Drugs used in pregnancy, labour and puerperium

DRUGS USED IN PREGNANCY,
LABOUR AND PUERPERIUM
D.Padmapriya
Tutor
SAVEETHA CON

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
List of drugs used in pregnancy are:-
• Folic acid
• Iron
• Calcium
• Anti -hypertensive drugs
• Diuretics

FOLIC ACID
Preparation
• Injection- 10ml vial (5mg/ml with 1.5% benzyl
alchoal)
• Tablet- 0.4mg , o.8mg , 1mg
Action
Stimulates normal erythropoiesis and
nucleoprotein synthesis.

Indications
1. Megaloblastic or macrocytic anemia
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 H/O fetal 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 anemia
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

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 citrate)
Preparation
each tablet contains 211mg or 10.6meq of
elemental calcium
tablet- 250mg, 500mg
Action
Replaces calcium and maintain calcium level
Indication
supplement

containdications
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

1.Advise patient to take oral calcium 1 or
1.5 hours after meals if GI 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.

ANTIHYPERTENSIVE 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 2oml vial
Tablets- 100mg,2oomg ,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
4. Headache
5. Vertigo
50mg or 100mg tablet OD orally
20mg/20ml Inj IV bolus wait for 10min if no response then
give 40mg slow bolus.

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
Preparations
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.
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

 250mg BD or TDS max 2g daily titrated by BP
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

 25mg tablet BD and if necessary may increase to
50mg BD
 5mg diluted in 10ml of NS slow IV at 15-20minutes
interval.
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

DIURETICS
Diuretics are used in the following conditions
during pregnancy:
1. PIH with massive edema
2. Eclampsia with pulmonary edema
3. Severe anemia in pregnancy with heart failure
4. Prior to blood transfusion in severe anemia
5. As an adjunct to certain antihypertensive
drugs.

FUROSEMIDE (LASIX)
Preparation
 Inj-10mg/ml
 Tablets-20mg,40mg,80mg,500mg
Action
Inhibits sodium and chloride reabsorption at proximal
and distal tubules and loop of Henle.
Indications
1. Acute pulmonary edema
2. Edema
3. Hypertension

Contraindications
1. Anuria
2. Hepatic cirrhosis
3. Allergic to sulfonamides
Adverse effects
1. Maternal: Weakness, fatigue, muscle cramps, hypokalemia
2. Fetal: May occur due to decreased leading to fetal compromise,
hyponatremia.
 40 mg tablet, daily following breakfast.
 In acute conditions, the drug is administered parenterally in
doses of 40-120 mg daily.

1. Monitor weight, BP and pulse rate routinely
for long term use.
2. Monitor patient I/O chart.
3. Watch the signs for hypokalemia such as
muscle weakness and cramps.
4. Monitor uric acid if patient is having gout.
5. Advise the patient to take drug in the morning
after food.
6. Advised patient to avoid direct sunlight to
prevent photosensitivity reactions.

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
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.
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 (yutopar)
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
6. Altered maternal & fetal heart tone & palpitations.
 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

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.

DRUGS USED IN LABOR
Here are the drugs used in labor are:-
1.Oxytocics
2. Analgesics
3. Anticonvulsant
4. Anticoagulant

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

Adverse effects
1. Hypertonic uterine activity
2. Fetal distress & fetal death
3. Uterine rupture
4. Hypotension
5. Neonatal jaundice
6. Water retention & water intoxication
 Controlled IV infusion ( 10 units of oxytocin in 1 L of
RL/5% Dextrose in water)
 Nasal spray for milk let- down

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.
 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.

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.

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 2nd trimester & 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
 Tablets: containing o.5 mg prostin E2
 Vaginal suppository: containing 20 mg PGE2 or 50 mg PGF2
alpha
 Vaginal pessary: 3mg PGE2
 Injectable ampoules/vials of prostinE2
 1 mg/ml prostin F2 alpha
 5mg/ml Misoprostol 50mg given 4 hourly by oral, vaginal/ rectal
route for induction of labour

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.

ANTICONVULSANTS
MAGNESIUM SULPHATE
Preparation
 Inj- 1amp=2ml contains 1gm Mgso4.
 Tablet-64mg
Action
Decreased acetylcholine in motor nerve terminals,
which is responsible for anticonvulsant properties,
thereby reduces neuromuscular irritability. It also
decreases intracranial edema & helps in diuresis. Its
peripheral vasodilatation effect improves the uterine
blood supply. Has depressant action on the uterine
muscles & CNS

Indications
1. It is a valuable drug lowering seizure threshold in women with
pregnancy- induced hypertension.
2. Used in preterm labor to decrease uterine activity.
Contraindications
1. Heart block
2. Impaired renal function
3. Pregnant women actively progressing labor.
Adverse effects
• Maternal
1. Severe CNS depression
2. Evidence of muscular paresis
• Fetal
1.Tachycardia
2. Hypoglycemia

1. For control of seizures, 20 ml of 20% solution IV slowly
in 3-4 mins, to be followed immediately by 10ml of 50%
solution IM & continued 4 hourly till 24 hours
postpartum.
Repeat injections are given only if knee jerks are present,
urine output exceeds 100 ml in 4 hours & respiration are
more than 10/ minute. The therapeutic level of serum
magnesium is 4-7 mEq/L
2. 4gm IV slowly over 10 min, followed by 2 gm/hr and
then 1gm/ hr in drip of 5% dextrose for tocolytic effect

1. Assess patients Vital signs 15 min after IV dose, do not
exceed 150 mg/min
2. Monitor magnesium level If using during labour, time of
contractions, determine intensity
3. Urine output should remain 30 ml/hr or more if less
notify physician
4. Examine patient Reflexes-knee jerk, patellar reflex.
5. Administer Only after calcium gluconate is available for
treating magnesium toxicity

6. Using infusion pump/monitor carefully, IV at less than
150mg/min ,circulatory collapse may occur
7. Provide Seizure precautions: place client in single
room with decreased stimuli, padded side rails
8. Positioning of client in left lateral recumbent position
to decrease hypotension & increased renal blood flow
9. Evaluate patient Mental status , sensorium, memory ,
Respiratory status & Reflexes.
10. Discontinue infusion if respirations are below 12/min,
reflexes severely hypotonic, urine output below 30ml/hr
or in the event of mental confusion/ lethargy/ fetal
distress.

ANALGESICS
valethamate bromide (epidosin)
Cervical spasmolytic
Preparation
Inj-1amp-8mg/ml
Action
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. Myasthemia 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

Inj-8mg deep IM. It may be repeated after 4 hours
if necessary.
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.

Tramadol hydrochloride
Preparation
 Inj-1amp=50mg
 Tablet-50mg,100mg,200mg
Action
Bind to opioid receptor and inhibit reuptake of
norepinephrine and serotonin
Indications
1. Moderate to moderately severe pain
2. Safe given during labor as it does not cause depression
to fetal respiratory centre and hence safe for baby.

Contraindications
1. Breast feeding mothers
2. Hypersensitiviy
3. Hepatic impairment
4. Increased ICP
Adverse effects
1. Dizziness
2. Headache
3. Malaise
4. Hypertonia

50 to 100mg IM 6hrly or as required.
1. Monitor patient CV and respiratory status.
2. Monitor patient at risk for seizure.
3. Monitor patient bowel and bladder function.

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

0.5mg IM within 1 hour of birth.
1. Document the giving of the medication to
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.

DRUGS GIVEN DURING PUERPERIUM
Here are the drugs given during puperium
are:-
1.Iron
2.Folic acid
3.Calcium
4.Acetaminophen(paracetamol)
5.Lactation suppressant (in case of stillbirth,
neonatal death, breast abscess or severe
psychiatric illness.

Acetaminophen (paracetamol)
Preparation
 Tablet-80mg,160mg,500mg
 Suppository-80mg,120mg
 Oral solution-16m/ml,80mg/ml
Action
Produce analgesia by inhibiting prostaglandins and other
substances that sensitizes pain receptors.
Indications
1. Mild to moderate pain
2. Fever

Contraindications
1. Liver disease
2. Hypersensitivity
Adverse effects
1. Neutropenia
2. Hemolytic anemia
3. Hypoglycemia
4. Urticaria

500mg tablet thrice a day for 5 days
1. Advise the patient to not to exceed the
prescribed dose.
2. Advise the patient hat drug is only for short
term use and avoid taking OTC drugs without
prescription.
3. Advise patient to take tablet after meal to
prevent GI symptoms.

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
 2.5mg tablet orally once in a day.

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.

EFFECTS OF MATERNAL MEDICATIONS
ON FETUS & BREAST FEEDING INFANTS
1. During early embryogenesis, the drugs taken by the
mother reach the conceptus through the tubal/ uterine
secretions by diffusion.
2. The harmful effect on the blastocyst is usually death, in
case of survival there is chance of congenital anomalies
3. From 2nd-12th week (period of organogenesis) drugs can
cause serious damages
4. Gross congenital malformations & even death of the
fetus may result, depending on route, length of time & dose
of exposure

5. From 2nd trimester transfer of drugs takes place
through the utero-placental circulation due to lowered
serum albumin concentration which results from
haemodilution
6. As the albumin binding capacity of the drugs is
decreased more free drug is available for placental
transfer
7.The metabolism of the drug may be hampered by the
increase in plasma steroids, increased utero-placental
blood flow, increased placental surface area & decreased
thickness of placental membrane are the additional
cause for increased drug transfer
8. Fetotoxic/ teratogenic drugs are prescribed only when
the benefits out weigh the potential risks. Prior
councelling is mandatory & minimum therapeutic dosage
is used for shortest possible duration

Maternal medications with established
teratogenic properties & their effects
1.Cytotoxic drugs: multiple fetal malformations &
abortion
2.Androgenic steroids, hydroxy progesterone:
masculinization of the female offspring
3.Lithium: increased congenital malformations when
used in the 1st trimester, neonatal goitre, hypotonia
& cynosis
4.Diethyl stillbestrol: vaginal stenosis, cervical
hoods & uterine hypoplasia in female fetuses.

Maternal drug intake & breastfeeding
Maternal drug intake of nursing mothers have adverse
effects on lactation & also on the baby as it may be
present on the breast milk
• Transfer of drugs through breast milk depends on the
following factors:
• Chemical properties
• Molecular weight
• Degree of protein binding
• Ionic dissociation
• Lipid solubility
• Tissue pH
• Drug concentration
• Exposure time

Drugs identified as having effects on
lactation & the neonates are listed below:
• Bromides: rash, drowsiness, poor feeding
• Iodides: neonatal hypothyroidism
• Chloramphenicol: bone marrow toxicity
• Oral pill: suppression of lactation
• Bromocriptine: suppression of lactation
• Ergot: suppression of lactation
• Metronidazol: anorexia, blood dyscrasias,
weakness, neurotoxic disorders

• Anticoagulants: hemorrhagic tendency
• Isoniazid: anti-DNA activity &
hepatotoxicity
• Antithyroid drugs & radioactive iodine:
hypothyroidism & goiter
• Diazepam, opiates, phenobarbitone:
sedation effect with poor sucking reflex.

CONCLUSION
• No drug should be administered to a woman during
pregnancy, labor and birth, unless the woman is fully
informed of the known risks and the relevant areas of
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
• 1. Annamma Jacob “ A Comprehensive Textbook of
Midwifery & Gynecological Nursing” 3rd edition. Jaypee
Brothers Medical Publishers (P) Ltd page no. 604-619
• 2. D.C.Dutta’s “Textbooks of Obstetrics” 7th edition. New
Central Book Agency (P) Ltd page no.666.
• 3. A.K Debdas “Drug handbook in Obstetrics”,3rd
edition.Jaypee brothers and medical publishers private
limited, New Delhi.
• 4. wolter Kluwer “Drug handbook”32 edition.lippincot
William &Wilkinson publisher ,London.
• 5.www.medicine.tcd.ie/pharmacology_therapeutics/....Obs&G
yn.pdf
• 6.www.elmmb.nhs.uk/formularies/joint-medicines-

Drugs used in pregnancy, labour and puerperium

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