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Drug name : Oxytocin (Pitocin) Dose, route, frequency :

o Induction/stimulation of labor : IV 0.5-2 mU/min; increase by 1-2 mU/minq 15-60 min until pattern established (usually 5-6 mU/min; maximum 20mU/min) then decrease dose

o

Postpartum Hemorrhage : IV 10 U infused at 20-40 mU/min; IM 10 Uafter delivery of placenta o Incomplete/inevitable abortion : IV 10 U at a rate of 20-40 mU/min

Indications for OB use: o IV: induction of labor at term o IV: facilitation of threatened abortion o IV, IM: postpartum control of bleeding after expulsion of the placentao Action: stimulates uterine smooth muscle, producing uterine contractions

similar to those in spontaneous labor. Has vasopressor and antidiureticeffects. Therapeuti c effects : induction of labor and control of postpartum

bleeding

Common Side Effects: Maternal coma, seizures, hypotension, hypochlorhemia,hyponatremia, water intoxication, increased uterine motility, painful contractions,abruptio placentae, decrease uterine blood flow, and hypersensitivity

Contraindications: Contraindicated in hypersensitivity and anticipatednonvaginal delivery. Use d cautiously in first and second stages of labor; slowinfusion over 24 hour has caused water intoxication with seizure and coma ormaternal death caused by oxytocins antidi uretic effects

Effects/Implications for pregnancy or breastfeeding : This is a category Xmedication in pregnancy.

o Fetal side effects : Intracranial hemorrhage, fetal asphyxia, hypoxia,arrhythmias, water intoxication

o Oxytocin is an essential hormone in lactation. Administration of oxytocinto mothers having difficulty in breastfeeding has not been clearly shown tohave a beneficial effect on lactation success or in the treatment of breastenragement. Effects on the infant are unlikely when given during

breastfeeding but some studies suggest that oxytocin given during laborcan negatively affect breastfeeding, possibly by reducing sucking behaviorin the newborn

Nursing Actions as applicable:o Assess fetal maturity, presentation, and pelvic adequacy before

administration of oxytocin for induction of laboro Assess character, frequency, and duration of uterine contractionso Monitor maternal BP and pulse frequently and FHR continuouslythroughout administrationo Monitor for signs and symptoms of water intoxication (drowsiness,

listlessness, confusion, headache, anuria)o Advise patient to expect contractions similar to menstrual cramps after

administration has started

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Drug name : Butorphanol (Stadol) Dose, route, frequency : IM 2 mg q 3-4h as needed (range 1-4 mg); IV mg q 3-4h

as needed ( range 0.5-2mg); Intranasal 1 mg (1 spray in 1 nostril) initially, anadditional dose may be given 60-90 min later, this sequence may be repeated in 3-4 hr, if pain is severe, an initial dose of 2 mg (1 spray in each nostril) may be

given, may be repeated in 3-4 hrs. Indications for OB use: Management of moderate-to-severe pain. Analgesiaduring labor; sedation before surgery; supplement in balanced anesthesia

Common Side Effects: confusion, dysphoria, hallucinations, sedation, nausea,constipation, sweating

Contraindications: Contraindicated in hypersensitivity; patients physicallydependent on opioids (may precipitate withdrawal)

Effects/Implications for pregnancy or breastfeeding : This is a pregnancycategory C drug. Animal studies have reported a higher frequency of stillbirthsand a higher incidence of post implantation loss than controls. There are nocontrolled data in human pregnancy before 37 weeks gestation; it should be used

only if potential benefit justifies the potential risk to the infant. Nasal spray forlabor is not recommended because it has not been studied.

o It has been detected in human milk, adverse effects in the nursing infantare unlikely, it is considered to be compatible with breast-feeding by theAmerican Academy of Pediatrics

o Fetal side effects: Use of drug during labor may cause sinusoidal fetalheart pattern without fetal hypoxia or neonatal adverse effects. Prolongedused of drug may cause neonatal withdrawal symptoms.

Nursing Actions as applicable:o Assess type, location, and intensity of pain before and 30-60 min after IM,

5 min after IV, and 60-90 min after intranasal administrationo Assess BP, pulse, and respirations periodicallyo Assess previous anagesic historyo Instruct patient on how and when to ask for pain medicationo Assess LOC for infant safety and patient

Drug name : Betamethasone Dose, route, frequency : 12 mg IM for 2 doses 24 hours apart Indications for OB use: To prevent or reduce the severity of neonatal respiratory

distress syndrome by accelerating lung maturity in fetuses between 24-34 weeksof gestation

o Action: Stimulates fetal lung maturation by promoting release of enzymesthat induce production or release of lung surfactant This is an unlabeled use for obstetrics

Common Side Effects: Pulmonary edema (if given with beta-adrenergicmedications); may worsen maternal condition (diabetes, hypertension)

Contraindications: Hypersensitivity, if mother has fungal infection anywhere on body, if have an infection, liver disease, kidney disease, thyroid disorder,diabetes, TB

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Effects/Implications for pregnancy or breastfeeding : This is a pregnancycategory C medication. This may be harmful to an unborn baby

o There are no data on the excretion of betamethasone into human milk. Themanufacturer recommends that due to potential for serious adversereactions in nursing infants, the benefits should outweigh the risks.

Nursing Actions as applicable:o Give deep IM in ventral gluteal or vastus lateralis muscleo Teach signs of pulmonary edemao Assess blood glucose levels and lung sounds

Drug name : Fentanyl citrate (Sublimaze) Dose, route, frequency : 25-50 mcg IV; 1-2 mcg with 0.125% bupivacaine at rate

of 8-10 ml/hr epidurally Indications for OB use: Because of its short duration of action with given IV,

they are most commonly administered epidurally or intrathecally, alone or incombo with a local anesthetic agent, to relieve moderate to severe labor pain and

postoperative pain after c-section o Action: opioid agonist analgesics that stimulate moth mu and kappa opioid

receptors to decrease the transmission of pain impulses, rapid action withshort duration

Common Side Effects: Dizziness, drowsiness, allergic reactions, rash, pruritis,maternal and fetal or neonatal respiratory depression, nausea and vomiting,urinary retention

Contraindications: Contraindicated with use of other opioid pain medications,COPD, history of head injury, heart rhythm disorder, seizures, depression, low

blood pressure, kidney disease, history of drug or alcohol addiction Effects/Implications for pregnancy or breastfeeding : This is a category C

pregnancy drug. It is only recommended if the benefit outweighs the risk to thedeveloping fetus

o Animal studies have revealed evidence of decreased fertility,embryotoxicity, fetoxicity, and embryolethality

o There are no controlled data in human pregnancyo Fentanyl is excreted into human milk and achieves levels in colostrum

which are greater than maternal serum levels; no adverse effects have beenreported in nursing infants

o Manufacturer states that symptoms of opioid withdrawal may occur ininfants at the cessation of nursing by women using fentanyl andrecommends that fentanyl not be used by nursing women

Nursing Actions as applicable:o Assess for respiratory depressiono Naloxone should be available as an antidote

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Drug name (generic & trade)o Insulin (HumuLIN R, NovoLIN R, ReliOn/HumuLIN R)

Doseo use a combination of maternal weight (in kg) and pregnancy trimester. First, a

24-hour total insulin dose is calculated using 0.7 units (U)/kg in first trimester,0.8 U/kg in second trimester, and 0.9 U/kg in third trimester.

Route(s)o SQ

How often giveno Two-thirds of the total dose is given in the morning before breakfast and one-

third at night (half of that before supper and half prior to bedtime). Indication for OBSTETRICAL USE -when & why is this med most often given in

OB: pregnancy, preoperative, intrapartum, postpartum, postoperative.o If exercise and diet modification fail and fasting values are < 95 mg/dL and 2hour after meal values are < 120 mg/dL

Common side effectso Hypoglycemia, bilateral presyopia, lipohypertrophy, anaphylaxis,

abnormalities in platelet function, clotting factors, the fibrinolytic system, anddyslipidemia, GI distress

Contraindicationso Eating Disorder, Liver Problems, Failure of Small Intestines to Digest and

Absorb Food, Kidney Disease, Body Temperature More Than 101 Degrees F,Throwing Up, Injury, Overactive Thyroid Gland, Underactive Thyroid, LowBlood Sugar, Low Amount of Potassium in the Blood

Effects/Implications for pregnancy or breastfeeding . Need side effects on fetus,not just a pregnancy class.

o pregnancy-induced hypertension or preeclampsia, premature delivery,Cesarean section, large-for-age offspring, and perinatal mortality, pregnancycategory B, delayed lactogenesis

Nursing actions as applicable.o Monitor BG of mother during pregnancy as well as injection sites. Watch for

signs of hypoglycemia, monitor diet of patient.

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