Maternity and Newborn

Medications

I. Oxytocic
medication: Oxytocin
(Pitocin)
1.

2.
3.

4.

Oxytocin stimulates the smooth

muscle of the uterus and induces
contraction of the myocardium
Oxytocin promotes milk letdown
Routes of administration include
intranasal, intramuscular and
intravenous(IV)
Minimal cervical change is
usually noted until the active
phase of labor is achieved

B. Uses
Induce or augment of labor
Control postpartum bleeding
Promote milk letdown and facilitate breast feeding(intranasal
route)
Induce or complete an abortion

C. Adverse reactions and contraindication

Adverse reactions are rare but may include allergies,
dysrhythmias, changes in blood pressure, uterine rupture, and
water intoxication, intranasal administration may cause nasal
vasoconstriction
Oxytocin may produce uterine hypertonicity resulting in fetal or
maternal injury
High doses may cause hypotension, with rebound hypertension
Postpartum hemorrhage can occur because the uterus may
become atonic when the medication wears of
Oxytocin should not be used in a client who cannot deliver
vaginally or in a client with hypertonic uterine contractions

D. interventions
Monitor maternal vital signs (every 15 minutes) especially the blood pressure and
heart rate, weight, intake and output, level of consciousness, and lung sounds
Monitor frequency, duration, force of contraction, and resting uterine tone every 15
minutes
Monitor fetal heart rate every 15 minutes, and notify the health care provider if
significant changes occur; an internal fetal scalp electrode should be used if possible
Administered by IV infusion via an infusion monitoring device (Y-setup or stopcock is
used with normal saline in the primary line); carefully monitor dose being
administered
Do not leave client unattended while the oxytocin is infusing
Administer oxygen if prescribed
Monitor for hypertonic contractions
Stop the medication if uterine hyperstimulation or nonreassuring fetal heart rate
occurs; turn the client on her side, increase the IV rate of the normal saline and
administer oxygen via facemask
Notify the health care provider if uterine hyperstimulation or nonreassuring fetal
heart rate occurs
Monitor for signs of water intoxication
Have emergency equipment available
Document the dose of the medication and the time the medication was started,
increased, maintained, and discontinued
Keep the family informed of the clients progress

II. Ergot Alkaloids

1.

2.

3.

4.

5.

Ergot alkaloids directly stimulate uterine

muscle and increase the force and
frequency of contractions
The medications produce a firm tetanic
contraction of the uterus
The medications produce arterial
vasoconstriction and can cause vasospasm
of the coronary arteries
Ergot alkaloids are not administered before
the delivery of the placenta
The medications may be administered by
oral or intramuscular route; for IV use in an
emergency either medication may be
administered undiluted

B. Uses
Postpartum hemorrhage
Postabortal hemorrhage resulting from atony or involution

C. Adverse reactions and contraindications

Ergot alkaloids can cause nausea
The medications can cause uterine cramping
The medication can cause bradycardia, dysrhythmias, myocardial
infarction, and severe hypertension
High doses are associated with peripheral vasospasm or
vasoconstriction, angina, miosis, confusion, respiratory depression,
seizures, or unconsciousness; uterine tetany can occur
The medications are contraindicated during pregnancy
The medications are contraindicated in clients with significant
cardiovascular disease, peripheral vascular disease, or
hypertension

D. Interventions
Monitor maternal vital signs, weight, intake and output, level
of consciousness, and lung sounds
Monitor the blood pressure closely, the medication produces
vasoconstriction, and if a rise in blood pressure is noted,
withhold the medication and notify the health care provider
Monitor uterine contractions(frequency, strength and duration)
Assess for chest pain, headache, shortness of breath, itching,
pale or cold hands or feet, nausea, diarrhea, or dizziness
Notify the health care provider if chest pain occurs
Assess the extremities for color, warmth, movement, and pain
Assess vaginal bleeding
Administer analgesics as prescribed, they may be required
because the medication produces painful uterine contractions

Ergot
Alkaloids
Ergonovine
(Ergotrate)

Methylergonovine
(methergine)

Carboprost
(hemabate)

Dinoprostone
(cervidil)

III. Uterine Relaxants

1.

2.

3.

4.

5.

Uterine relaxants produce uterine

relaxation
Ritodrine is the medication of choice to
control premature labor
Ritodrine may be used orally or
intravenously
Ritodrine usually is administered
intravenously when premature labor
begins; when contractions have been
controlled for 12 to 24 hours, the client
may be started on orally administered
ritodrine the IV infusion may be removed
Contraction may resume when the client
is on oral therapy.

B. Uses
Ritodrine is used to halt spontaneous labor when it appears
after the 20th week of pregnancy and before the thirty-sixth
week
Terbutaline, primarilly used to control bronchospasm, is an
alternative medication for the control of premature labor

C. adverse reactions and contraindications

Ritordine
Ritodrine can cause heart palpitations, tachycardia, nausea and
vomiting, trembling, flushing, and headache
Ritodrine can cause fetal tachycardia
high doses can cause cardiovascular symptoms and pulmonary edema
Ritodrine is contraindicated in clients with preexsisting cardiac disease

terbutaline
Hypokalemia, pulmonary edema, and hypoglycemia may occur if
given during labor
Hypoglycemia may be found in neonate

D. Interventions
Monitor vital signs, uterine contractions, and fetal
heart rate every 5 minutes when initiating therapy
every 15 to 30 minutes when the client is stable and
every 4 hours when the client is taking oral
maintenance doses
An infusion monitoring devise is used when the
medications are administered by the IV route
Monitor for pulmonary edema; assess lung sounds for
crackles
Monitor potassium and glucose levels
Instruct the client to contact the health care provider if
four to six contractions per hour occur

Ritodrine
(Yutopar)

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IV. Prostaglandins
1.

2.

3.

Prostaglandins are potent stimulators of the

myometrium
Dinoprostone is administered as a gel or
suppository directly into the vagina
Carboprost can be administered by deep
intramuscular injection

B. Uses
Prostaglandins are abortifacients
Prostaglandins can induce abortion during the second trimester,
when the uterus is resistant to oxytocin
Dinoprostone also is used to soften and promote dilation of the
cervix to facilitate vaginal delivery

C. adverse reactions and contraindications

Significant gastrointestinal side efects, including diarrhea, nausea,
vomiting, and stomach cramps
Fever, chills, and flushing
Anaphylaxis, dysrhythmias, bronchoconstriction, chest pain,
hypertension, and peripheral vasoconstriction
Contraindicated in clients with significant cardiovascular disease or
those with a history of asthma or pulmonary disease
Uterine cramping and tetany caused by high doses

D. Interventions
Monitor maternal vital signs, especially the blood pressure and
heart rate, weight, intake and output, level of consciousness, and
lung sounds
Monitor frequency, duration force of uterine contractions, and
resting uterine tone frequently; palpate the fundus
Monitor vaginal bleeding
Remain with the client for 30 minutes after administration to
monitor for anaphylaxis; signs include shortness of breath or
difficulty in breathing, tachycardia, hives, tightness in the chest,
or swelling in the face
Maintain client in a supine position for 30 minutes following
administration of the medication
Keep side rails up; have suction machine at the bedside
Administer antidiarrheal and antiemetic medication as prescribed

V. Magnesium Sulfate
1.

2.

3.

Magnesium sulfate is a central

nervous system depressant and
anticoagulant
The medication causes smooth
muscle relaxation
The antidote is calcium
gluconate

B. Uses
Prevent and control seizures and preeclamptic and eclamptic clients
Treat preterm labor

C. Adverse Reactions and Contraindications

Magnesium sulfate can cause reduced respiratory rate, decreased reflexes,
flushing, hypotension, and decreased heart rate
Continuous IV infusion increases the risk of magnesium toxicity in the neonate
Intravenous administration should not be used for 2 hours preceding delivery
Magnesium sulfate is continued for the first 12 to 24 hours postpartum if it is
used for preeclampsia
High doses can cause loss of deep tendon reflexes, heart block, respiratory
paralysis, and cardiac arrest.
The medication is contraindicated in the client with heart block, myocardial
damage, or renal failure
The medication is used with caution in the client with severe renal impairment

D. interventions
Monitor maternal vital signs, especially respirations, every 30 to 60 minutes
Calls the health care provider if respirations are less than 12, indicating respiratory
depression
Assess renal function and electrocardiogram for cardiac function
Monitor magnesium levels, for the target range is 4 to 7 mEq/L; if a rise in the
magnesium level occurs, notify the healthcare provider
Administer by IV infusion via an infusion monitoring devise; carefully monitor dose
being administered
Keep calcium gluconate on hand in case of a magnesium sulfate overdose, because
calcium gluconate antagonizes the efect of magnesium sulfate
Monitor deep tendon reflexes hourly for signs of developing toxicity
Test patellar or knee jerk reflex before administering repeat parenteral doses (used
as an indicator of central nervous system depression; suppressed reflex may be a
sign of impending respiratory arrest)
Patelar reflex must be present and respiratory rate must be greater than 16 breaths
per minute before each parenteral dose
Monitor intake and output hourly should be maintained at 30 ml per hour because
the medication is eliminated through the kidneys

VI. Meperidine
hydrochloride
1.
2.

3.

Narcotic analgesic
Administered by
intramuscular or IV route
Antidote: naloxone (Narcan)

B. Use:
To relieve moderate to severe pain associated with labor.
C. Adverse reactions and contradictions:
o Meperidine can cause dizziness, nausea, vomiting, sedation, decreased blood
pressure, decreased respirations, diaphoresis, flushed face, decreased urination.
o Meperidine may be administered with promethazine (Phenergan) to prevent nausea.
o High dosages may result in respiratory depression, skeletal muscle flaccidity, cold,
clammy skin, cyanosis, extreme somnolence progressing to convulsions, stupor, and
coma.
o Meperidine is used cautiously in clients delivering preterm infants.
o Meperidine is not administered in early labor because it may slow the labor
process.
o Meperidine is not administered in advanced labor (within 1 hour of delivery if the
neonate is to be delivered before the medication is removed adequately from the
fetal circulation (may cause respiratory depression).
o Regular use of opiates during pregnancy may produce withdrawal symptoms in the
neonate (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting,
diarrhea, yawning, sneezing, and seizures).

o
o

D. interventions:
Monitor vital signs, particularly respiratory
status; if respirations are 12 per minute or
fewer, withhold medication and contact
health care provider.
Monitor for blood pressure changes
(hypotention). Maintain in a recumbent
position.
Have antidote available.

VII. Rho (D) IMMUNE

GLOBULIN ( RhoGam)
1.

2.

3.

Prevention of anti-Rh(D) antibody formation

is most successful if the medication
administered twice: at 28 weeks of gestation
and again within 72 hours after delivery.
The immune globulin also should be
administered within 72 hours after potential
or actual exposure to Rh-positive blood; must
be given with each subsequent exposure or
potential exposure to rh-positive blood.
The immune globulin is of no benefit once
the client has developed a positive antibody
titer to the Rh antigen.

B. Use:
o To prevent isoimmunization in Rh- negative clients who are
exposed or potentially exposed to Rh- positive red blood cells
by transfusion, termination of pregnancy, amniocentesis,
chorionic villus sampling (CVS), abdominal trauma, or
bleeding during pregnancy or the birth process.
C. Adverse reactions and contradictions:
o Elevated temperature.
o Tenderness on the injected side.
o Contradicted to Rh-positive women.
o Contradicted in clients with a history of systemic allergic
reactions to preparations containing human immunoglobulins.
o Not administered to new born infants.

o
o
o

D. Interventions:
Administer to mother by intramuscular
injection at 28 weeks gestation and within
72 hours after delivery.
Never administer by the IV route.
Monitor for temperature elevation.
Monitor injection site for tenderness.

VIII.
BETAMETHASONE
(CELESTONE)
1.

2.

Betamethasone is a
corticosteroid.
Betamethasone increases
production of surfactant.

B. Use:
o For client in preterm labor between 28 and 32 weeks
whose labor can be inhibited for 48 hours without
jeopardizing the mother or the fetus.
C. Adverse reactions and contradictions:
o Decreases mothers resistance to infection.
o Breast-feeding contraindicated during medication
administration.
D. Interventions:
o Monitor maternal vital signs.
o Monitor mother for signs of infection.
o Monitor white blood cell count.

IX. LUNG SURFACTANTS:

Beractant (Survanta),
Colfosceril palmitate (Exosurf)
1.

2.

Lung surfactants replenish

surfactant and restore surface
activity to the lungs.
Lung surfactants are administered
by the intratracheal route.

B. Use:
o To prevent or treat respiratory distress
syndrome (hyaline membrane disease) in
premature infants.
C. Adverse reactions and contradictions:
o Side efects include transient bradycardia
and oxygen desaturation.
o Surfactants are administered with caution in
those at risk for circulatory overload.

D. Interventions:
Instill surfactant through catheter inserted
into infants endotracheal tube; avoid
suctioning for at least two hours after
administration.
Monitor bradycardia and decreased oxygen
saturation during administration.
Assess lung sounds for moist breath sounds.

X. EYE PROPHYLAXIS
FOR THE NEONATE
1.

2.

3.

Erythromycin (0.5% Ilotycin) and tetracycline (1%)

ophthalmic ointment or drops are bacteriostatic and
bactericidal and provide propylaxis against Neisseria
gonorrhoeae and Clamidiya trachomatis.
Silver nitrate (1%) solution may be prescribed, but
its use is minimal because it does not protect
against chlamydial infection and can cause chemical
conjunctivitis.
Preventive treatment of gonorrhea is required by
law.

B. Use:
o As a prophylactic measure to protect against Neisseria
gonorrhoeae and chlamydia trachomatis.
C. Adverse reaction
o Silver nitrate (1%) solution can cause chemical conjunctivitis.
D. Interventions
o Cleanse the neonates eyes before instilling drops or
ointment.
o Instill into each of the neonates conjunctival sacs within
1hour after delivery; eye prophylaxis may be delayed until
an hour or so after birth to facilitate eye contact and parentinfant attachment and bonding.
o Do not flush the eyes after installation.

XI. VITAMIN K
(AquaMEPHYTON)
1.

2.

Vitamin K is necessary for aiding in

the production of active prothrombin.
Newborns are deficient in Vitamin K
for the first 5 to 8 days of life
because of the lack of intestinal flora
that is necessary to absorb Vitamin
K.

B. Use:
o For prophylaxis and to treat hemorrhagic
diseases of the newborn.
C. Adverse reaction:
o Vitamin K can cause hyperbilirubinemia in
the newborn.
D. Interventions
o Protect the medication from light.
o

D. Interventions
o Protect the medication from light.
o Administer during early neonatal period.
o Administer in the vastus lateralis muscle of
the thigh.
o Monitor for bruising at the injection site and
for bleeding of the cord.
o Monitor for jaundice and monitor bilirubin
level because the medication can cause
hyperbilirubinemia in the newborn.