SUBMITTED BY

SUBMITTED TO

MS DIMSEY .R.MARAK
MS SUBHASHINI.G

1ST YEAR MSC NURSING

HOD OBG NURSING

P.I.O.N.
P.I.O.N.
 MASTER PLAN

TOPIC : PHARMOCO DYNAMICS IN

OBSTETRICS

UNIT : VII

COURSE AND YEAR : MSC NURSING 1ST YEAR

DATE AND TIME :

NAME OF THE STUDENT : MS DIMSEY.R.MARAK

NAME OF THE SUPERVISOR : MS SUBHASHINI. G.

SUBJECT : OBSTETRICS AND

GYNAECOLOGY NURSING
 SL .NO CONTENT

1. INTRODUCTION
2. OBJECTIVES
3. TERMINOLOGIES
Teratogenic
Orgenogenesis
Hypotonea
Substance
4. CONTENT
• Definition
• Drug used in pregnancy, labour, and post
natal mothers
• Drug used in new born
• Definition of analgesics and types
• Definition of anaesthesia and types
• Role and responsibilities of midwifery
• Standing orders.
5. CONCLUSION
6. BIBLIOGRAPHY
7. ABSTRACT JOURNAL
INTRODUCTION

Most women are exposed to drugs of one type or another

during pregnancy. These may be prescribed drugs or those
bought over the counter. They may be given as part of the
management of the pregnancy itself or that of coincidental
medical problem. However, when considering the use of any
drugs in a pregnant or breastfeeding woman, it is important to
consider the effects of drug not only on the women itself, but
also on the foetus or neonate. Many drugs have undesirable
effects of the foetus and should therefore be avoided during
pregnancy. On the other hand, some drugs are given to the
women because of their therapeutic effects on the foetus.

DEFINITION: Drogue means a dry herb in French is a

substance used in the diagnosis and present or treatment of a
disease

DEFINITION BY WHO:

Drug is any substance or product that is used or intended to be

used to modify or explore physiological systems or pathological
status for the benefit of the recipient.

DRUGS USED IN PREGNANCY

➢ Folic acid:

It is recommended that all women planning a pregnancy should

take folic acid in a dose acid of 400mg daily and that this
should continue throughout the first trimester. Folic acid is a
vitamin that is involved in the process of cell growth and
division. There are no risks associated with folic at this dose.

➢ Iron preparation:

Iron is one nutrient requesed for production of hune

compounds; especially haemoglobin in the red blood cells.Both
 mother and foetus produce red blood cells, during the last
trimester, the foetus absorbs more iron to produce blood.
Supplements may cause nausea and constipation.

➢ Antacid drugs: antacids are alkalis that act by reducing the

acidity of stomach acid. Modern antacid drugs are mostly
based on calcium, magnesium and aluminium salts, which are
relatively non-absorbable. They are often combined with
alginates, which coat the lining of the oesophagus and stomach
and therefore reduce contact with stomach acid. Because they
are relatively non-absorbable, they are safe for use in
pregnancy.

ANTIHYPERTENSIVE DRUGS:

Antihypertensive drugs are used in hypertensive disorders of

pregnancy. The commonly used drugs. They are as follows

➢ Methyldopa: It stimulates central a-adrenergic receptors

or acts as false transmitter, resulting in reduction of arterial
pressure.

Dose and administration: 250mg BID to 1gm TID orally and

IV infusion 250-500mg

Side effects: Nausea vomiting, diarrhoea, constipation,

bradycardia angina weight gain, drowsiness, dizziness
headache and depression

➢ Labetalolis:It is a nonselective b blocker

Dose and administration: 100mg tid upon 800mg daily AC

HS and IV infusion

1-2mg/min until desired effect.

Side effects: Orthostatic hypotension, bradycardia, chest,

pain, drowsiness

, headache, nightmares, lethargy, sore throat, dry burning

eyes.
➢ Propranolol: It is b adrenergic blocker-decreases preload,
after load, which is responsible for decreasing left ventricular
end diastolic pressure and systemic vascular resistance.

Dose and administration: 80mg-240mg in divided doses

orally.

Side effects:

Maternal: Severe hypotension, sodium retention, bradycardia,

bronchospasm, cardiac failure.

Fetal: Bradycardia and impaired foetal responses to hypoxia,

IUGR with prolonged therapy, neonatal hypoglycemia.

➢ Nifedipine: It is calcium channel blocker and

produces direct arteriolar vasodilatation by inhibition of
inward calcium channels in vascular smooth muscles.

Dose and administer: 5-10mg TID AC HS

Side effects: Flushing, hypotension, palpitations, bradycardia,

inhibition of labour headache, fatigue, drowsiness, nausea,
vomiting

➢ Sodium nitroprusside It is peripheral vasodilator, directly

relaxes arteriolar, venous smooth muscle, resulting in
reduction of cardiac preload and after load.

Dose and administration: IV infusion 0.5mg-

10mg/kg/minute.

Side effects:

Maternal

Nausea, vomiting, severe hypotension. Restlessness decreased

reflexes, loss of consciousness.

Fetal: Toxicity, due to metabolites-cyanide and thiocyanate.

DIURETICS: Diuretics are used in the following conditions

during pregnancy
Pregnancy induced hypertension with massive oedema.

Eclampsia with pulmonary edema.

Severe anaemia in pregnancy with heart failure.

Prior to blood transfusion in severe anaemia

Frusemide:A loop diuretic acts on loop of Henle by increasing

excretion of sodium and chloride.

Dosage and administration:

Tab 40mg daily following breakfast for 5 days a week .In acute
conditions, the drug is administered parenterally in doses of
40mg-120mg daily.

Side effects:

Maternal: Weakness, fatigue, muscle cramps, hypokalaemia,

hypocalaemia hyponatraemia and postural hypotension.

Fetal: May occur due to decreased placental perfusion leading

to foetal comprise. Thrombocytopenia and hyponatraemia are
other hazards.

Hydrochlorothiazide: It is sulphonamide derivative and acts on

distal tubule by increasing excretion of water, sodium, chloride
and potassium.

Dose and administration: Orally 25-100mg/day

Side effects: Polyuria, glycosuria, frequency, nausea, vomiting,

anorexia, rash urticaria, fever.

TOCOLYTIC AGENTS:

These drugs can inhibit uterine contractions and used to

prolong the pregnancy. In women who develop premature
uterine contractions, in addition to putting them to absolute
bed rest and sedating, tocolytic drugs are administered in an
attempt to inhibit uterine contractions.
Isoxsuprine (duadilan): It acts directly on vascular smooth
muscle, causes cardiac stimulation and uterine relaxation.

Dose and administration:

Initial: I V drip 100mg in 5 percent dextrose. Rate 0.2mg per

minute to continue for at least two hours after the contractions
cease.

Maintenance: IM 10 mg six hourly for 24 hours, tab 10 mg 6-8

hourly.

Side effects: Hypotension, tachycardia, nausea, vomiting,

pulmonary edema, cardiac arrhythmias, adult respiratory
distress syndrome.

RITODRINE hydrochloride (yutopar): Uterine relaxant-acts

directly on vascular smooth muscle. Causes cardiac stimulation
and uterine relaxation.

Dose and administration:

Initial: IV drip 100mg in 5% dextrose. Rate, 0.1mg per minute

gradually increased by 0.05mg per minute q10 min until
desired response. To continue for at least 2 hours after the
contractions cease.

Maintenance: Tab 10 mg 6-8 hourly

P.O 10 mg given half hour before termination of IV per minute

Side effects: Hyperglycaemia, headache, restlessness,

sweating, chills and drowsiness, nausea, vomiting, anorexia
and malaise.Alterd maternal and foetal heart tone and
palpitations.

ANTICONVULSANTS:
The commonly used anticonvulsant is magnesium
sulphate.Diazepam; phenytoin and phenobarbitone are also
used.

MAGNESIUM SULPHATE: It decreases acetylcholine in motor

nerve terminals, which is responsible for anticonvulsant
properties, thereby reduces neuro muscular irritablitity.It also
decreases intracranial edema and helps in dieresis and
depressant action on the uterine muscle and CNS.

Dose and administration For control of seizures,20ml of 20%

solution IV in 3-4 minutes; to be followed immediately by 10ml
of 50% solution IM< and continued 4hourly till 24 hours
postpartum. Repeat injections are given only if the knee jerks
are present, urine output exceeds 100ml in previous 4 hours
and the respirations are more than 10/minute. The therapeutic
level of serum magnesium is 4-7 mEq/L.

4gm IV slowly over 10min, followed by 2gm/hr, and then

1gm/hr in drip of 5% dextrose for tocolytic.

Side effects

Maternal:Severe CNS depression evidence of muscular

paresis(diminished knee jerks)

Fetal: Tachycardia,hypoglycaemia

Depresses subcortical levels of CNS, anticonvulsant and

antianxiety.

Dosage and administration:PO, 2 -10 mg tid-qid with milk or

food to avoid G.I symptoms

IV, 5-10 mg(bolus),2 mg/min may repeat q5-10 min, not to

exceed 60 mg,may repeat in 30 min if seizures reappear.

Side effects

Mother:Hypotension,dizziness,drowsiness,headache.
Fetus:Respiratory depressant effect, which may last for even
three weeks after birth.Hypotonea and thermoregulatory
problems in newborn.

PHENYTOIN(Dilantin):

It inhibits spread of seizure activity in motor cortex.

Dosage and administration

Eclampsia-10 mg/kg IV at the rate not more than 50mg/minute,

followed 2

Hours later by 5mg/kg.

Epilepsy-300-400mg daily orally in divided doses.

Side effects

Maternal:Hypotension, cardiac arrhythmias and phlebitis at

injection site.

Fetal :Prolonged use by epileptic patients may cause

craniofocal abnormalities; MR, microcephalcy and growth
deficiency.

Dose and administration :

120-240mg/day in divided doses

Maternal :Sedation, drowsiness,hangover headache,

hallucination.

Fetal: Withdrawal syndrome.

ANTICOAGULANTS:

HEPARIN:It prevents conversion of fibrinogen to fibrin.

Dose and administration

Administered parenterally; only 5,000-7,000 IU to be

administered initially as
IV push followed by 2,500 units subcutaneously every 24 hours.

Side effects

Leukopenia, thrombocytopenia, osteoporosis, haemorrhage

alopecia.

ANALGESICS

PETHIDINE: It is synthetic narcotic analgesic agent, well

absorbed by all routes of administration. It actions to inhibits
ascending pain pathways in central nervous system, increases
pain threshold and alters pain perception.

Dose and administration

Injectable preparation contains 50mg/ml, can be administered

SC, IM, and IV. Its dose is 50-100mg IM combined with
promethazine 25mg.

Side effects

Mother: Drowsiness, dizziness confusion, headache, sedation,

euphoria, nausea and vomiting

Fetal: Respiratory, depression, asphyxia.

NALBUPHINE (Nubain): It is classified as a narcotic agonist-

antagonist analgesic that works by interacting with opiate
receptors in the central nervous system.

Dose and administration: It is given10-20mg subcutaneous or

intravenous every 3 to 6 hour.

Side effects: respiratory depression, headache, sedation,

dizziness, nervousness, restlessness confusion, nausea and
vomiting.

Foetal: Respiratory depression.

160mg in 24hour intramuscular or intravenous

Fentanyl: It is a synthetic narcotic analgesic agent.

DOSE AND ADMINISTRATION: 0.05-0.1mg IM q 1 to 2 hours

prn. Available in injectable form, 0.05mg/ml.

SIDE EFFECTS: Dizziness, delirium,

euphoria,nausea,vomiting, muscle rigidity, blurred vision.

PROMETHAZINE(Phenergan): It is an antihistamine,H1 -
receptor antagonist belonging to the phenothiazine group.It is
used in 1st stage of labour

DOSAGE AND ADMINISTRATION:Available for oral use as

12.5,24 and 50mg tablets and for parenteral use as 25 and 50
mg/ml solutions.The dose is 25mg, 8 hourly orally and 25 mg
intramuscularly, to be repeated as necessary.

SIDE EFFECTS: Drowsiness, dizziness,poor coordination,

fatigue, anxiety, confusion neuritis, parasthesia.

DRUG USED IN LABOUR

OXYTOCIN: It is a hormone normally produced by the

posterior pituitary;it stimulates uterine contractions.It may be
used either to induce labour or to augment a labour that is
progressing slowly because of inadequate uterine contractions.

Indications for pregnancy

To induce abortion
To expedite expulsion of hydatidiform mole
To stop bleeding following evacuation
To induce labour

Labour

To augment labour
To prevent and treat PPH.

Postpartum

To initiate milk let-down in breast engorgement

DOSAGE AND ADMINISTRATION

Controlled and intravenous infusion begin induction at 0.5

milliunits/min and increase dose 1 to 2 milliunits/min intervals
of no less than 30 to 60 min until adequate progress is
achieved.

SIDE EFFECTS

Hypertonic uterine activity

Foetal distress and fetal death
Uterine rupture
Hytopension
Neonatal jaundice

ERGOT DERIVATIONS :It acts directly on the myometrium.It

stimulates uterine bleeding. It is used in the treatment and
prevention of PPH.As the drug produces titanic uterine
contractions,it should only be used after delivery of the anterior
shoulder or following delivery of the baby.

DOSAGE AND ADMINISTRATION: 0.2mg IM every 2-4 hour

and 0.5-1mg tablets.

SIDE EFFECT

 Hypertension, nausea ,vomiting headache.

 Prolonged use in puerperium may interfere with lactation
by decreasing the concentration of prolactin.
 Prolonged use may lead to gangrene of the toes due to its
vasoconstrictive effect.

PROSTAGLANDINS(PGS): Prostaglandins are synthesized

from one of the essential fatty acids, arachidonic acid, which is
widely distributed throughout the body.It is induction of
abortion during second trimester and as well as for induction of
labour in intra- uterine death of fetus.

DOSE AND ADMINISTRATION:

Tablets- containing 0.5 mg prostin E2

Vaginal suppository-containing 20mg PGE2 or 50 mg PGE2α

Injectable ampoules or vials of prostin E2 1mg/ml Prostin F2α

5mg/ml.

SIDE EFFECTS

Headache, dizziness, hypotension leg cramps, joint swelling

blurred vision.

DRUG USED IN NEWBORN

BRONCHODILATORS:

Adrenaline (Epinephrine) 1mg / ml (1:1000 concentrations)

it used as a part of newborn resuscitation cardio-pulmonary
resuscitation

Dose 0.1-0.3ml/kg/dose of 1:10,000 dilutions, repeat every 3-5

minute, if necessary.

Route intravenous or endotracheal route .direction: Take 0.1 ml

in syringe.Dilute it with 0.9ml to make with water for injection
(10 times dilution)

Aminophylline injection 250 mg in 10 ml ampoules. It used for

apnoea of prematurity.

Dosage loading does:5.0-8.0mg/kg intravenous.Maintenance:1-

2mg/kg/dose q 8 hourly intravenous.

Directions for use: 250mg/10ml vial. Take 0.1ml of solution in

1ml syringe. Dilute with 0.9ml to make 1ml with water for
injection. Resultant concentration is 2.5mg/ml.Administer
required dose IV over 2 minutes.

Compatible: With 5% dextrose, normal saline, ringers lactate.

Calcium gluconate

Presentation: 9mg/ml

Uses: Treatment of low blood calcium level.Dosage:1-

2ml/kg/dose every 6-8 hourly intravenous (infusion or bolus)

Direction for use

1. To be diluted in equal amount of distilled water.

2. Inject very slowly while monitoring heart rate. If there is

bradycardia discontinue the injection.

3.Take care to avoid extravasations, if being given as infusion-

as it may cause sloughing of skin.

ANTIBIOTICS

Ampicillin

Presentation: injection 100, 250,&500 mg vials

Dosage: 50-100 mg/kg/day divided q 8-12 hourly,IV IM

Meningitis: 100-200 mg/kg/day divide q 6-8 hourly IV

Directions: 250mg vial. Add 2.5ml water for injection. Resultant

concentration 50mg/ml.

Compatible: Normal saline, ringer lactate.

Amikacin:

Neonates

Single daily dosing IV, IM.Under 30 week gestation 7.5

mg/kg/dose 24hourly.

30-35 week gestation: 10mg/kg/dose 24hourly

Term: Week 1 of life: 15mg/kg/dose 24 hourly

Week 2 to 4 of life: 22.5mg/kg/dose 24 hourly

Infants and children to 10 years. Single daily dosing

22.5mg/kg/dose 24 hourly.

ANTICONVULSANTS

Phenobarbitone

Presentation: Injection 200mg/ml 1ml ampoules. It used in

neonatal seizures.

Dosage: Loading dose: 15-20mg/kg IV

Maintenance: 3-5mg/kg/day PO in 1-2 divided doses.

Direction for use 200mg/1ml.give required amount slowly over

15-20 minutes.

Phenytoin100mg /2ml

Dosage: Loading dose: 15-20mg/kg IV

Direction for use Dilute in normal saline and give slowly at a

rate 1mg/min infusion.

Compatible Normal saline only

ANALGESICS AND ANTIPYRETICS

Acetaminophen: 40 to 65 mg /kg/24hour orally in 4 divided

doses.

Paracetomal: 40 to 65 mg /kg/24hour orally in 4 divided doses.

ANTIEMETICS:

Promethazine: 0.25mg to 0.5mg/kg/dose-repeat 6 hour later.

Domperidone: 0.3 to 0.6mg/kg/24 hour in divided doses.

ANALGESICS AND ANAESTHESIA

Pain is a highly subjective experience. Pain is whatever the

client says it is. The amount and type of pain experienced
during labour vary widely from person to person. During labour
different types of pain arise from different sources. As the
uterus contracts and the cervix dilate, the client feels visceral
pain as described persistent, aching, or spreading. The pain
may be localised to the abdominal region or felt in the lower
back, hips or thighs. Some women describe generalised aching
throughout the body. This type of pain is intensified by fatigue.
Another type of pain sensation is caused by pressure of the
descending foetus as it stretches the birth canal. This type of
generalised body pain is called somatic pain described as
intense pressure or need to bear down, is typically most
intense during the transition phase of the first stage of labour
and during the second stage of labour.

Analgesia is the use of medication to reduce the sensation of

pain.

PARENTERAL AND INHALATIONAL ANALGESIA

ξ Parenteral narcotics: Pethidine is the most frequently

used narcotic given intramuscularly. It is administered in a
dosage of 50mg to 100mg intramuscularly with 2 to 4
hours interval. Alternatively it can titrated intravenously to
effect in the presence of severe pain for a rapid response.
Morphine can also be administered but it is not frequently
used as the neonatal respiratory depression and maternal
nausea and vomiting associated with morphine are more
severe.
ξ Inhalational analgesia: Nitrous oxide is the main
inhalational anaesthetic that is used for obstetric
analgesia. It is used mainly in a 50:50 combination with
oxygen. It is delivered with a demand valve and there will
not be any flow from the system unless an inspiratory
effort is made with the mask properly sealed on the face.
It may produce light headedness and nausea. It is suitable
for use when the mother is in severe pain especially
during late whilst waiting for the effects of other methods
to take their effects.
 REGIONAL ANALGESIA
Regional analgesia is the most effective method of
providing labour analgesia for the mother currently
available and is more costly and need the services of an
anaesthetist in their administration and maintenance.
ξ Epidural analgesia: This involves the administration of a
dilute amount of local anaesthetic either in the form
bupivacaine combined with a low concentration of short
acting narcotic like fantasy through a catheter placed in
the epidural space and administered either in the form of
bolus doses by a doctor or nurse.
ξ Combined spinal epidural (CSE) analgesia: This
technique is fairly similar to an epidural except that after
the epidural needle is an in the epidural space, a long
spinal needle is placed through this needle to the
intrathecal space. The CSE set is more expensive
compared to an epidural set.
ξ Spinal analgesia: This method which involves the
administration of a small amount a local anaesthetics and
narcotic into the intrathecal space as a bolus dose is not
frequently used for labour analgesia. The local anaesthetic
provides only 1 to 3 hours of pain relief which may not be
adequate to cover pain toward the end of the first stage or
second stage.

Complications:
Complication can arise from these methods in the form of
hypotension, spinal headaches, and convulsions,
peripheral or central neurological damage.

ANAESTHESIA

Anaesthesia is the use of medication to partially or totally block

all sensation to an area of body. It may loss of normal
sensation, and sometimes in loss of consciousness.
Local infiltration: It is the least extensive form of anaesthesia
and presents the lowest risk to the mother and fetus.It is
administered by direct injection of the anaesthetic agent, such
as lidocaine, into the perineal tissue surrounding the area
where the episiotomy will be made. Local anaesthesia is
performed immediately before the delivery and blocks
sensation long enough for the delivery and for repair of the
episiotomy. The most side effects are hypotension, dizziness,
palpitations and headache, tachycardia or tremors.

REGIONAL ANAESTHESIA

Regional anaesthetics block a nerve or group of nerves without

causing loss of consciousness. This form of anaesthesia allows
the women to remain alert and able to participate in the
delivery. Regional forms of anaesthesia are most commonly
recommended by health care providers and chosen by
expectant. It includes paracervical,pudendal, epidural and
spinal blocks.

Paracervical Block :Paracervical Block prevents impulse

transmission from the lower segment of the uterus surrounding
the cervix.It is accomplished by injecting a local anaesthetic
transvaginally,adjacent to the outer rim of the cervix.It may be
administered during the active phase of labour, achieving rapid
and complete relief of uterine pain during cervical dilation. It
does not block pain impulses from the vagina or perineum and
also not interfere with the bearing down reflux. It is used
infrequently.

Pudendal Block: Pudenda Block prevents impulse

transmission through the pudendal nerves, which transmit
impulses from the perineum. The pudendal nerve is located
near the lower margin of the ischial spines. Injection of the
pudendal nerves is accomplished by the transvaginal route. A
long needle, with or without a protective guide (sometimes
called a trumpet),is used to instill medication around the
nerves on each side of the body. The pudendal block is given
within a few minutes of delivery and gives result in relaxation
of the muscles of the perineum hastening the delivery. It also
blocks pain transmission when episiotomy is performed and
repaired.

Epidural Block: Epidural anaesthesia results in loss of

sensation from the lumbosacral region of the spinal cord by
blocking impulse transmission from major nerve roots located
outside the dura mater.While the pain impulses are blocked by
epidural anaesthesia, sensation of manipulation or pressure
can still be detected by the women. It administered by the
epidural route affects the lower trunk and legs; therefore it can
be used during labour and during either vaginal or caesarean
delivery. Epidural anaesthesia is accomplished by insertion of a
needle or catheter into the epidural space and medication is
inserted through the needle or catheter so that it can flow
around the dura mater and may be administered as a single
dose shortly before delivery. The site of insertion will vary
based on the type of epidural selected. In the lumbar epidural
the needle or catheter is inserted into the space between
vertebrae L4 and L5 using surgical aseptic technique.

Spinal Block: Spinal anaesthesia causes loss of sensation to

the lower trunk and lower extremities by blocking transmission
of nerve impulses from major nerve roots located within the
subarachnoid space of the spinal column. It is not typically
used for vaginal delivery but is reserved for caesarean delivery.
It is administered using a procedure similar to that used in a
spinal tap.

GENERAL ANAESTHESIA

General anaesthesia is administered intravenously or by

inhalation. Medications used for general anaesthesia given by
inhalation include the gases nitrous oxide, halothane,
enflurane, and isoflurane.Intravenous medications used for
include ketamine and thiopental sodium. General anaesthesia
using is not common because of the risks it presents to both
the mother and fetus.It may be used for routine caesarean
sections but is less desirable than spiral anaesthesia. It may be
required in emergency situations when rapid administration of
anaesthesia is essential or in cases where a regional
anaesthesia is contraindicated because of other medical
conditions such as infection, malformation of the spinal column.

When general anaesthesia is anticipated, the woman is given

supplemental oxygen before surgery in order to increase the
oxygen saturation level. An intravenous line is established so
that there is direct access to the vasculature. The intravenous
line is used to administer anaesthetics for induction and to
provide immediate access for any other medications that may
be needed.

All parturient for caesarean section, more so those who have

undergone a period a labour and given narcotic parenterally
are considered to have “full stomach” as they have delays in
gastric emptying. These when aspirated whilst they are
rendered unconscious during the administration of a general
anaesthesia can give rise to consequences that can threaten
the mother’s life. Hence, general anaesthesia for caesarean
section whether in an elective or emergency situation involves
a “crash induction” which is the administration of an induction
agent together with a very rapid- acting muscle relaxant whilst
cricoids pressure is applied before the endotracheal tube is
inserted and its cluff inflated.

TYPES OF GENERAL ANAESTHESIA

Nitrous oxide: The anaesthetic, which is 40 percent nitrous

oxide and 60 percent oxygen, is administered by facemask
or inhaler. Its induction is fast and pleasant and it is non-
irritating, on-explosive and less disruptive of physiological
functions than any other general anaesthetic. Its main use is
in the second stage of labour, as an induction agent or as a
supplement to more potent general anaesthesia.
Halothane (Fluothane): Not used as frequently as nitrous
oxide, halothane nevertheless bears mention for obstetrical
anaesthesia. Its induction is rapid, predictable and safe,
since it causes little or no nausea or vomiting. It provides
 moderate to good uterine relaxation, although it may cause
respiratory depression as well as irritability of cardiac tissue,
which can result in arrhythmia. It may also cause increased
uterine contraction along with the risk of postpartum
haemorrhage.
Methoxyflurane (Penthrane): Administered by inhaler for
analgesia, or in combination with other agents for
anaesthesia, methoxyflurane induction is pleasant but
slower than with gas agents. Uterine contraction may result
from its use, and administration is restricted to low doses for
short periods because of the risk of postpartum bleeding.
Thiopental sodium (Pentothal): This ultra short-acting
barbiturate is given intravenously and it produces narcosis
within 30 seconds. Induction and emergence are smooth
and pleasant, with little nausea or vomiting. It is most
frequently used for induction or as an adjuvant to more
potent anaesthetics.

ROLES AND RESPONSIBILITIES OF MIDWIFERY NURSE

PRACTIONER.

Midwives must

➢ Know and comply with the state laws and regulations

regarding prescribing of medications.
➢ Know and comply with the state nurse practice act related
to medication prescribing authority.
➢ Limit access to prescription pads and notify local
Pharmacies and the drug enforcement agency if blank
prescriptions are stolen.
➢ Limit telephone refills to one prescription and require the
patient to come in and be seen before providing additional
telephone refills,
➢ Avoid refilling narcotics and pain medication by telephone
and outside of regular office hours
➢ Perform peer review of the prescribing practices of
licensed independent practitioners and obtain additional
education and expertise as needed
➢ Maintain drugs in a safe area with limited access and if
appropriate or required by law, under lock and key
 ➢ Store drugs at manufacturer’s recommended
temperature
➢ Store drugs in a separate location away from food or other
materials or supplies
➢ Avoid storing similar looking drugs near one another
➢ Avoid keeping drugs with similar sounding names o the
formulary, but if such similarities do occur, provide
adequate additional warnings on packaging
➢ Regularly check drug expiration dates and properly
discard/destroy expired drugs prescribing medications
➢ Know the appropriate indications, dosage range,route(s)
of administration, contraindications, side effects, and
warnings related to the drugs prescribed and/or
administered
➢ Maintain readily available, current drug reference
materials and refer to them whenever there are questions
regarding a drug or when prescribing a drug that is not
frequently prescribed.
➢ Maintain access to resources that provide clinical
information on drug interactions.
➢ Consult with physicians and pharmacists when
appropriate to confirm appropriate drug selection,
prescription and ordering, and to check for potential drug
interaction or contraindication with patient’s existing drug
therapy.

STANDING ORDERS

The objectives of the public health policy in health care by

MOHFW are:
1) To further develop health care services with improved
access and quality to respond to the needs of disadvantaged
groups.
2) To ensure that no one is denied services due to inability to
pay.
3) To ensure better and equitable utilization of services.
1. Increased health spending
2. Promotion of the third sector (not-for- profit voluntary sector)
3. Restructuring the public health systems to increase
accountability 40
i) Upgradation of health facilities will be linked with reform in
hospital management, financing and accountability systems.
This is covered in greater detail in other sections.
ii) Systems for collection, compilation, analysis and feedback of
relevant data will be developed for evidence based policy
formulation and programmatic interventions with
disaggregated data, focussing on the disadvantaged.
Economic, gender, social and geographical factors will be used
in the disaggregation.
iii) Need based planning and budget allocations will be made in
accordance with the extent of disease burden, economic
backwardness and poverty levels of regions, districts and
blocks.
4. Promoting Social Health Insurance
5. Improving public sector efficiency and utilization through a
mix of inputs
6. Management Information System for data on health
indicators for the poor and disadvantaged
7. Differential Planning and Budgeting 41
i) Where required regulatory mechanisms will be
established to ensure optimum utilization of facilities by
the poor and disadvantaged. Medical audit and innovative
mechanisms to check exploitation and malpractices will be
instituted.
ii) To ensure health care in tribal and remote / hilly areas,
mapping of health facilities will be done and deficiencies
made good through mobile health units. Local bodies
(PRIs) will be encouraged to establish and run mobile
health units in tribal areas.
iii) Appointment of Community Health Workers in tribal
areas, selected from the habitation by the community,
trained and paid by the state (as done in Andhra Pradesh)
will be done with necessary modifications made to gain
community support, participation and self-reliance.
Involvement of traditional healers and dais will be
encouraged, with training and linkages with support
systems.
iv) The existing shortage of PHCs in tribal areas will be
made good by establishing approximately 39 new PHCs.
This will however be done on the basis of a detailed facility
mapping exercise, and in consideration of other factors
 influencing access of tribal people to adequate primary
health care
v) Facilities in all block PHCs will be upgraded in a phased
manner, and in Blocks where no CHCs exist the remaining
Block PHCs will be converted into CHCs.
• vi) Cost effective interventions will be made through the
infrastructure and manpower available in the established
private sector, local bodies and NGO establishments (as in
West Bengal, Karnataka and Andhra Pradesh on public.
8. Strengthening incentives, regulation and redress
mechanisms
9. Outreach services in inaccessible areas
10. Establishing more PHCs in tribal areas and converting all
block PHCs into CHCs 42
Private partnership basis to address health needs of the urban
poor. Services of doctors and allied health professionals for
basic and specialist care may be contracted from the private
sector.
ii) Donations and sponsorship will be sought from the private
sector and philanthropists to support particular interventions
e.g., for street children’s health care and health promotion in
government and municipal schools.
11. Primary health care in urban slums

CONCLUSION: Medication taken in pregnancy can harm the

unborn child through teratogenic effects. Teratogenic effects
may take the form of malformations that occur during the
period of organogenesis or subsequently by causing alterations
in the structure or function of organ systems formed during
orgenogenesis.It is important to remember for the safety and
well being of the women, all prescriptions for medication are
legible and clear in their instruction.It is equally important that
prescribed medicines are given at the appropriate time.

JOURNAL ABSTRACT:

“Drugs which have been taken by only a limited number of

pregnant women and women of childbearing age, without an
increase in the frequency of malformation or other direct or
indirect harmful effects on the human foetus having been
observed.”

“Every child comes with the message that God is not yet discouraged of man”
Rabindranath Tagore

BIBLIOGRAGRAPHY

1. Annamma Jacob “A comprehensive textbook of mifwifery”

Chapter 54,2005 edition, Jaypee brothers medical
publishers,New Delhi.P 624-642.
2. V.Sivanesaratnam,Alokendu Chatteerjee,Pratap Kumar.
“Essential of obstetrics”Chapter 31, 2004 1st edition, Jaypee brothers
Medical ,New Delhi 110002.P.250-257.
3. Diane M.Fraser,Margaret A. Cooper. “Myles Textbook for Midwives”
Chapter 48 ,Fourteenth edition Churchill Livingstone,London New
York .P905-917.
4. Gloria Hoffmann Wold “Contemporary maternity
nursing”Chapter 11,1997 Mosby, P225-235.
5. D.C.Dutta ,Hiralal Konar. “Text book of obstetrics: in pregnancy”
Chapter33 6th edition 2004,New Central Book Agency (P) LTD.P498-519.
6. Nightingale nursing times Vol 4, Issue 5, August 2008.
7. Health action October 2009
 TERMINOLOGIES
• Substance: material constituting an organ or body

• Dose: the quantity to be administered at one time as a

specified amount of medicine.

• Teratogenic: an agent that causes physical defects in

the developing embryo.

• Organogenesis: the origin and development of organs

• Thiocyanate: a salt analogous in composition to a

cyanate, but containing sulphur instead of oxygen.

• Hyponatraemia :deficiency of sodium in the blood.

• Hypotonia: diminished thymus activity.

• Microcephaly:having an abnormally small head.

• Vasoconstrictive:decrease in the calibre of blood

vessels.
• Inspiratory:the drawing of air into the lungs

• Alginates: a salt of alginic acid .