Induced labour drugs

1. Done by: Marwa Alhazeen KhadeejaAbu Hwichel Sara Kouta Ekhla’s Abu Safia Nuha Abu Khater Yasmeen Abu Issa Safaa Zino Noor Alnono Induced labour drugs

2. Labour: child birth, the process of delivering a baby, the placenta, membranes and umbilical cord from the uterus to vagina to the outside world.

3. Labour done during three stages: 1. stage one( called dilation) the cervix dilates fully to a diameter of about 10cm. 2.Stage two(called expulsion) The baby moves out by uterus contractions through the cervix and vagina to be born. 3. Stage three: begins after a complete delivery of baby, and ends when the placenta and membranes are expelled.

4. There area wide range of reasons that a women may take medication during labour and birth: • To induce labour • To speed up labour • To relieve pain during labour • To speed expulsion of the placenta • To halt postpartum haemorrhage

5. Indecation of using oxytoxic drug: Premature rupture of membrane Uteroplacental insufficiency Maternal diabetes Preclampsia and clampsia Post term pregnancy IUGR Fasting the slow labour تحفيز البدء بعملية الولادة لإمرأة لم تبدأ بالأعراض Side effects: uterine overstimulation- uterine rupture- fetal hypoxia- hypotension- water intoxication. Oxytoxic Drug: Oxytocin - Prostaglandin

6. Drugs that used during labour: • Prostaglandin (Denoprostone) • We give it in first stage of labour to • Dilation of cervix prior labour • Induce contractions and speed labour • Used specially in hypertensive or G.D.M womens • Dose: 3ml administerted as (suppository, vaginal, gel).

7. Oxytocine ( pitocin, syntocinon) • We give it in second stage of labour to: • Induce and speed up labour • Halt postpartum haemorrhage • Speed expulsion of the placenta • DOSE: Administer it by I.V infusion very slowly( about 8 drops per 1 minute), put oxytocine in N/S or dextrose 5%. • Antagonist:Tractocile

8. Cytotec(Misoprostol) • Synthetic prostaglandin, used in the second stage to: • Induce and speed labour • Halt postpartum hemorrhage • May use it in gastrointestinal ulcers • Dose: 200mg administered as (vaginal, rectal suppository, sublingual tablet) • The risk of uterine rupture increases with advantage gestational ages & with prior uterine surgery.

9. Methergine • Used in third stage after complete delivery because it closes cervix • Uses: • to prevent or control postpartum hemorrhage • To speed expulsion of the placenta • Dose: ,2 mg (IV, IM, Orally) • Side effects: hypertension, seizures, N&V, coronary artery vasoconstriction, pulmonary hypertension • Contraindication: DVT, Asthma, HTN, Cardiac disease.

10. syntometrine • Belongs to a group of oxytocics • We give it immediately after delivery of baby or when see the baby's shoulder (in third stage) • We use it to: • Help the delivery of placenta • Prevent or control bleeding after delivery. • Dose: ,5-1 ml by (IV or IM) • Side effects: • Hypertension, headache, rash, dizziness, chest pain.

11. Oxygen • Administrated through an oxygen mask to labouring moms, to help mother deliver oxygen to her baby. • Oxygen mask might be given quickly if baby's heart rate is dropping due to fetal distress.

12. Pain management • There is a range of options for pain relief in labour including non medical techniques and medical pain relief options. • 1.Non medical techniques: help to reduce pain, reduce anxiety and help to better cope with labour, techniques such as: exercise gently and regularly during pregnancy, breathing techniques, warm shower, massage. • 2. Medical pain relief options: • in general there are two types of pain relief: • 1. Analgesics: lessen pain without loss of feeling or muscle movement. • 2. Anesthetics: relieve pain by loss of sensation. • Pain relief medications can either be: • 1. Systemic: affect the entire body without loss of consciousness. • 2. Regional: affect a region of the body. • 3. Local: affect only small area of the body.

13. Options that may be used in delivery: Epidural block: is the local anesthesia or analgesic used for vaginal birth and also for caesarean sections, pain medications are given through a tube placed in the space at the base of the spine. Spinal block: is a regional anesthesia used in CS only, pain medication are administered into the spinal fluid. General anaesthesia: mother is completely a sleep and doesn't have sensation or consciousness, used only in caesarean.

14. Analgesics: drugs that relieve pain without loss of muscle function, such as: • Pethedine • Is a strong pain reliever (analgesics) • Used in labour to relieve pain and help in dilation of cervix prior to labour. • Give it as I.M or I.V slowly injections. • It can cause nausea, so we administer anti nausea medication at the same time (Pramine) • Other side effects: • Respiratory depression for mom and baby.

15. Hyoscine( Scabotyl) • Antispasm, relieving spasm in the smooth muscles of gastrointestinal tract, biliary, urinary tract and female genital organs. • Promethazine: (Phenergan) • Antihistamine and antiemetic.

16. hyoscine &phenergan • We use hyoscine and phenergan together in first stage to: • Soften and dilate the cervix • Shortens the duration of first stage (dilation of cervix) • Decrease of labour pain. • DOSE: • Inject of 25mg of phenergan I.M in dilatation 3-5cm. • Inject 20mg of hyoscine I.M in dilatation 3-5cm.

17. Dexamethasone(decort) • It is a part of corticosteroids (anti inflammatory) • We may use it in case of allergy caused by hyoscine • Use it in unexpected premature labour, to stimulation of fetal lung maturation (bronchodilator) • Decrease number of neonates with respiratory distress syndrome and improve survival in preterm delivered neonates. • Help in relieve pain during labour.