Drug name: Oxytocin (Pitocin)

Dose, route, frequency:

o Induction/stimulation of labor: IV 0.5-2 mU/min; increase by 1-2 mU/min
q 15-60 min until pattern established (usually 5-6 mU/min; maximum 20
mU/min) then decrease dose
o Postpartum Hemorrhage: IV 10 U infused at 20-40 mU/min; IM 10 U
after delivery of placenta
o Incomplete/inevitable abortion: IV 10 U at a rate of 20-40 mU/min
Indications for OB use:
o IV: induction of labor at term
o IV: facilitation of threatened abortion
o IV, IM: postpartum control of bleeding after expulsion of the placenta
o Action: stimulates uterine smooth muscle, producing uterine contractions
similar to those in spontaneous labor. Has vasopressor and antidiuretic
effects. Therapeutic effects: induction of labor and control of postpartum
bleeding
Common Side Effects: Maternal coma, seizures, hypotension, hypochlorhemia,
hyponatremia, water intoxication, increased uterine motility, painful contractions,
abruptio placentae, decrease uterine blood flow, and hypersensitivity
Contraindications: Contraindicated in hypersensitivity and anticipated
nonvaginal delivery. Use d cautiously in first and second stages of labor; slow
infusion over 24 hour has caused water intoxication with seizure and coma or
maternal death caused by oxytocins antidiuretic effects
Effects/Implications for pregnancy or breastfeeding: This is a category X
medication in pregnancy.
o Fetal side effects: Intracranial hemorrhage, fetal asphyxia, hypoxia,
arrhythmias, water intoxication
o Oxytocin is an essential hormone in lactation. Administration of oxytocin
to mothers having difficulty in breastfeeding has not been clearly shown to
have a beneficial effect on lactation success or in the treatment of breast
enragement. Effects on the infant are unlikely when given during
breastfeeding but some studies suggest that oxytocin given during labor
can negatively affect breastfeeding, possibly by reducing sucking behavior
in the newborn
Nursing Actions as applicable:
o Assess fetal maturity, presentation, and pelvic adequacy before
administration of oxytocin for induction of labor
o Assess character, frequency, and duration of uterine contractions
o Monitor maternal BP and pulse frequently and FHR continuously
throughout administration
o Monitor for signs and symptoms of water intoxication (drowsiness,
listlessness, confusion, headache, anuria)
o Advise patient to expect contractions similar to menstrual cramps after
administration has started


Drug name: Butorphanol (Stadol)
Dose, route, frequency: IM 2 mg q 3-4h as needed (range 1-4 mg); IV mg q 3-4h
as needed ( range 0.5-2mg); Intranasal 1 mg (1 spray in 1 nostril) initially, an
additional dose may be given 60-90 min later, this sequence may be repeated in 3-
4 hr, if pain is severe, an initial dose of 2 mg (1 spray in each nostril) may be
given, may be repeated in 3-4 hrs.
Indications for OB use: Management of moderate-to-severe pain. Analgesia
during labor; sedation before surgery; supplement in balanced anesthesia
Common Side Effects: confusion, dysphoria, hallucinations, sedation, nausea,
constipation, sweating
Contraindications: Contraindicated in hypersensitivity; patients physically
dependent on opioids (may precipitate withdrawal)
Effects/Implications for pregnancy or breastfeeding: This is a pregnancy
category C drug. Animal studies have reported a higher frequency of stillbirths
and a higher incidence of post implantation loss than controls. There are no
controlled data in human pregnancy before 37 weeks gestation; it should be used
only if potential benefit justifies the potential risk to the infant. Nasal spray for
labor is not recommended because it has not been studied.
o It has been detected in human milk, adverse effects in the nursing infant
are unlikely, it is considered to be compatible with breast-feeding by the
American Academy of Pediatrics
o Fetal side effects: Use of drug during labor may cause sinusoidal fetal
heart pattern without fetal hypoxia or neonatal adverse effects. Prolonged
used of drug may cause neonatal withdrawal symptoms.
Nursing Actions as applicable:
o Assess type, location, and intensity of pain before and 30-60 min after IM,
5 min after IV, and 60-90 min after intranasal administration
o Assess BP, pulse, and respirations periodically
o Assess previous anagesic history
o Instruct patient on how and when to ask for pain medication
o Assess LOC for infant safety and patient

Drug name: Betamethasone
Dose, route, frequency: 12 mg IM for 2 doses 24 hours apart
Indications for OB use: To prevent or reduce the severity of neonatal respiratory
distress syndrome by accelerating lung maturity in fetuses between 24-34 weeks
of gestation
o Action: Stimulates fetal lung maturation by promoting release of enzymes
that induce production or release of lung surfactant
This is an unlabeled use for obstetrics
Common Side Effects: Pulmonary edema (if given with beta-adrenergic
medications); may worsen maternal condition (diabetes, hypertension)
Contraindications: Hypersensitivity, if mother has fungal infection anywhere on
body, if have an infection, liver disease, kidney disease, thyroid disorder,
diabetes, TB
Effects/Implications for pregnancy or breastfeeding: This is a pregnancy
category C medication. This may be harmful to an unborn baby
o There are no data on the excretion of betamethasone into human milk. The
manufacturer recommends that due to potential for serious adverse
reactions in nursing infants, the benefits should outweigh the risks.
Nursing Actions as applicable:
o Give deep IM in ventral gluteal or vastus lateralis muscle
o Teach signs of pulmonary edema
o Assess blood glucose levels and lung sounds

Drug name: Fentanyl citrate (Sublimaze)
Dose, route, frequency: 25-50 mcg IV; 1-2 mcg with 0.125% bupivacaine at rate
of 8-10 ml/hr epidurally
Indications for OB use: Because of its short duration of action with given IV,
they are most commonly administered epidurally or intrathecally, alone or in
combo with a local anesthetic agent, to relieve moderate to severe labor pain and
postoperative pain after c-section
o Action: opioid agonist analgesics that stimulate moth mu and kappa opioid
receptors to decrease the transmission of pain impulses, rapid action with
short duration
Common Side Effects: Dizziness, drowsiness, allergic reactions, rash, pruritis,
maternal and fetal or neonatal respiratory depression, nausea and vomiting,
urinary retention
Contraindications: Contraindicated with use of other opioid pain medications,
COPD, history of head injury, heart rhythm disorder, seizures, depression, low
blood pressure, kidney disease, history of drug or alcohol addiction
Effects/Implications for pregnancy or breastfeeding: This is a category C
pregnancy drug. It is only recommended if the benefit outweighs the risk to the
developing fetus
o Animal studies have revealed evidence of decreased fertility,
embryotoxicity, fetoxicity, and embryolethality
o There are no controlled data in human pregnancy
o Fentanyl is excreted into human milk and achieves levels in colostrum
which are greater than maternal serum levels; no adverse effects have been
reported in nursing infants
o Manufacturer states that symptoms of opioid withdrawal may occur in
infants at the cessation of nursing by women using fentanyl and
recommends that fentanyl not be used by nursing women
Nursing Actions as applicable:
o Assess for respiratory depression
o Naloxone should be available as an antidote








Drug name (generic & trade)
o Insulin (HumuLIN R, NovoLIN R, ReliOn/HumuLIN R)
Dose
o use a combination of maternal weight (in kg) and pregnancy trimester. First, a
24-hour total insulin dose is calculated using 0.7 units (U)/kg in first trimester,
0.8 U/kg in second trimester, and 0.9 U/kg in third trimester.
Route(s)
o SQ
How often given
o Two-thirds of the total dose is given in the morning before breakfast and one-
third at night (half of that before supper and half prior to bedtime).
Indication for OBSTETRICAL USE-when & why is this med most often given in
OB: pregnancy, preoperative, intrapartum, postpartum, postoperative.
o If exercise and diet modification fail and fasting values are < 95 mg/dL and 2
hour after meal values are < 120 mg/dL
Common side effects
o Hypoglycemia, bilateral presyopia, lipohypertrophy, anaphylaxis,
abnormalities in platelet function, clotting factors, the fibrinolytic system, and
dyslipidemia, GI distress
Contraindications
o Eating Disorder, Liver Problems, Failure of Small Intestines to Digest and
Absorb Food, Kidney Disease, Body Temperature More Than 101 Degrees F,
Throwing Up, Injury, Overactive Thyroid Gland, Underactive Thyroid, Low
Blood Sugar, Low Amount of Potassium in the Blood
Effects/Implications for pregnancy or breastfeeding. Need side effects on fetus,
not just a pregnancy class.
o pregnancy-induced hypertension or preeclampsia, premature delivery,
Cesarean section, large-for-age offspring, and perinatal mortality, pregnancy
category B, delayed lactogenesis
Nursing actions as applicable.
o Monitor BG of mother during pregnancy as well as injection sites. Watch for
signs of hypoglycemia, monitor diet of patient.

















References

Betamethasone. Retrieved from http://www.drugs.com/breastfeeding/betamethasone.html
Butorphanol. Retrieved from http://www.drugs.com/pregnancy/butorphanol.html
Fentanyl. Retrieved from http://www.drugs.com/pregnancy/fentanyl.html
Lowdermilke, D., Perry, S., Cashion, K., & Alden, K. (2012). In Carter R. (Ed.), Maternity &
women's health care (10th ed.). St. Louis, MO: Elsevier: Mosby
Nagtalon-Ramos, J. (2014). Maternal-newborn nursing care (1
st
ed.). Philadelphia, PA: F. A.
Davis Company.
Oxytocin. Retrieved from http://www.drugs.com/breastfeeding/oxytocin.html
Rho (D) immune globulin. Retrieved from http://www.drugs.com/mtm/rho-d-immune-
globulin.html