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Chapter 37

Chapter 37. Agents Used in Obstetrical Care. The Uterus. Pear shaped organ Highly muscular Rich blood supply Smooth muscle – very strong During pregnancy uterus size increases tenfold. The Uterus. Strong rhythmic contractions can cause mild to strong discomfort or pain during labor

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Chapter 37

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  1. Chapter 37 Agents Used in Obstetrical Care

  2. The Uterus • Pear shaped organ • Highly muscular • Rich blood supply • Smooth muscle – very strong • During pregnancy uterus size increases tenfold

  3. The Uterus • Strong rhythmic contractions can cause mild to strong discomfort or pain during labor • Many drugs stimulate smooth muscle of the uterus • Oxytocic agents • Initiate or increase uterine contractions • Used to control postpartum hemorrhage or to induce post first trimester abortion

  4. Agents Used in Obstetrical Care • This presentation focuses on the following drug agents: • Uterine stimulants • Uterine relaxants • RhoGAM

  5. Oxytocin • Oxytocin is a hormone excreted by the posterior pituitary gland • Primarily stimulates smooth muscle of the uterus and mammary gland • Synthetic oxytocin (Pitocin) • Increases frequency and force of contractions

  6. Oxytocin • Dependent on estrogen’s presence • During last trimester uterus becomes more sensitive to oxytocin • Also released during intercourse to aid transport of sperm

  7. Oxytocin • Muscle contraction in mammary glands results in milk letdown • Synthetic form is Pitocin - used IV when initiating or augmenting labor • Infusion should be maintained at the lowest level to permit labor

  8. Oxytocin • Also used for postpartum hemorrhage, uterine atony, or after caesarean delivery • Can be administered IV in IV fluids or as an IM injection • When Pitocin is used before the fetus is delivered, fetal heart rate and pattern must be carefully and constantly monitored. • Pitocin during labor can cause exhaustion of uterine muscles (atony), stress on the baby, edema in the mother and other severe complications

  9. Nursing Considerations • Nurse must frequently assess vital signs, contraction strength and frequency, and fetal status during administration of oxytocin • Use of a pump for delivery is required • Able to precisely control dosage • Continuous fetal heart rate monitoring is required

  10. Ergot Derivatives • Complex mixture • Derived from fungus • Stimulates uterine smooth muscle • Ergonovine and methylergonovine • Causes powerful uterine contractions

  11. Ergot Derivatives • Not for use in induction or augmentation of labor • Used for postpartum hemorrhage • Usually given orally or IM (IV only in emergencies) • Can cause elevation of blood pressure • Potent vasoconstrictive effect

  12. Nursing Considerations • Monitor blood pressure • Monitor for development of headache • Monitor postpartum bleeding • Monitor for signs of anemia

  13. Prostaglandins • Can stimulate uterine contractions at any stage of pregnancy • Used in terminating pregnancy between 12th and 20th week • Used to treat incomplete abortion and fetal death

  14. Prostaglandins • Use of prostaglandins for induction or augmentation of labor has not been approved by the FDA • Scientific evidence confirmed usefulness • Are approved for second trimester abortions

  15. Prostaglandins • Hemabate - administered IM - used for second trimester abortion and postpartum hemorrhage • Dinoprostone - vaginal suppository or gel - promotion of cervical ripening • Adverse effects include nausea, vomiting, and diarrhea

  16. Premature Labor • Premature birth accounts for most neonatal deaths • Stopping preterm labor is desirable • Usually attempted when labor starts after 20 weeks gestation

  17. Uterine Relaxants • Prevent premature labor • Terbutaline sulfate (Brethine) • Stimulates beta2 receptors • Relaxes the uterus

  18. Uterine Relaxants • Magnesium sulfate • IV, must be titrated carefully • Deep tendon reflexes should be monitored • Calcium gluconate: antidote

  19. Nursing Considerations • Assess for signs of advancing labor • Assess for rapid heart rate or palpitations • Bed rest and pelvic rest required • Report pulse rate greater than 120 before giving dose

  20. Nursing Considerations • Educate patients terbutaline can cause anxiety and tremors • Assess for signs of anxiety and tremors • Consider obtaining order for antianxiety medication • Terbutaline may not be given for more than 48-72 hours at a time due to risk of cardiac problems

  21. RHoGAM • Sterile concentrated solution of gamma globulin • Administered IM to nonsensitized Rh-negative mothers after delivery of an Rh-positive baby • Suppresses formation of antibodies • Protects against hemolytic disease

  22. RhoGAM • Must be given with 72 hours of delivery • Never administer to an infant • Patients may experience pain at injection site, mild fever, or mild headache • Anaphylaxis is rare • Store in refrigerator; never freeze

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