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Chapter 40
Drugs Used in Obstetrics
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 40
Lesson 40.1
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Slide 2
Objectives
• Describe nursing assessments and nursing
interventions needed for the pregnant patient
during the first, second, and third trimesters of
pregnancy
• Identify appropriate nursing assessments,
nursing interventions, and treatment options
used for the following obstetric complications:
infection, hyperemesis gravidarum,
miscarriage, abortion, preterm labor,
premature rupture of membranes, gestational
diabetes, and pregnancy-induced
hypertension
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Slide 3
Objectives (cont’d)
• State the methods and time parameters of
each approach to the termination of a
pregnancy
• Summarize the care needs of the pregnant
woman during labor and delivery and the
immediate postpartum period including the
patient education needed before discharge
to promote safe self-care and care of the
newborn
• State the purpose of administering
glucocorticoids to certain women in preterm
labor
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Slide 4
Nursing Assessments in Obstetrics
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Prenatal visit
Nutritional history
Elimination pattern
Psychosocial cultural history
Medication history
Physical examination
Assessment during the first, second, and third
trimesters
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Slide 5
Obstetric Complications
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Infections
Hyperemesis gravidarum
Miscarriage, placental separation, abortion
Preterm labor
Premature rupture of membranes
Gestational diabetes mellitus (GDM)
Pregnancy-induced hypertension (PIH)
Amniocentesis may determine fetal lung
maturity and detect fetal disorders
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Slide 6
Termination of Pregnancy
• Abortion methods
 Before 12 weeks gestation – suction curettage
or dilation and evacuation
 Between 12 and 20 weeks gestation – giving
hypertonic saline solutions (20%) intraamniotically, or prostaglandins intraamniotically, IM or vaginal suppository
 After 20 weeks gestation – prostaglandin
suppository +/- oxytocin
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Slide 7
Normal Labor and Delivery Care
• Labor and delivery care
 Status of labor, membranes, fetal heart rate
 Provide pain relief and comfort measures
• Postpartum care of the newborn
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Airway
Clamp the umbilical cord
Health status
Temperature maintenance
Eye prophylaxis
Other procedures
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Slide 8
Patient Education
and Health Promotion
• Postpartum care
 Assess fundal height and lochia
 Promote rest postpartum; sleep patterns will
be disturbed
 Promote adequate fluid intake
• Teach
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Breastfeeding techniques, as appropriate
Activity and exercise
Nutritional needs
Infant care needs
Follow-up appointments
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Slide 9
Chapter 40
Lesson 40.2
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Slide 10
Objectives
• State the actions, primary uses, nursing
assessments, and monitoring parameters for
uterine stimulants, uterine relaxants,
clomiphene citrate, magnesium sulfate, and
Rho(D) immune globulin
• Compare the effects of uterine stimulants and
uterine relaxants on a pregnant woman’s
uterus
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Slide 11
Objectives (cont’d)
• Describe specific nursing concerns and
appropriate nursing actions when uterine
stimulants are administered for induction of
labor, augmentation of labor, and postpartum
atony and hemorrhage
• Describe specific assessments needed
before and during the use of terbutaline or
magnesium sulfate
• Identify emergency supplies that should be
available during magnesium sulfate therapy
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Slide 12
Objectives (cont’d)
• Cite the effects of adrenergic agents on beta1 and beta-2 receptors, and then identify the
relationship of these actions to the serious
adverse effects when adrenergic agents are
used to inhibit preterm labor
• Identify the action, specific dosage,
administration precautions, and proper timing
of the administration of Rho(D) immune
globulin and rubella vaccine
• Summarize the immediate nursing care
needs of the newborn following delivery
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Slide 13
Drug Class: Uterine Stimulants
• Actions
 Stimulate the uterus to induce labor
• Uses
 Induce or augment labor
 Control postpartum atony and hemorrhage
 Control postsurgical hemorrhage (as in
cesarean birth)
 Induce therapeutic abortion
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Slide 14
Drug Class: Uterine Stimulants
• Drugs: dinoprostone (Prostin E2, Prepidil, Cervidil)
• Action
 Cause uterine and GI smooth muscle stimulation,
start and continue cervical ripening at term
• Uses
 Expel uterine contents after fetal death, benign
hydatidiform mole, missed spontaneous miscarriage,
second-trimester abortion
• Common adverse effects
 Nausea, vomiting, diarrhea, fever
• Serious adverse effects
 Orthostatic hypotension
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Slide 15
Drug Class: Uterine Stimulants
• Drug: misoprostol (Cytotec)
• Action
 Cause uterine contractions in pregnancy
• Uses
 Cervical ripening agent, induce labor, treat
serious postpartum hemorrhage
• Common adverse effects
 Nausea, vomiting, diarrhea, fever
• Serious adverse effects
 Orthostatic hypotension
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Slide 16
Drug Class: Uterine Stimulants
(cont’d)
• Drugs: ergonovine (Ergotrate Maleate),
methylergonovine (Methergine)
• Actions
 Directly stimulate uterine contractions
• Uses
 Control bleeding and maintain firmness in
postpartum patients
• Common adverse effects
 Nausea, vomiting, abdominal cramping
• Serious adverse effects
 Hypertension
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Slide 17
Drug Class: Uterine Stimulants
(cont’d)
• Drug: oxytocin (Pitocin)
• Action
 Stimulate uterine smooth muscle, blood vessels,
mammary glands
• Uses
 Initiate active labor during third trimester; used
postpartum to control uterine atony, hemorrhage
• Common adverse effects
 Uterine contractions, nausea, vomiting
• Serious adverse effects
 Fetal distress, hypotension, hypertension, water
intoxication, dehydration, postpartum hemorrhage
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Slide 18
Drug Class: Uterine
Relaxants
• Drug: magnesium sulfate
• Action
 Produce anticonvulsant effects and smooth
muscle relaxation, inhibit uterine muscle
contractions
• Uses
 Inhibit preterm labor, control seizure activity
associated with preeclampsia and eclampsia
• Serious adverse effects
 Absence of deep tendon reflexes, confusion,
reduced urine output
 Calcium gluconate used as an antidote for
magnesium toxicity
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Slide 19
Drug Class: Uterine Relaxants
(cont’d)
• Drug: terbutaline sulfate (Brethine)
• Actions
 Produce relaxation of uterine, bronchial, and
vascular smooth muscles; increase heart rate
• Uses
 Stop premature labor when no underlying
pathology indicates pregnancy be discontinued
• Serious adverse effects
 Tachycardia, palpitations, hypertension,
hypotension, tremors, nervousness, anxiety,
restlessness, headache, dizziness, nausea,
vomiting, hyperglycemia, electrolyte imbalance
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Slide 20
Other Agents
• Drug: clomiphene citrate (Clomid)
• Actions
 Stimulate ovaries to release ova for potential
fertilization
• Uses
 Induce ovulation in women with reduced
estrogen levels
• Common adverse effects
 Nausea, vomiting, diarrhea, constipation, hot
flashes, abdominal cramps
• Serious adverse effects
 Severe abdominal cramps, visual
disturbances, dizziness
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Slide 21
Other Agents (cont’d)
• Drug: Rho(D) immune globulin
• Actions
 Suppress stimulation of active immunity by
Rh-positive foreign blood cells; prevent
Rh hemolytic disease of newborns in
subsequent pregnancies
• Uses
 Prevent Rh immunization of Rh-negative patient
exposed to Rh-positive blood
• Common adverse effects
 Localized tenderness, fever, arthralgias,
generalized aches, pains
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Slide 22
Other Agents (cont’d)
• Drug: erythromycin ophthalmic ointment
(Ilotycin)
• Actions and uses
 Macrolide antibiotic used prophylactically to
prevent ophthalmia neonatorum; effective
against C. trachomatis
• Common adverse effects
 Mild conjunctivitis
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Slide 23
Other Agents
• Drug: phytonadione
• Actions
 Fat-soluble vitamin K for the production of
blood clotting factors
• Uses
 Administered prophylactically to protect
against hemorrhagic disease of the newborn
• Serious adverse effects
 Bruising, hemorrhage
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Slide 24