse Effects
Non Serious Side Effects:
 (Frequent, during initial cycles)
Nausea, vomiting
Headache, migraine precipitated
Breakthrough bleeding or spotting (P)
Breast Discomfort

10. Hormonal Contraception:
Adverse Effects
Side Effects Appearing later:
 Weight gain, acne, increased body hair (older
P)
 Cholasma
 Pruritis vulvae
 Carbohydrate intolerance (older
formulations)
 Mood Swings, abdominal distentions (P)

11. Drugs Used in Antenatal
Care: Anti-helminthics
 Albendazole, Mebendazole
 Mechanism of Action:
Binds to β-tubulin of susceptible worms 
polymerization inhibited  intracellular
microtubules gradually lost  worm
immobilized and killed.
Blocks glucose uptake by parasite  glycogen
storage depleted  worm killed
Hatching of nematode eggs and their larvae
are also inhibited

12. Drugs Used in Antenatal
Care: Anti-helminthics
Uses:
 Ascariasis
 Hookworm
 Enterobius, Trichuris (400 mg single oral
dose; 3 day treatment for heavy
trichuriasis)
 Tapeworm and strongyloidosis

13. Drugs Used in Antenatal
Care: Anti-helminthics
Side Effects:
 Pregnancy Category C
 Well tolerated
 GI side effects, dizziness
 Headache, fever, alopecia, jaundice,
neutropenia on prolonged use.

14. Drugs Used For Induction and
Augmentation of Labour
 Posterior Pitutary Hormone: Oxytocin,
Desamino oxytocin
 Prostaglandins
 Ergot Alkaloids: Ergometrine,
Methylergometrine
 Miscellaneous: Ethacridine, Quinine
 *Mifepristone

15. Oxytocin
 Effects on Uterus:
Increases force and frequency of uterine
contraction
Response of uterus varies
 Effects on Breast:
Contracts myoepithelium of mammary
alveoli.

16. Oxytocin
 Cardiovascular System (CVS):
Higher Dose: brief fall in blood pressure,
reflex tachycardia, flushing
 Kidney:
ADH like action at high doses (pulmonary
edema at high doses of oxytocin with large
amounts of intravenous fluids)

17. Oxytocin
 Mechanism of Action:
Oxytocin receptors (GPCR)
On Activation:
Depolarization of muscle fibres and influx
of Ca++ ions
 Effective in near term pregnancy
 Increase Prostaglandin (PG) synthesis and
release by the endometrium

18. Oxytocin: Uses
 Induction of Labour (slow i.v. infusion 5IU in
500 ml glucose or NS; 10milli IU/mL: 0.2-2.0
mL/min)
 Uterine Inertia
 Postpartum Haemorrhage
 Breast Engorgement (inefficient milk ejection
reflex; intra-nasally)
 Oxytocin Challenge Test (risky and rarely
performed)

19. Oxytocin: Side effects
 Injudicious use: maternal and foetal
soft tissue injury, ruptured uterus,
foetal asphyxia/death
 Water intoxication

20. Prostaglandins
 Local Hormones
 Mechanism of Action:
Change in myometrial cell membrane
permeability and/or alteration of membrane
bound Ca++
Also sensitizes uterus to oxytocin
 Promotes myometrial contraction irrespective
of duration of gestation

21. Prostaglandins
 Misoprost
 Dinoprostone (PGE2): cervical
maturation/ripening; 5 times potent than and
less toxic than PGF2α; costly
 Dinoprost tromethammine(PGF2α):
myometrial contractility

22. Prostaglandins: Uses
 Induction of abortion: molar pregnancy, tubal
pregnancy
 Induction of labour
Poor pre-induction cervical score
 Acceleration of labour
 Management of atonic postpartum
haemorrhage
Refractive cases

23. Prostaglandins: Side Effects
 On systemic use:
Nausea, vomiting, diarrhoea, pyrexia,
bronchospasm
 Cervical laceration when used as an
abortifacient
 Tachy-systole of uterus during induction
 Meconium passage by foetus (Foetal Distress)
 Rupture of uterus: Rare
Should not be used in patients with previous
history of Caesarean Section

24. Ergot Alkalodis
 Ergometrine and Methylergometrine
 Uterus:
Partial agonistic action on 5-HT2 and
alpha adrenergic receptors
Force, frequency and duration of uterine
contraction increased
Dose dependent response

25. Ergot Alkalodis
 CVS:
Weak vasoconstrictors
Can raise blood pressure
 Gastrointestinal Tract:
Increased peristalsis

26. Ergot Alkalodis & Oxytocin
Similarity Disparity
Gravid, (near) term
and early puerperal
uterus more sensitive
Polarity of uterus not
maintained

27. Ergot Alkaloids: Uses
 Control and Prevent Postpartum
Haemorrhage
 After Caesarean Section/Instrumental
Delivery- to prevent uterine atony
 To ensure normal involution

28. Ergot Alkaloids: Side Effects
 Nausea, vomiting
 Rise in blood pressure
 Decrease milk secretion if used n higher dose
for many days postpartum
 Should be avoided in patients with:
Vascular disease
Presence of sepsis
Liver and Kidney Disease

29. Mifepristone
 Anti-progestational, anti-glucorticoid,
antiandrogenic activity
 Anti-fertility effects by various mechanisms
 Abortifacient effect:
Sensitizes myometrium to PG
Blocks decidualization  conceptus
dislodged
hCG production falls decreased
progesterone  cervix softens

30. Mifepristone: Uses
 Termination of Pregnancy
 Cervical ripening
 Post-coital contraceptive
 Induction of labour*
 Once-a-month contraceptive
 Cushing Syndrome