In obstetrics medications are used to support pregnancy, manage labor, and treat complications.
A medicine/medication, also called pharmaceutical drug is a chemical substance or compound used to treat, cure, prevent or diagnose a disease or to promote well-being. All medicines are drugs, but clinically, all drugs are not medicines. Medicines are made for treatment of a particular disease, while drugs are often considered as narcotic, stimulant or hallucinogen. Medicines never cause stupefaction while drugs do.
Drugs are Mainly Four Types
- Stimulants, e.g., cocaine
- Depressants, e.g. alcohol
- Opium related pain killers, e.g., heroin
- Hallucinogens, e.g., LSD
Most medications are used to cure or treat a disease or condition, e.g., antibiotics are used to cure an infection.
Medications Used During Pregnancy
No drug whether prescription, over the counter or herbal preparations can be considered 100 percent sale during pregnancy. However, only a few drugs are known to be harmful to a developing fetus and many can be used safely during pregnancy, and some are even necessary. A golden rule to follow is to take only those medications prescribed by the doctor who knows your pregnancy status
Common Obstetrics Medications
| Drug Class | Examples | Purpose |
|---|---|---|
| Oxytocics | Oxytocin (Pitocin), Syntometrine | Induce or augment labor, control postpartum hemorrhage |
| Ergot Alkaloids | Ergometrine | Stimulate sustained uterine contractions, manage postpartum bleeding |
| Prostaglandins | Misoprostol, Dinoprostone | Cervical ripening, labor induction, postpartum hemorrhage control |
| Tocolytics | Nifedipine, Terbutaline, Ritodrine | Delay preterm labor by relaxing uterine muscles |
| Antihypertensives | Methyldopa, Labetalol, Hydralazine | Manage pregnancy-induced hypertension or preeclampsia |
| Anticonvulsants | Magnesium sulfate | Prevent and treat eclamptic seizures |
| Analgesics | Pethidine, Epidural anesthetics | Pain relief during labor and delivery |
| Antiemetics | Ondansetron, Metoclopramide | Manage nausea and vomiting during pregnancy |
| Antibiotics | Ampicillin, Clindamycin, Erythromycin | Treat infections, especially during labor or cesarean delivery |
| Anticoagulants | Heparin (unfractionated or LMWH) | Prevent thromboembolic events in high-risk pregnancies |
Teratogenic medications and associated birth defects
Teratogenicity is the capacity of drug to cause fetal abnormalities when administered to the pregnant mother. Congenital malformations most often result from teratogen exposure in the 3rd to 8th weeks of pregnancy, at which time organogenesis is taking place. The placenta does not strictly constitute a barrier, and any drug can cross it to a greater or lesser extent.
Risk Factors for Birth Defects
The potential for harm depends on a range of factors including:
- The type of drug.
- The size of the dose.
- How often it is taken.
- The stage of development (gestational age) at the time of exposure.
- The individual response of the fetus to the drug.
- Other factors such as maternal diet or illness.
Classes of Teratogens
- Radiation.
- Maternal infections.
- Chemicals.
- Drugs.
Medications to be Avoided During Pregnancy
| Class of medication | Name of medication | Birth defects |
| ACE inhibitors (angiotensin- converting enzyme inhibitors) | Captopril Enalapril Ramipril Lisinopril | Fetal renal malformations. |
| Anticonvulsant drugs | Valproate Carbamazepine (Tegretol) Phenytoin Phenobarbital | Neural tube defects. Cardiac defects. Cleft palate. Fetal hydantoin syndrome. Skeletal abnormalities. |
| Anthelmintic agent | Albendazole | Teratogenic. Embryotoxic. |
| Alkylating agents | BusulfanCyclophosphamide | Absence of digits. Other abnormalities. |
| Angiotensin II receptor blocker (antihypertensives) | Losartan Candesartan Valsartan | Teratogenic effects unspecified. |
| HMG-CoA reductase (antilipid) | Atorvastatin Rosuvastatin Clopidogrel | Congenital defects unspecified. |
| Aminoglycosides (antibiotics) | Gentamicin Tobramycin Streptomycin Kanamycin | Ototoxicity. |
| Amphenicols (antibacterial) | Chloramphenicol Ciprofloxacin Tetracycline | Unspecified teratogenic effects. Inhibited bone growth. |
| Nonsteroidal form of estrogen | Diethylstilbesterol (DES) | Congenital mullerian anomalies. |
| Anti-allergic | Benadryl diphenhydramine | Unspecified teratogenic effects. |
| Folate antagonists/ Antimetabolites | Trimethoprim Methotrexate | Neural tube defects. |
| Antithyroid drugs | Propylthiouracil Thiouracil Methimazole | Aplasia cutis. Congenital focal absence of dermis. |
| Anticoagulant | Warfarin Coumadin | Fetal haemorrhage. Bone deformities. |
| Acne medication | Accutane Retin A | Cardiovascular anomalies. Nervous system defects. Facial deformities. |
| Antidepressant | Lithium | Congenital heart defects. |
General Recommendations to Mothers
- Avoid smoking and drinking alcohol during pregnancy.
- Avoid taking non-prescription and illegal drugs.
- If taking medications for chronic illness, consult doctor for management of the condition. The doctor may prescribe similar drugs that does not have known physical effects on fetus.
- Take folic acid supplements prior to conception and during first trimester as directed by the doctor.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
- Damian Apollo, Obstetric Medications, Updated: Jul 1 2024, https://step2.medbullets.com/drugs/121612/obstetric-medications
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
