labor & delivery
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| Oxytocics: oxytocis - uterine stimulants | induction of labor (postterm pregnancy, PROM, preeclampsia)
delivery of placenta (postpartum, miscarriage)
mgmt. of postpartum hemorrhage. stress testing
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| dinoprostone | a prostaglandin used to promote cervical ripening & to stimulate uterine contractions.
complications: uterine tachysystole - monitor: VSs length, strength & duration of contractions. Assess fetal status.
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| Methylergonovine | contracts the uterus & is used for emergency intervention for serious postpartum hemorrhage.
complications: hypertensive crisis (headache, n/v, increased BP)
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| oxytocics - complications | uterine rupture, uterine tachysytole, placental abruption, hyponatremia. RN consideration: monitor VSs, I&O, length, strength & duration of contractions, assess fetal status.
avoid concurrent use w/MAOIs. CNS depressants increase effects.
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| oxytocin contraindications/precautions | maternal factors: sepsis, an unripe cervic, active genital herpes, HX of multiple biths, uterine surgery. fetal factors: imm lungs, cephalopelvic disproportion, fetal malprstn, prolapsd umbl cord, fetal distrss, plactl abnormalities, threatened spontane
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| dinoprostone contraindications/precautions | cesarean birth, fetal distress, vaginal bleeding.
use w/caution w/maternal hx of hypotension, htn, athsma.
avoid concurrent use w/other oxytocics increase effects, monitor VSs, uterine activity, fetal status.
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| methylergonovine contraindications/precautions | HTN, preeclampsia, asthma, cardiac disease
use only after delivery & not during labor.
caution: w/maternal HX of severe renal or hepatic disease, DM, sepsis, epilepsy. avoid concurrent use w/vasopressors, ergots increase effects. monitor VSs.
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| nursing administration | 1 milliunits/min every 30 to 60 min.
monitor VSs 30 to 60 min. uterine contraction every 15 min. during 1st. stage of labor. every 5 min during 2nd. stage of labor, uterine tachysystole, FHR & rhythm
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| tocolytics medications | Terbutaline, hydroxyprogesterone caproate, nifedipine, indomethacin, magnesium.
delays delivery for 48 hours to allow maximum benefit of glucocorticoids to decrease the incidence of RDS.
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| terbutaline | monitor VSs, blood glucose, potassium levels
report A/Es. have propranolol available
hypersensitivity: caution w/chronic/active hepatic disease, renal disease. interactions w/MAOIs, green tea, decrease effect of beta-blockers,
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| hydroxyprogresterone caproate | inject site reactions: monitor for pain, swelling, itching & appearance of hives.
caution: uncontrolled HTN, liver disese, hx of thrombosis, breast cancer.
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| nifedipine | hypotsn, headache, dizziness, nausea . caution w/hypotsn, hepatic/ renal disease or acute MI. hypersensitivity: avoid conct use w/magnesium sulfate or terbutaline. avoid using w/grapefruit juice, ginkgo biloba, ginseng, melatonin, St. John's Wort.
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| Indomethacin | Matl: n/v heartburn, GI bleed, thrombocytopenia Fetal: neona-tal pulmonary HTN, oligohydramnios. caution: GI bleeding, hyper-sensitivity, use <32wks. gest. for 48 hrs. avoid NSAIDs, alcohol, salicylates, mtr toxicity blurred vision, ringing in ears).
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| magnesium sulfate | monitor serum magnesium level, limit fluids to 125ml/hr
have calcium gluconate available. d/c infusion w/intolerable A/Es
avoid concurrent use w/nifedipine. increase antihypertensives, calcium blockers, neuromuscular blockers, decrease effect digoxin
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| glucocorticoid meds: adm bet/n 24 & 34 wks of gestation. betamethasone 12mg IM for 2 doses 24hrs. apart dexamethasone 6mg IM for 4 doses 12 hours apart. | releases enzymes that produce & release lung surfactant to stimulate lung maturity in a fetus.
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| opioids: fentanyl, butorphanol, nalbuphine | adm w/in provide pain relief w/out causing respiratory depression in mother & fetus. adm IM or IV or IV during labor.
complications: dry mouth, n/v, neonatal depression, tachycardia, hypotension, decreased FHR variability, sedation
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| opioids contraindications/precautions | delivery w/in 1 to 4 hr of adm. if opioid is gven too soon, it can delay progression of labor. if given too late, it can depress neonatal resprations
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