Drugs Administered during Delivery

NAME OF DRUG Generic Name: Methylergome trine maleate Brand Name: Methergin CLASSIFICATI ON AND ACTION Classification : Genitourinary drugs Action: Act directly at the uterine smooth muscles to stimulate rate, tone and amplitude of contractions. It reduces rapid, sustained titanic uterotonic effects that shortens the third stage of labor and reduce blood loss. INDICATION CONTRAINDICAT ION 1st and 2nd stage of labor before crowning of the head, primary and secondary uterine inertia. Patients with severe hypertension, preeclampsia, eclampsia, severe or persistent sepsis, vascular disease, impaired renal or renal function. Hypersensitivity to ergot alkaloids. SIDE EFFECTS AND ADVERSE REACTION Common: Abdominal pain with large doses, hypertension, headache, skin eruptions. Uncommon: Dizziness, nausea, vomiting, convulsions, sweating, chest pain, hypotension. Rare: Bradycardia, tachycardia, palpitations, arterial spasm. NURSING RESPONSIBILITIES Assess calcium level before administering therapy. Hypocalcemia must be corrected to increase drug effectiveness. Assess and document fundal tone, nonphasic contractions, and check for relaxation or severe cramping. Monitor vital signs and note for changes that may indicate hemorrhage. Assess respiration rate, rhythm, and depth. Assess for ergotism (overdose): nausea, vomiting, weakness, muscular pain, insensitivity to cold and paresthesia to determine dose adjustments or drug withdrawal. Advice patient to take only as prescribed and no to exceed dose.

Active management of the third stage of labor, interior hemorrhage following separation of placenta and uterine atony, subinvolution of iochometra, caesarian section, menorrhagia, metrorrhagia. Post- partum and postaboital uterine bleeding.

Drug

Dosage/ Route

Classification

Indication

Contraindication

Side Effects

Nursing Responsibilities

TRADE NAME:

Available Forms:

Pharmacologic Class:

-to induce or stimulate labor

Oxytocin

10 units/ml in 1ml ampule, vial or syringe in compatible IV solution.

-hypersensitive to drug when vaginal delivery is advised

Posterior pituitary hormone

CV: Hypertension, increased heart rate, systemic venous return, cardiac output

- cephalopelvic disproportion is present

Continuously monitor contractions, fetal and maternal heart rate, and maternal blood pressure and ECG. Discontinue infusion if uterine hyperactivity occurs. Monitor patient extremely closely during first and second stages of labor because of risk of cervical laceration, uterine rupture and maternal and fetal death. Assess fluid intake and output. Watch for signs and symptoms of water intoxication.

GI: Nausea, vomiting

Therpeutic Class: -when delivery requires conversion as in transverse lie RESPIRATORY: Anoxia, asphyxia

Uterine-active agent

OTHERS: Low APGAR score at 5 mins.

Generic Name (Brand Name) Hyoscine Butylbromid e (Buscopan)

Indication

Dosage, Route, Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Indication: To reduce secretions perioperativel y.

Given via IV, 1mg/ml to promote cervical effacemen t.

Hyoscine Butylbromide Inhibits muscarinic actions of acetylcholine in the ANS Affecting neural pathway Relieves spasticity, nausea and vomitting; reduces secretions; and blocks cardiac vagal reflexes.

CNS: dizziness, headache, restlessness, disorientation, irritability, fever GI: constipation, dry mouth, nausea, vomiting CV: palpitations, tachycardia, flushing EENT: dilated pupils, blurred vision, photophobia, dysphagia GU: urinary hesitancy, urinary retention Skin: rash, dryness

Contraindicated in patients with angle-closure glaucoma, obstructive uropathy, asthma, COPD, myasthenia gravis, paralytic ileus, intestinal atony, & unstable CV.

>Be alert for adverse reactions and drug interactions. >Encourage pt. to void >Monitor BP for possible hypotension. >Monitor cervical effacement and dilatation.

 Promotes cervical effacement Generic Name (Brand Name) Lidocaine (Xylocaine) >Injected prior to normal spontaneous delivery to anesthetize the area of the perineum to be used for episiotomy. Indication Dosage, Route, Frequency Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

For normal vaginal delivery: 50mg/ml of a 5% hyperbari c solution or 9mg15mg (0.6ml1ml) of a 1.5% solution.

>Used as a local anesthesia for Cesarean section.

Lidocaine Stabilizes the neuronal membrane Inhibits sodium ion movemnts Conduction of impulses are inhibited Local loss of pain sensation

> Dizziness >Paresthesia >Drowsiness >Confusion >Respiratory Depression >Convulsions

>Hypovolemia >Heartblock >Other Conduction Disturbances

> Observe for untoward reactions such as drowsiness, depressed respiration, or seizures.

For Cesarean

Section: Up to 75 mg (1.5ml) of a 5% hyperbari c solution.

NAME OF DRUG

MECHANISM OF ACTION

INDICATIONS

CONTRAINDICATIONS

SIDE EFFECTS

NURSING CONSIDERATIONS

Generic: Nalbuphine Brand: Nubain Dosage: 10mg Classificatio n: Narcotic agonistantagonist analgesic

Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at receptors

Relief of moderate to severe pain Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery.

Hypersensitivity to nalbuphine, sulfites; lactation. Use cautiously with emotionally unstable clients or those with a history of narcotic abuse; pregnancy prior to labor, labor or delivery, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery.

CNS: nervousness, crying, depression, restlessness, euphoria, hostility, confusion, faintness, floating, unusual dreams, numbness, feeling of heaviness, and psychotomimeti c effects such as hallucinations, feeling of unreality and dysphoria. Cardiovascular : hypertension, hypotension, bradycardia, tachycardia. Gastrointestin al: cramps, dyspepsia, bitter

Monitor respiratory rate before and after giving nubain because it causes respiratory depression Monitor I and O to determine if there is excessive fluid loss Monitor Bp before and after administering the medication to prevent any complication

Generic Name

Indication

Dosage, Route, Frequenc

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

(Brand Name) Hydralazine (Apresoline) Indication: Preeclampsia / eclampsia

y 5 mg/dose then 5-10 mg every 20-30 minutes as needed. Hydralazine CNS: peripheral neuritis, headache, dizziness Contraindicated to patients who are hypersensitive to the drug and any of its component and in those with coronary artery disease or mitral valvular rheumatic heart disease. >Assess blood pressure before starting therapy and regularly thereafter.

Directly relaxes arteriolar smooth muscle CV: orthostatic hypotension, tachycardia, arrythmias, Vasodilaion angina, palpitations. Lowers Blood Pressure

>Instruct client to take oral form with meals.

>Inform client that orthostatic Use cautiously in GI: n/v, diarrhea, hypotension can patients with anorexia be minimized by suspected cardiac rising slowly and disease, CVA, or not changing severe renal position suddenly. Hematologic: impairment, and neutropenia, in those taking leukopenia, other agranulocytopen antihytensives. ia

Metabolic: weight gain,

sodium retention

Skin: rash

OB SCORING
PURPOSE: To provide a consistent system for the evaluation of presenting women with pregnancy-related issues in compliance with federal EMTALA requirements. POLICY: It is the policy of this hospital to provide a medical screening examination to all patients presenting for unscheduled obstetrical evaluation, testing or services within the capabilities of the Obstetrical Unit and the ancillary services routinely available to the Obstetrical Department, including the use of on-call physicians. Patients 20 weeks gestation or greater, with obstetrical or gynecological presentations (other than for scheduled procedures) will receive a medical screening examination in the Obstetrics Department consistent with this policy. Patients fewer than 20 weeks gestation will be provided a medical screening examination in the Emergency Department. Where trauma and/or medical conditions that are emergency medical conditions are present in the pregnant patient, the patient will be assessed in the Emergency Department and the location of further assessment and treatment will be at the medical discretion of the Emergency Department physician. PROCEDURE: 1. All patients presenting for obstetrical and gynecological conditions, other than scheduled procedures, will be logged in by the Emergency Department, or directly in the Obstetrics department, if they present there initially. 2. Patients with less than 20 weeks estimated gestation will be evaluated in the Emergency Department following the Emergency Department patient screening policy. 3. Patients with 20 weeks or greater estimated gestation will be evaluated in the Obstetrics Department following initial log entry in the Emergency Department. The patient shall be transported to the Obstetrics Department by wheel chair or gurney by an Emergency Department nurse. An Emergency Department record will be created on the patient, with at least name, date of birth, time of presentation, estimated gestation and

presenting complaint noted. The record shall state the patient was transferred to obstetrics by wheel chair [or gurney], the name of the nurse accompanying the patient, the time of the transfer, and the time of arrival in the Obstetrics Department, together with any medically relevant observations, vital signs, and interventions. 4. All patients reporting for evaluation will receive at least the standard obstetrics evaluation indicated by the Obstetrics Evaluation form and performed by a qualified evaluator. Patients requesting a "labor check" or asking to be evaluated for their ability to reach another facility must receive the standard evaluation, unless they refuse evaluation in writing on the refusal of services form. 5. The obstetrics evaluation will be conducted in segments as follows: The initial evaluation will include the determination and documentation of all items indicated by the Obstetrical Evaluation form. o EXCEPTION: Patients less than 35 weeks gestation and without uterine contractions will not receive vaginal examinations. Patients with ruptured uterine membranes will not receive vaginal examinations except on the initial and final examinations. o At approximate 30-minute intervals, two additional physical assessments will be performed, unless the patient's progress into labor or distress obviates the need for further assessment prior to the admission decision. 6. The patient will be scored as indicated on the Obstetrics Evaluation form and the patient will be given a score at the conclusion of the each exam and the score noted. Where data blocks are shaded, use the last value obtained for that item for the purposes of scoring. 7. Patients receiving a score on ANY examination that indicates that the patient must be seen by a physician or nurse midwife must be seen by a physician or nurse midwife without awaiting further interval scoring. Where the patient is expected to deliver immediately, the Obstetrics Evaluation form need not be completed in its entirety, but initial observations should be logged to the form. 8. When the results of any scoring indicates that a physician exam is required, or upon the request of a nurse evaluator, the patient's attending physician or the on-call obstetrician shall personally examine the patient for the purposes of completing the medical screening examination. 9. Attending private physicians are bound by the same timely response requirements as on-call specialists for the purpose of securing a physician examination. In the event that the private physician fails to present in a timely manner, the on-call specialist will be contacted by nursing staff to perform the physician examination. 10.Patients with 6 or fewer points in Block C, with no physician exam required by Box A or Box B after evaluation by a non-physician Qualified Evaluator may be discharged upon telephone orders from the private attending physician or on-call specialist. A copy of the written discharge instructions provided to the patient shall be included in the medical record, signed by the patient, and signed, dated and timed by the nurse providing the discharge instruction.
o

11.All phone contacts with the attending or on-call physician shall be noted and timed in the record. 12.Patients, after examination by a physician or nurse midwife as indicated by the scoring criteria, may be discharged upon the written order of the examining physician or nurse midwife, if: delivery is not expected in the next 6 hours; and discharge poses no likelihood of material deterioration in the condition of the mother or fetus; and discharge does not pose a threat to the health or safety of the mother or fetus. Any patient discharged under this provision shall be given written discharge instructions. A copy of the written instructions shall be included in the medical record, signed by the patient, and signed, dated and timed by the nurse providing the discharge instruction. 13.Pertinent nursing observations other than those provided in the Obstetrics Evaluation form and nursing care provided shall be documented on a standard patient record form. Physician orders shall be documented in the standard medical record. 14.In the event that the patient is discharged prior to delivery, the medical record shall contain the time of discharge, the vital signs of the patient and fetus at discharge, and the labor status of the patient at discharge, and the written or verbal orders of the physician shall be documented in the record.. 15.No patient with a score of 7 or more after examination by a physician or nurse midwife, nurse practitioner, or Physician assistant, shall be transferred, referred, or directed to any other facility, except for care not available at this hospital or by reason of patient initiated transfer or departure Against Medical Advice, as provided in the Patient Transfer Policy of this hospital. All transfers, directions or referrals will comply with the Patient Transfer Policy. Patients with a score of 7 or more are deemed unstable for the purpose of transfer procedures.
o o o

Bishop score, also Bishop's score, is a pre-labor scoring system to assist in predicting whether induction of labor will be required.[1] It has also been used to assess the odds of spontaneous preterm delivery.[2] Scoring Each component is given a score of 0-2 or 0-3. The highest possible score is 13. Bishop score

Parameter\S core

Description

Position

Posteri Intermedia Anterio or te r

The position of the cervix varies between individual women. As the anatomical location of the vagina is actually downward facing, anterior and posterior locations relatively describe the upper and lower borders of the vagina. The anterior position is better aligned with the uterus, and therefore there is an increased likelihood of spontaneous delivery.

Consistency Firm

Intermedia Soft te

In primigravid women the cervix is typically tougher and resistant to stretching, much like a balloon that has not been previously inflated. Furthermore, in young women the cervix is more resilient than in older women. With subsequent vaginal deliveries the cervix becomes less rigid and allows for easier dilation at term.

Effacement 0-30% 31-50%

5180%

Effacement is a measure of stretch already present in the cervix. It is analogous to stretching a rubber band; as the rubber band is >80 stretched further, it becomes thinner. This is affected by individual % variation and previous surgery such as loop excision for cervical dysplasia or cancer.

Dilation

0 cm

12 cm

Dilation is a measure of the diameter of the stretched cervix. It >5 c 34 cm complements effacement, and is usually the most important m indicator of progression through the first stage of labour.

Fetal station

-3

-2

-1, 0

+1, +2

Fetal station describes the position in of the foetus' head in relation to the distance from the ischial spines, which can be palpated deep inside the posterior vagina (approximately 810 cm) as a bony protrusion. Negative numbers indicate that the head is further inside, above the ischial spines.

Interpretation A score of 5 or less suggests that labor is unlikely to start without induction. A score of 9 or more indicates that labor will most likely commence spontaneously.[3] A low Bishop's score often indicates that induction is unlikely to be successful.[4] Some sources indicate that only a score of 8 or greater is reliably predictive of a successful induction. Modified Bishop score According to the Modified Bishop's pre-induction cervical scoring system, effacement has been replaced by cervical length in cm, with scores as follows- 0>3 cm, 1>2 cm, 2>1 cm, 3>0 cm.[5]

Another modification for the Bishop's score is the modifiers. Points are added or subtracted according to special circumstances as follows:

One point is added for:

1. Existence of pre-eclampsia 2. Every previous vaginal delivery

One point is subtracted for:

1. Postdate pregnancy

2. Nulliparity (no previous vaginal deliveries) 3. PPROM (premature preterm rupture of membranes)

Sources: http://www.scribd.com/doc/36560560/DRUGSTUDY-RANITIDINE-METRONIDAZOLE-CEFUROXIME-KEtorolac-NUBain http://www.nursingcare101.com/stages-of-labor http://www.babies.sutterhealth.org/laboranddelivery/labor/ld_contractns.html http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/how-to-perform-leopolds-maneuver/ http://www.google.com.ph/search?hl=tl&rlz=1C1_____enPH375&q=AOG,+LMP,+EDC+&aq=f&aqi=&aql=&oq= http://www.slideshare.net/alleicarg/handout-prenatal/download http://www.scribd.com/doc/26662532/Delivery-Room-Drug-Study http://www.scribd.com/doc/20928106/Maternal-Nursing-Ob http://www.facebook.com/pages/UC-College-Of-Nursing-Nurses-Anatomy/213296865383097?ref=ts