Maternity and Newborn Medications

This final section is a review of medications used to

promote or retard labor, ease the pain of labor, and
help ensure the health of the mother and newborn.
Priority Concepts primarily include Reproduction and
Safety.
Oxytocin
 Oxytocinstimulates the smooth muscle of the uterus
and induces contraction of the myocardium.
 It
is used to induce or augment labor or control
postpartum BLEEDING
Nursing Considerations
 Oxytocin may produce uterine hypertonicity resulting in fetal
or maternal injury.
 Postpartum hemorrhage may result if the uterus becomes
atonic when the medication wears off.
 Oxytocin should not be used in a client who cannot deliver
vaginally or in a client with hypertonic uterine contractions.
 Check maternal vital signs every 15 minutes, especially blood
pressure and heart rate; monitor daily weight, intake and
output, level of consciousness, and lung sounds.
 Assess the frequency, duration, and force of contractions and
resting uterine tone every 15 minutes.
Nursing Considerations
 Check the fetal heart rate (FHR) every 15 minutes and notify
the health care provider if significant changes occur; an
internal fetal scalp electrode may be placed if not
contraindicated.
 An IV infusion monitoring device is always used; the
prescribed additive solution (e.g., normal saline) is
piggybacked at the port nearest the point of venous insertion.
 Do not leave the client unattended while the oxytocin is
infusing.
 Administer oxygen, if prescribed.
Nursing Considerations
 Uterine hyperstimulation or a nonreassuring FHR > stop
the oxytocin infusion> turn the client on her side
increase the IV rate of mainline> oxygen by way of
face mask, and notify the provider.
 Monitor the client for signs of water intoxication.
 Have emergency equipment available.
 Document the dosage of the medication and the
times at which administration was started, increased,
maintained, and discontinued.
 Keep the family informed of the client's progress.
Self-Check Question
A pregnant client is receiving an IV infusion of
oxytocin. Monitoring the client closely, the nurse
suddenly notes the presence of uterine hypertonicity.
Which action should the nurse take immediately?
 1. Document the finding
 2. Turn the client on her side
 3. Stop the oxytocin infusion
 4. Increase the rate of infusion of the nonadditive IV
solution
ANSWER: 3
 RATIONALE: Oxytocin is an oxytocic agent used to
induce labor. If uterine hypertonicity or a nonreassuring
FHR occurs, the nurse must intervene to reduce uterine
activity and increase fetal oxygenation. The nurse
would immediately stop the oxytocin infusion, increase
the rate of the nonadditive (e.g., normal saline) IV
solution, place the client in a side-lying position, and
administer oxygen by way of face mask at a rate of 8
to 10 L/minute. The nurse would then notify the health
care provider, continue monitoring the client, and
document the occurrence and findings. However, the
immediate action is stopping the infusion.
Management of Postpartum
Hemorrhage
 Medicationsused to treat postpartum hemorrhage
include ergot alkaloids, prostaglandin F2a (carboprost
tromethamine), and oxytocin.
 Thesemedications stimulate uterine muscle and
increase the force and frequency of contractions.
Nursing Considerations
 Ergot
alkaloids can produce arterial vasoconstriction
and vasospasm of the coronary arteries; severe
hypertension is a concern.
 ALWAYS CHECK BP before. Notify HCP is increased.
 Ergot
alkaloids are not administered before the
DELIVERY OF PLACENTA
Tocolytics

Tocolytics such as magnesium sulfate are

used to stop uterine contractions and
prevent preterm birth.
Nursing Considerations
Maternal contraindications
severe preeclampsia and eclampsia,
active vaginal bleeding,
 intrauterine infection,
cardiac disease, and a medical or obstetric
condition that contraindicates the
continuation of pregnancy.
Nursing Considerations
 Fetal contraindications
 estimated gestational age greater than 37 weeks,
 cervical dilation greater than 4 cm,
 fetal demise, lethal fetal anomaly, chorioamnionitis,
acute fetal distress, and chronic intrauterine growth
restriction.
 Theclient should be positioned on her side to
enhance placental perfusion and reduce pressure on
the cervix.
Nursing Considerations
 Maternal vital signs, fetal status, and labor status are
assessed frequently or in accordance with agency
protocol.
 Monitor daily weight and intake and output.
 Provide comfort measures and psychosocial support
to the client and family.
Magnesium Sulfate
 CNS depressant and anticonvulsant that causes
smooth muscle relaxation.
 Stop preterm labor to prevent preterm birth and
prevent and control seizures in preeclamptic
and eclamptic clients.
Nursing Considerations
 Administered by way of IV infusion with the use of an
infusion monitoring device; carefully monitor the dose
being administered.
 Slow
the respiratory and heart rates, dull reflexes, and
cause flushing or hypotension.
A continuous infusion increases the risk of magnesium
toxicity in the neonate and should not be used in the
2 hours preceding delivery.
 Prescribed
for the first 12 to 24 hours after delivery if it is
being used for preeclampsia.
Nursing Considerations
 High doses= loss of deep tendon reflexes, heart block,
respiratory paralysis, and cardiac arrest, so the medication is
contraindicated in the client with heart block, myocardial
damage, or renal failure and used with caution in the client
with renal impairment.
 Keep calcium gluconate.
 Test the patellar (knee-jerk) reflex before administering
repeat parenteral doses. (Suppression of this reflex, which is
used as an indicator of CNS depression, may be a sign of
impending respiratory arrest.)
 The patellar reflex must be present and the respiratory rate
faster than 16 breaths/min before each parenteral dose.
Monitoring the Client Receiving Magnesium Sulfate
 Check maternal vital signs, especially respirations, every 30
to 60 minutes. Call the health care provider if the
respiratory rate is slower than 12 breaths/min, indicating
respiratory depression.
 Monitor renal function values and the ECG.
 Check deep tendon reflexes hourly for signs of toxicity.
 Monitor the magnesium level: The target range is 4 to 7.5
mEq/L (5 to 8 mg/dL). Increase? Notify the health care
provider.
 Check intake and output hourly; urine output should be
maintained at 30 mL/hr, because the medication is
eliminated through the kidneys.
Self-Check Question
A pregnant client with preeclampsia is receiving an
IV infusion of magnesium sulfate. Which medication,
the antidote to magnesium sulfate, does the nurse
ensure is readily available?
 1. Vitamin K
 2. Acetylcysteine
 3. Protamine sulfate
 4. Calcium gluconate
ANSWER: 4
 RATIONALE: Magnesium sulfate is a CNS depressant and
anticonvulsant. It causes smooth muscle relaxation and is used
to stop preterm labor to prevent preterm birth and prevent and
control seizures in preeclamptic and eclamptic clients. Calcium
gluconate, which acts as the antidote to magnesium, should
be placed in the room of the client receiving magnesium
sulfate. Vitamin K is the antidote to warfarin. Protamine sulfate is
the antidote to heparin. Acetylcysteine is the antidote to
acetaminophen.
Prostaglandins

 Prostaglandinsare used to soften and

promote dilation of the cervix to facilitate
vaginal delivery.
Nursing Considerations
 GIside effects include nausea and vomiting, stomach
cramps, and diarrhea.
 Fever,
chills, flushing, headache, and hypotension
may occur.
 Monitor maternal vital signs, FHR patterns, and the
status of pregnancy, including signs of labor or
impending labor.
 Havethe client void before administration and
maintain the client in a SUPINE POSITIONG for 30 to 60
minutes after administration of the medication.
Nursing Considerations
 Remain with the client for 30 minutes after
administration to monitor her for anaphylaxis;
signs include shortness of breath or difficulty
breathing, tachycardia, hives, tightness in the
chest, and swelling of the face.
 Monitor the client for hyperstimulation of the
uterus and vaginal
Opioid Analgesics

These medications are used to relieve

moderate to severe pain associated
with labor.
Nursing Considerations
 Withdrawal symptoms in the newborn (e.g., irritability,
excessive crying, tremors, hyperactive reflexes, fever,
vomiting, diarrhea, yawning, sneezing, and seizures).
 Obtain a drug history before administration of an
opioid analgesic; some medications may be
contraindicated if the client has a history of opioid
dependency, because these medications can
precipitate withdrawal symptoms in the client and
newborn.
Nursing Considerations
 Monitor vital signs (if the respiratory rate is less
than 12 breaths/min withhold the medication
and contact the health care provider).
 Monitor the fetal heart rate.
 Have the antidote naloxone available.
Rho(D) Immune Globulin
 (RhoGAM) is administered twice: at 28 weeks of
gestation and within 72 hours of delivery.
 Prevents isoimmunization in Rh-negative clients
who are exposed or may have been exposed
to Rh-positive RBCs through transfusion,
termination of pregnancy, amniocentesis,
chorionic villus sampling, abdominal trauma, or
bleeding during pregnancy or the birth process.
Nursing Considerations
 RhoGAM should be administered in the 72 hours after
potential or actual exposure to Rh-positive blood; it must be
given with each subsequent exposure or potential exposure
to Rh-positive blood.
 It is of no benefit once the client has developed a positive
antibody titer to the Rh antigen.
 RhoGAM is contraindicated in Rh-positive women and in
clients with a history of systemic allergic reactions to
preparations containing human immunoglobulins.
 It is not administered to the newborn.
Rubella Vaccine

 Given subcutaneously before hospital

discharge to the nonimmune postpartum client
(rubella titer less than 1:8).
Nursing Considerations
 Notadministered if the client or other family members
are immunocompromised.
 Theclient must be informed that pregnancy should
be avoided for 1 to 3 months (or as prescribed) after
receiving the rubella vaccine and about the need to
use a contraceptive method at this time.
 Assessfor an allergy to duck eggs and notify the
health care provider before administration if an
allergy exists.
Lung Surfactants
 Thesemedications replenish surfactant and restore
surface activity to the lungs.
 Theyare used to prevent or treat respiratory distress
syndrome (hyaline membrane disease) in the
premature infant.
Nursing Considerations
 Administered with caution in newborns at risk for circulatory
overload.
 The medication is inserted into the infant’s endotracheal tube.
(Avoid suctioning for at least 2 hours after administration, if
possible.)
 Lung surfactants may cause transient bradycardia and
oxygen desaturation.
 Monitor the infant for bradycardia and decreased oxygen
saturation during administration.
 Assess lung sounds for crackles.
Neonatal Eye Prophylaxis
 Preventiveeye treatment against ophthalmia
neonatorum in the newborn is required by law in the
United States.
 Erythromycin(0.5%) is bacteriostatic and
bactericidal and provides prophylaxis against
Neisseria gonorrhoeae and Chlamydia trachomatis.
Nursing Considerations
 Cleanse the neonate’s eyes before instilling drops or
ointment.
 Instill medication into each of the neonate’s conjunctival
sacs within 1 hour of delivery; eye prophylaxis may be
delayed until an hour or so after birth as a means of
facilitating eye contact and parent-infant bonding.
 Do not flush the eyes after instillation.
Vitamin K
 Vitamin K aids production of active prothrombin.
 The
newborn is deficient in vitamin K for the first 5 to 8
days of life because of the lack of intestinal flora.
 Vitamin
K is used for prophylaxis and to treat
hemorrhagic disease of the newborn.
Nursing Considerations
 Vitamin K can cause hyperbilirubinemia in the newborn
although the incidence is rare.
 Protect the medication from light.
 Administer vitamin K to the neonate during the early
neonatal period in the lateral aspect of the middle third
of the vastus lateralis muscle of the thigh.
 Monitor the neonate for bruising at the injection site
and for bleeding from the cord.
 Watch for jaundice and monitor the bilirubin level,
because the medication can cause hyperbilirubinemia
in the neonate.
Recombivax HB Pediatric
(Hepatitis B Virus [HBV])Vaccine
 Recommended for all newborns to prevent
hepatitis B
 Given intramuscularly to the newborn before
discharge home
 Adverse effects include rash, fever, erythema,
and pain at the injection site
Nursing Considerations
 Parenteral consent must be obtained
 Administer in the lateral aspect of the middle third of the
vastus lateralis muscle of the thigh
 If the infant was born to a mother positive for hepatitis B
surface antigen, hepatitis B immune globulin should be
given within 12 hours of birth in addition to the HBV
vaccine. Then, the regularly scheduled HBV vaccination
schedule is followed.
 Document immunization administration on a vaccination
card for parents to have a record that it was
administered.