Common drugs used in labor

presentation about Medications for labor

1. Common Drugs Used In Labor Obstetric and Gynecological nursing department Division 3 - Group 1 Cairo University Faculty of Nursing 2022-2023

2. Prepared by 1- Ibrahim Hassan Abdel-Fattah 9-Menna Gaber Samir 2- Aya Atya Gomaa 10- Hassan Dawood 3- Merna Abu Al-Saad Mikhael 11- Ayat Ibrahim lsmill elsyed 4- Hajar Ragab Bayoumi 12-Mahmoud Mohamed Mahmoud Gaballah 5- Omnya Ismail Muhammad 13-Eslam Mahmoud Mohamed Mahmoud 6- Eman Ramadan Muhammad 14-Ekramy Ashraf Maher 7- Ahmed El sayed Abdullah 15-Alshimaa shaban Abdelmotaleb 8-Mariam Mahmoud Abdel Salam 16-Mahmoud Mohamed shabaan

3. Outlines Oxytocin prostaglandin Methargin Pethidine Xylocian Dospa, Primperan & Bisolvon Actions, indications, contraindications, adverse effects, nursing care for each medication.

4. Introduction Introduction Labor is defined as regular and painful uterine contractions that cause progressive dilation and effacement of the cervix. The World Health Organization (WHO) defined normal birth as "spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and delivery. to make sure labor is smooth and less painful there are several medications that the mother can take it to facilitate and help during the process of labor and when we used this medications the health care provider need to consider the effect of medication on both mother and fetus.

5. Oxytocin oxytocin

6. Oxytocin oxytocin Induction & augmentation:- Induction of labor is defined as the artificial process of initiating labor before spontaneous onset, using mechanical or pharmacological methods. Augmentation of labor, however, is the stimulation of uterine contractions once the woman has spontaneously initiated labor, but the progress is considered inadequate. Augmentation with synthetic oxytocin may result in uterine hyperstimulation, with adverse effects such as fetal asphyxia and uterine rupture Oxytocin plays a vital role in labour and delivery. The hormone is produced in the hypothalamus and moves to pituitary where it is stored.

7. Oxytocin oxytocin Action The concentration of oxytocin receptors on the myometrium increases significantly during pregnancy and reaches a peak in early labor. Activation of oxytocin receptors on the myometrium leads to increased intracellular calcium in uterine myofibrils which strengthens and increases the frequency of uterine contractions. In humans, most hormones are regulated by negative feedback; however, oxytocin is one of the few that is regulated by positive feedback.The head of the fetus pushing on the cervix signals the release of oxytocin from the posterior pituitary of the mother. Oxytocin then travels to the uterus where it stimulates uterine contractions.The elicited uterine contractions will then stimulate the release of increasing amounts of oxytocin. This positive feedback loop will continue until delivery Causes contraction of the myoepithelial cells around milk-containing alveoli, resulting in milk ejection during lactation.

8. Oxytocin oxytocin Indication : - oxytocin is indicated in the antepartum period to initiate or improve uterine contractions for vaginal delivery - in situations where there is fetal or maternal concern. For example, It may be used to induce labor in cases of maternal diabetes, preeclampsia at or near term, and when delivery is indicated due to prematurely ruptured membranes. -Importantly, oxytocin is not approved or indicated for elective induction of labor. - Oxytocin may be used to reinforce labor in the management of abortion. - In the postpartum period, oxytocin may be used to induced contractions in the 3rd stage of labor and to control postpartum bleeding or hemorrhage.

9. Oxytocin oxytocin Contraindication ◇Cephalopelvic disproportion ◇Women at risk of uterine rupture ◇Umbilical cord prolapses ◇In fetal distress where delivery is not imminent; ◇In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma, active herpes genitals, total placenta previa, vasa previa, and cord presentation or prolapse of the cord ◇In abnormal fetal positions or presentations, such as transverse lies, which are undeliverable without conversion prior to delivery. ◇Where the uterus is already hyperactive or hypertonic ◇In patients with hypersensitivity to the drug

10. Oxytocin oxytocin -Side effects ◇Uterine hyper stimulation leading to uterine rupture ◇Cardiovascular reactions including: -increased heart rate -hypertension - cardiac arrhythmias - nausea and vomiting ◇Excessive maternal fluid retention. ◇Vaginal bleeding ◇Fetal effects related to uterine hypo perfusion include: - fetal hypoxia -bradycardia and death. • ◇Neonatal yellowing of skin or eyes

11. Oxytocin oxytocin Nursing care ◇ALWAYS administer oxytocin via infusion pump ◇Monitor blood pressure, maternal pulse, respirations, and fetal heart rate (FHR); contraction pattern every 15 minutes and with each increase in dose. ◇Monitor intake and output. ◇Ensure fetal position and size and absence of complications that are Contraindicated with oxytocin before therapy ◇Signs/symptoms of water intoxication; e.g., headache, irritability, confusion, nausea. ◇Monitor any signs of allergies ◇Monitor rate and strength of contractions discontinue drug and notify physician at any sign of uterine hyperactivity or spasm.

12. Prostaglandins

13. Prostaglandins Prostaglandins What are prostaglandins? Prostaglandins are a group of lipids with hormone-like actions that your body makes primarily at sites of tissue damage or infection. There are several different types of prostaglandins, and they play several essential roles in regulating bodily processes

14. Prostaglandins Prostaglandins Prostaglandins include , misoprostol, also referred to as PGE1 and dinoprostone, also referred to as PGE2. MECHANISM OF ACTION Stimulates collagenase in the cervix, promoting cervical ripening Increases intracellular calcium within uterine smooth muscle cells, stimulating uterine contraction Prostaglandins are produced naturally by the body during the process of labor. Their role is to prepare the cervix and to help open the cervix in response to contractions.

15. Prostaglandins Prostaglandins INDICATIONS Induction and management of abortion Cervical ripening Control postpartum hemorrhage Cervical ripening Management of spontaneous abortion Induction of abortion

16. Prostaglandins Prostaglandins CONTRAINDICATIONS Previous cesarean section or other uterine surgery Grand multiparity Cephalopelvic disproportion Unfavorable fetal position Placenta previa Pelvic infection Active genital herpes Asthma Glaucoma Hepatic, renal, respiratory, or cardiovascular disease

17. Prostaglandins Prostaglandins SIDE EFFECTS Uterine hyperstimulation Abnormal fetal heart rate Nausea Vomiting Diarrhea Diaphoresis Cardiac arrhythmias Disseminated intravascular coagulation Amniotic fluid embolism

18. Prostaglandins Prostaglandins Nursing care When using prostaglandins for cervical ripening Prior to administration Reinforce education provided by obstetrician / midwife Assessments: contraindications and precautions; cervical status, fetal lie, fetal position; baseline uterine and fetal heart monitoring If administering misoprostol, have terbutaline readily available After administration Keep client supine 15–30 minutes after receiving gel or for two hours after receiving vaginal insert Assessments: uterine activity, FHR, maternal vital signs; monitor for side effects Therapeutic response: cervical softening, minimal uterine activity, normal FHR Undesired outcomes: hyperstimulation; monitor FHR for indeterminate / abnormal patterns Provide comfort measures as needed

19. Prostaglandins Prostaglandins Nursing care When using misoprostol to control postpartum hemorrhage . Teaching: expect uterine contractions and decreased bleeding Assessments: uterine tone, amount of bleeding, vital signs; monitor for side effects Therapeutic response: increased uterine tone, control of hemorrhage Undesired outcomes: continued hemorrhage Provide comfort measures as needed

20. Methergin methargin

21. METHARGIN methargin Action Methergine (methylergonovine maleate) acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic contractions. Indications of methergin: Following delivery of the placenta, for routine management of uterine atony, hemorrhage, and subinvolution of the uterus. For control of uterine hemorrhage in the second stage of labor following delivery of the anterior shoulder.

22. METHARGIN methargin Contraindications During pregnancy , The first and second stage of labor. heart disease A stroke. Blockage or narrowing of mitral heart valve. High blood pressure. Coronary artery diseaseA blockage of the arteries called arteriosclerosis obliterans. Serious numbness or prickling or tingling of fingers and toes.

23. METHARGIN methargin ❖ More common 1) Abdominal pain 2) headache 3) increased blood pressure side effect of methargin 10) pain or discomfort in the arms, jaw, back, or neck 11) pain, tenderness, or swelling of the foot or leg 12) puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue 13) slow or fast heartbeat 14) skin rash 15) sweating 16) vomiting ❖ Rare 1) Blood in the urine 2) change in skin color 3) chest pain or discomfort 4) difficult or labored breathing 5) difficulty with swallowing 6) dizziness 7) fast, pounding, or irregular heartbeat or pulse 8) hives 9) lightheadedness, dizziness, or fainting

24. METHARGIN methargin NURSING CARE Monitor vital signs (particularly BP) and uterine response during and after parenteral administration of methylergonovine until partum period is stabilized (about 1–2 h). Notify physician if BP suddenly increases or if there are frequent periods of uterine relaxation Give IV slowly over several minutes  Monitor blood pressure closely  Monitor uterine contraction

25. Pethidine Pethidine

26. Pethidine Pethidine Action - Narcotic, analgesic and sedative drug has been traditionally used during childbirth. - Decrease moderate to sever pain. - Can taken IV slowly diluted on 10cm ringer's lactate,or IM and oral as tablet Indication -Used to relief of moderate to sever pain. - given before 2 hour of second stage of labor

27. Pethidine Pethidine Contraindication* - breastfeeding mothers. - Hypersensitivity to medication. - Respiratory problem side-effects: The most common side-effects are feeling dizzy or sleepy, sweating and nausea . Other common side-effects include headache, dry mouth, skin rash , drowsiness ,dizziness , constipation , vomiting , urinary retention ( difficulties passing urine ) , dyspnea ( difficulty in breathing ). CNS : Nervousness, headache, restlessness, uneasiness, fatigue, confusion, depression, hallucinations, tremors, muscle twitches, increased intracranial pressure and fits. CV : Hypotension ,tachycardia , palpitation. GIT : Loss of appetite, stomach cramp, muscle spasm, spincture muscle dysfunction , vomiting, constipation. Skin : Flushed, dry skin, skin rash. Other side effects: Weakness, General hypersensitivity reactions, and pain at injection site

28. Pethidine Pethidine ✓Monitor blood pressure prior to administration. Hold if systolic BP < 100 mm Hg or 30 mm Hg below baseline. ✓ Monitor patient's respiratory rate prior to administration. ✓Monitor for respiratory depression and hypotension frequently up to 24 hours after administration of pethidine. ✓Using appropriate pain scale to document whether this durg is successful in helping manage the patient's pain. ✓Identifying patients at risk for unintended advancing sedation and respiratory depression. ✓Implementing plans of care to assess and monitor patients. ✓Intervening to prevent the worsening of adverse events. ✓Monitor psychological status if there confusion . ✓Be alert seizures or increased seizure activity especially at the onset of drug treatment , document the number, duration and severity of seizures and reporting these findings immediately to the physician. NURSING CARE

29. Xylocaine Xylocaine

30. Xylocaine Xylocaine Lidocaine -Trade names: Xylocaine Class: -Local anesthesia, and anti arrhythmic Action: Local anesthesia: blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential , increasing excitation threshold and slowing conduction velocity. indications in labor: in normal delivery with episitomy we use it S.C

31. Xylocaine Xylocaine -Contraindication: allergy to lidocaine or amide-type local anethetic.CHF.cardiogenic shock.second-or third degree heart block. -Side effect: CNS: dizziness.light headedness.fatigue.drawsiness.unconsciousness.tremors twiching.vision change.may progress to seziures.convulsions. -GI: nausea.vomiting -Cv: cardiac arrhythmias cardiac arrest .vasodilation.hypotension -Respiratory: respiratory depression and arrest -Hypersensitivity: rash anaphylactic reaction -Other: malignant hyperthermia

32. Xylocaine Xylocaine *Nursing considration: -don't aded lidocain to blood transfusion. -make certain that vials "for cardiac arrhythmia". -assess for history of hypersensitivity. -use 5%dexterouse solution to prepare drug (stable for 24 hours ). -use electronic infution devics to regulare the infution of the drug. -obtain Bp .pulse .Resp.rate as basedline data to evaluate response to treatment. -drug shold be given in a monitored environment. -assess Bp frequently during adminstration. -assess for respiratory depression. -if advers reaction occur discontinue infusion&prepare for emergency management.

33. Dospa, Primperan & Bisolvon The main action of this drugs is: Soften of the cervix.Effacement of the cervix Dospa, Primperan & Bisolvon

34. Dospa, Primperan & Bisolvon ● Dospa :Antispasmodic It is used to relieve pain caused by irritable bowel syndrome, headaches, menstrual periods also Used to smooth muscle spasm highly effective in reducing the duration of active phase of labor by hastening cervical dilatation. Primperan: Antiemetic is a medicine that relieves symptoms of nausea, vomiting, heartburn, and a feeling of fullness. Bisolvon : Mucolytic This medicine is used in the treatment of cases of cough accompanied by sputum, as it helps to dissolve sputum and reduce its viscosity, and thus helps to treat the following

35. Dospa ●contraindications: 1] Liver, kidney and heart diseases 2] pregnancy 3] breast feeding 4] hypersensitivity 5] other medications as Antimuscarinics, analgesics . 6] Diabetes 7] Bedridden or immobile for a long time ● Side effects: 1) Nausea, Vomiting 2) Diarrhea 3) Dryness in mouth 4)Nervousness, Dizziness, Drowsiness 5) blurred vision 6) Photophobia 7)Abdominal pain 8)Insomnia 9) Anorexia 10) Confusion, Hallucination 11) Dry skin 12)Reduced bronchial secretions 13) Vertigo, Flatulence.

36. Dospa ● Nursing action for this drug: 1} Monitor vital signs esp.(HR and BP) 2} Monitor blood pressure during I.V administration 3} don't chew this drug 4} monitor intake and output 5} monitor characteristics of pain (monitor uterine contraction duration,frequency,intensity) 6} monitor skin for any circulatory abnormalities (allergy, flushing) 7} Monitor the patient for any side effect. 8}Make sure that the monitor does not sensitive to the drug. 9} Stay alert for any depression and some effect of CNS.

37. References Lippincott.W,Nursing2022 Drug Handbook (Nursing Drug Handbook) Pharmacology Made Incredibly Easy 4th Edition Arrowsmith, S., & Wray, S. (2014). Oxytocin: its mechanism of action and receptor signalling in the myometrium. Journal of neuroendocrinology‏ Helliwell, R. J., Adams, L. F., & Mitchell, M. D. (2013). Prostaglandin synthases: recent developments and a novel hypothesis. Prostaglandins, Leukotrienes and Essential Fatty Acids