1. The document discusses several emergency drugs used in obstetrics including tranexamic acid, lidocaine, misoprostol, anti-D immunoglobulin, and dexamethasone. 2. Tranexamic acid and misoprostol are used to prevent and treat postpartum hemorrhage. Lidocaine is used for local anesthesia during procedures like episiotomies. Anti-D immunoglobulin prevents Rh isoimmunization. Dexamethasone is given to improve outcomes for premature babies by promoting lung maturation. 3. The document provides information on the indications, dosages, administration methods, and nursing responsibilities for each drug. Side effects are also outlined.

1. EMERGENCY DRUGS USE IN
OBSTETRIC

2. Objective
Tranexamic acid
Lidocaine
Mesoprostol
Anti D immunoglobulin
Dexamethasone

3. Tranexamic acid

4. Cont..
• Tranexamic Acid (TXA) is a lysine analogue and works by binding to
plasminogen, thereby inhibiting fibrinolysis.
• TXA has been used for years in the management and prevention of
hemorrhage ,in the surgical setting including cardiac, orthopedic
and trauma surgery.
• TXA has also been used to prevent PPH in vaginal delivery
Brand Name:
• Hemostan, Cyclokapron, Fibrinon, Lysteda, Transamin

5. Cont..
Goals:
1. To reduce the incidence of postpartum hemorrhage in
patients at high risk for hemorrhage due to known risk
factors.
2. To reduce the severity of postpartum hemorrhage once a
patient has been identified as having a hemorrhage (EBL >
500 ml in vaginal delivery or > 1000 ml in Cesarean delivery)
delivery.

6. Cont..
Clinical Practice:
1. Prophylactic use: Consider prophylactic use in cesarean or
vaginal delivery with patients at increased risk for hemorrhage ,
especially in circumstances where uterotonics may be
contraindicated. Discuss possible use at briefing or at team
meeting.
2. Therapeutic use: Consider use when patient has been
identified as having a hemorrhage. Team agreement prior to
administration.

7. Cont..
Method of administration:
Dosage: 1 gram given intravenously over 10 minutes.
Possible methods of administration include 1g diluted into 10 ml of normal
saline or 1g diluted into 100 ml of normal saline.
Timing: Administer immediately after delivery of baby in either vaginal or
cesarean delivery, or when hemorrhage has been identified.
Consider redosing 1g after 30 minutes in continuing hemorrhage. Consider
infusion (5mg/kg/hr) if prolonged bleeding period is expected.

8. Cont..
Side effects:
• Minor: nausea, vomiting, GI upset, headaches, dizziness, hypotension, color
blindness
• Major: thromboembolic complications (PE, DVT, MI), seizure, anaphylaxis
contraindication
• History of thromboembolic disease (DVT, PE or CVA)
• History of ischemic heart disease
• Known disorder of hypercoagulability (ex. Factor V Leiden)
• Prior reactipn to txa

9. Cont..
Nursing Responsibilities:
• Unusual change in bleeding pattern should be immediately
reported to the physician.
• For women who are taking Tranexamic acid to control
heavy bleeding, the medication should only be taken during the
menstrual period.
• The medication can be taken with or without food.
• Inform the patient that she inform if severe side effects occurs:
allergic reaction, chest pain, shortness of breath etc.

10. LIGNOCAINE

11. lignocaine
• Lignocaine (Cadila) 2 % Injection is an effective agent that is
used to numb a specific area of the body to reduce pain and
discomfort caused by surgical or other invasive medical
procedures
• Lidocaine injection is also given in an epidural (spinal
block) to reduce the discomfort of contractions during
labor.
• Episiotomy is the most common obstetric surgical
procedure and discomfort and pain is a common
experience for all women exposed to episiotomy.

12. Cont..
Usual dose: 7 mg/kg
Onset: Rapid 60–90 min
Use:
• Local or pudendal block for episiotomy
• epidural or spinal for cesarean delivery
Nursing responsibility:
Carry out baseline and regular observations

13. MESOPROSTOL

14. Mesoprostol
• Misoprostol is a prostaglandin analogue
• It binds to myometrial cells to cause strong myometrial
contractions leading to expulsion of tissue.
• This agent also causes cervical ripening with softening and
dilation of the cervix.
• Given by PO/PV route

15. Cont..
Clinical use:
• Cervical ripening and Induction of labor.
• Medical termination of pregnancy.
• Medical management of miscarriage/ IUD ( For 1st trimester single
dose of 400mcg; From 12- 34 weeks 400mcg 3hrly ,max 5 doses)
• Postpartum hemorrhage- 800m
• For cervical ripening in advance of endometrial biopsy to reduce the
need for use of a tenaculum or cervical dilator.cg PR/PV
Side effects:
• nausea, vomiting, diarrhoea, abdominal pain

16. Cont..
Nursing responsibility
• Uterine activity and fetal status should be monitored
• Observe for any complication
• Assess the safety of mother and fetus during misoprostol
administration.

17. Anti D immunoglobulin

18. Anti D immunoglobulin
• Rho(D) immune globulin (RhIG) is a medication used to
prevent RhD isoimmunization in mothers who are RhD
negative and to treat idiopathic thrombocytopenic purpura (ITP)
in people who are Rh positive.
• It is often given both during and following pregnancy.
• It may also be used when RhD negative people are given RhD
positive blood.
• It is given by injection into muscle or a vein.
• Rho(D) immune globulin is made up of antibodies to
the antigen Rho(D) present on some red blood cells.
• It work by blocking a person's immune system from
recognizing this antigen.

19. Cont..
• It is recommends that all RhD negative mothers, regardless of
fetal blood type, receive RhIG at about 28 weeks gestation,
and again shortly after delivery in the case of an RhD positive
or RhD unknown baby.
• It should be given within 3 days of a potential exposure to Rh
positive blood from the baby such as may occur during second
or third trimester miscarriage, amniocentesis, cordocentesis,
chorionic villus sampling, external cephalic version, trauma, or
delivery

20. Cont..
Dose of anti D immunoglobulin
• Rh-incompatible pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM, at gestational
week 26 to 28, or within 72 hours of birth of an RHo (D) positive
baby.
Rhophylac(R): 1500 international units (300 mcg), IV or IM, at
gestational week 29 to 30; repeat dose within 72 hours of birth of an
RHo (D) positive baby.
WinRho(R): 1500 international units (300 mcg), IV or IM, at
gestational week 28; give an additional 600 international units (120
mcg) dose within 72 hours of birth of an RHo (D) positive baby.

21. Cont.…
• Amniocentesis and chorionic villus sampling before 34 weeks
gestation:
RhoGAM(R): 1500 international units (300 mcg), IM
WinRho(R): 1500 international units (300 mcg), IV or IM,
immediately after the procedure
• Abortion or miscarriage of up to 12 weeks gestation:
BayRho-D Mini-Dose(R): 1 syringe, IM, within 3 hours, or as soon
as possible (within 72 hours of pregnancy termination).
• Abortion or miscarriage after 12 weeks gestation:
RhoGAM(R): 1500 international units (300 mcg), IM

22. Cont.…
• Abortion, amniocentesis, or any other manipulation after
34 weeks gestation:
WinRho(R): 600 international units (120 mcg), IV or IM, within
72 hours
• Ectopic pregnancy:
RhoGAM(R): 1500 international units (300 mcg), IM

23. Cont..
contraindication
• D-negative females whose fetus is known to be D-negative
 D-negative females who have been previously alloimmunized to D
(they have already formed an anti-D alloantibody)
 Any D-positive females
 Women who test positive for one of the weak D mutations by
molecular testing should be considered RhD positive and not
receive RhIG
 Women who test positive for one of the partial D mutations (by
molecular testing) should be treated as RhD negative and receive
RhIG as clinically indicated

24. Cont..
Nursing responsibility
• Consent
All pregnant women should receive appropriate written and verbal
information about anti-D immunoglobulin to inform their choice and be
given time to consider their options. As a human derived blood product
the administration of anti-D Immunoglobulin needs to be consented.
• Prescribing responsibilities
Anti-D Ig has been added to the exempt list of drugs for midwives,
therefore midwives can administer it to their patients without a
prescription or PGD.

25. Cont.…
• Individual responsibilities
Anti-D prophylaxis should be discussed with the patient in advance
and consent must be documented in the woman’s hand held
records and /or in the medical notes.
• Documentation responsibilities
All request forms need to be fully completed.
Full details of any anti-D immunoglobulin administered should be
fully recorded on the ward blood transfusion pathway. This must
include Woman’s identity including surname, forename, date of
birth and a unique ID number.

26. Dexamethasone

27. Dexamethasone
• Dexamethasone is a corticosteroid medication
• In preterm labor, it is used to improve outcomes in the baby
• Dexamethasone may be given to women at risk of delivering
prematurely to promote maturation of the fetus' lungs. This
administration, given from day to one week before delivery

28. Cont.…
• A single course of corticosteroids is recommended for pregnant
women between 24 0/7 weeks and 33 6/7 weeks of gestation who
are at risk of preterm delivery within 7 days, including for those with
ruptured membranes and multiple gestations.
• Dose:
Dexamethasone is available in:
• in tablet form (0.5 mg each);
• in the form of a solution in ampoules for intramuscular and
intravenous injections (4 mg / ml)

29. Cont.…
side effects:
• Fluid retention
• Increase blood pressure
• Increase blood glucose level in patient with diabetes mellitus
• Decrease patient’s resistance to infection
Nursing responsibility:
• Monitor for maternal vital sign and fetal heart rate
• Monitor blood glucose level of the patient and increase insulin as
prescribed