ALL OB Medications

Ibuprofen (Oral: Motrin; IV: Caldolor)

(Postpartum)

Purpose

• Mild pain (1-3/10)

• Reduce inflammation

• Fever

---

Barely enters breast milk

Contraindication

• Pregnancy (r/t persistent pulmonary hypertension in infants)

• Asthma (IV)

• Preeclampsia

• HELLP

Docusate sodium (Colace)

(Postpartum)

Purpose

• Constipation (stool softener)

  • Draws water into stool to soften it

  • Prevents straining with bowel movements

---

Not prompt

Lactation safe

Avoid

• Diarrhea

Acetaminophen (Tylenol)

(Postpartum)

Purpose

• Mild (pain 1-3/10) to moderate pain (4-7/10)

• Fever

Acetaminophen (Ofirmev)

(Postpartum)

Purpose

• Mild (pain 1-3/10) to moderate pain (4-7/10)

• Fever

---

Can be given during labor for maternal fever.

Given for post-cesarean patients

Avoid

• Liver or kidney disease.

• Malnourishment.

Hydrocodone/Acetaminophen (Norco)

(Postpartum)

Purpose

• Moderate (pain 4-7/10) to severe pain (8-10/10)

Acetaminophen/Codeine (Tylenol #3)

(Postpartum)

Purpose:

• Moderate pain (4-7/10)

---

Causes constipation (r/t

Caution

• Hypothyroidism

• Renal disease

Avoid

• Lactation

Acetylcysteine (Mucomyst, Acetadote)

Antidote for Acetaminophen

Naloxone (Narcan)

Antidote

• Hydrocodone/Acetaminophen (Norco)

• Acetaminophen/Codeine (Tylenol w/ Codeine #3)

• Darvocet N-100 (Propoxyphene Napsylate/Acetaminophen)

Lactation safe

Docusate sodium (Colace)

Ketorolac (Toradol) IV Push

(Postpartum)

Purpose

• Short-term pain

  • <5 days

• Post C-section

---

Can cause GI Bleeding

Enters breastmilk (low concentration)

Rapidly and completely absorbed following all routes of administration.

Enters breastmilk (low concentration)

Ketorolac (Toradol)

Darvocet N-100 (Propoxyphene Napsylate/Acetaminophen)

Bisacodyl Rectal (Dulcolax)

(Postpartum)

Purpose:

• Constipation

---

Does not enter breastmilk

Avoid

• Suppository on 4th-degree tear

• Suppository on 4th degree extension (episiotomy)

Darvocet N-100 (Propoxyphene Napsylate/Acetaminophen)

(Postpartum)

Purpose:

• Mild (pain 1-3/10) to moderate pain (4-7/10)

---

Enters breastmilk

Adverse Effects

• Dizziness

• Hypotension

• Constipation

Misoprostol (Cytotec) (Rectal)

(Postpartum)

Purpose:

• Postpartum hemorrhage / Uterine Atony

  • Stimulates uterine contractions

• Prevents NSAID-induced gastric ulcers

  • Reduces stomach acid and increases mucus production

(Prostaglandin E analog)

---

Fever & Diarrhea (infant/mother)

Oxytocin (Pitocin) Postpartum

(Postpartum)

Purpose:

• Postpartum hemorrhage

• Uterine atony

---

Complications

• Coma

• Hypotension

• Water intoxication

• Vasopressor & Antidiuretic Effects

Iron FeSO4 (Ferrous Sulfate)

(Postpartum)

Purpose

• Treats/prevents iron deficiency anemia

---

OJ for best absorption

Passes through breast milk

Complication

• 33-50% less absorption with food

  • Avoid antacids, dairy, tea, coffee within 2 hours before/after

Deferoxamine Mesylate (Desferal)

Antidote for Iron FeSO₄ (Ferrous Sulfate)

Depo-Provera (Medroxyprogesterone Acetate)

(Postpartum)

Purpose

• Contraception

---

Doses: Every 6 weeks

Complications

• Decreases breast milk supply

  • Wait 6 weeks before

• Enters breast milk

  • But can receive prior to discharge

Enoxaparin Sodium (Lovenox)

(Postpartum)

Purpose

• Prevention of DVTs in high-risk post-surgical patients

---

Complications

• Risks small hematoma

  • Administer 24 hours after C/S

Avoid

• Active bleeding

Protamine Sulfate

Antidote for Enoxaparin Sodium (Lovenox)

Methylergonovine Maleate (Methergine) IM

(Postpartum)

Purpose

• Treats/prevents PP hemorrhage

  • Constricts blood vessels

• Uterine atony / Sub-involution

  • Stimulates uterine contractions

(Ergot Alkaloid)

---

Complication

• Causes pain:

  • Use with pain medication

• Reduces breastmilk yield

Contraindication

• Hypertension / Preeclamspia

• Smoking

• Breastfeeding (adverse effects to infant)

  • Wait at least 12 hours after last dose

Carboprost Tromethamine (Hemabate)

(Postpartum)

Purpose:

• Controls PP hemorrhage

  • Synthetic Prostaglandin F2 or M that stimulates uterine smooth muscle contractions

• Last effort before hysterectomy

---

Repeated Q15 (with total dose limit)

MAY pass through breastmilk

Complications

• Severe abdominal cramps, n/v, diarrhea (body overreacts)

  • HYDRATE

Caution

• Asthma (bronchospasm risk)

• Heart disease

• Liver disease

• High or Low BP (Affects BP in general)

• Epilepsy

Tranexamic Acid (Lysteda)

(Postpartum)

Purpose:

• Treats/prevents PP hemorrhage:

  • Uterine atony

  • Sub-involution

---

Avoid

• Active thromboembolic issues (DVT, PE, cerebral thrombosis)

• Renal impairment

• Color blindness

Diphenhydramine (Benadryl)

(Postpartum)

Purpose

• Pruritus (itching)

• Mild nighttime sedation

• Adverse drug reactions

---

Avoid

• Chamomile tea (increases CNS depression)

• Lactation

• Asthmatics

Physostigmine (Use with caution)

Antidote for Diphenhydramine (Benadryl)

Tucks Medicated Pads (Witch Hazel)

(Postpartum)

Purpose:

• Dry, soothes, protects skin (lacerations, sutures, episiotomies, hemorrhoids)

---

Gently dry and clean skin before using

Applied after sitz bath

Used AFTER bowel movements

Can dry or tighten skin around anus

Dermoplast Spray (Benzocaine, Dibucaine, and Lidocaine)

(Postpartum)

Purpose:

• Pain (numbs) & Itching

  • Sutures, episiotomies, hemorrhoids

---

Caution

• Use occasionally in small amounts

RhoGAM (Rho (D) Immune Globulin)

(Immunizations)

Purpose

• Prevents antibody response from Rh- mothers and hemolytic disease to Rh+ baby

  • Prevents Erythroblastosis Fetalis and Hydrops Fetalis for futurep regnancies

• 12-week Prophylactic @ 28 weeks, trauma, or abortion

---

1st Dose: 28 weeks; lasts 12 weeks

2nd Dose: MUST be given 72 hours after delivery

Caution

• If Coombs (+), it is too late: will have problems with future pregnancies if Rh+ baby

When is the RhoGAM doses?

Two doses

• 28 weeks

• up to 72 hours PP

Rubella Live Vaccine (Meruvax) (MMR - Measles, Mumps, Rubella Vaccine)

(Immunizations)

(Live Vaccine)

Purpose

• Immunization against German measles

• Prevent risk of congenital rubella syndrome in future pregnancies.

  • Given when titer <1:8

---

Contraindication

• Pregnancy for 3 months after vaccination

• Egg allergy

Varicella Zoster (VariZig, VZIG) Vaccine

(Immunizations)

Purpose:

• Immunization against chickenpox virus

---

Avoid

• Pregnancy for 3 months after vaccination

Influenza (FluMist) Vaccine

(Immunizations)

(Active Live Vaccine)

Purpose

• Immunizes against A and B

---

Avoid

• Allergic to eggs

• Received another live vaccine w/in 1 month

• Received inactivated vaccine w/in 2 weeks

Pneumococcal Conjugate Vaccine (PCV, Prevnar 13)

(Immunizations)

Purpose

• Immunization against pneumococcal pneumonia.

---

Contraindication

• DTaP allergy

DTaP Vaccine

(Immunizations)

Purpose

• Immunization against diphtheria, tetanus, and atypical pertussis.

---

Individual components given for unusual reactions

Engerix-B

(Neonatal)

Purpose

• Active immunization against infection caused by Hepatitis B virus.

---

BE RIGHT - Administer in the right thigh (vastus lateralis).

Given per doctor’s order (some prefer to postpone it until the first well-baby checkup).

Obtain consent before administering.

Check expiration date on the vial before use.

Monitor injection site for redness and swelling

Erythromycin Ointment (Ilotycin)

(Neonatal)

Purpose

• Prophylaxis usually given to all babies for ophthalmia neonatorum

  • Blindness in newborns due to gonorrhea or chlamydia infections at births

---

Must be administered within 1 hour of birth.

• If microbes are present, delaying administration could lead to infection.

Aqua Mephyton (Phytonadione)

(Neonatal)

Purpose

• Prevention of bleeding

  • Due to the lack of intestinal bacteria needed to produce Vitamin K in newborns.

---

"Kick Left" – Administer in the left thigh (vastus lateralis).

Usually given within 1 hour of birth.

Surfactant (Lucinactant, Surfaxin)

(Neonatal)

Purpose

• Prevention of Respiratory Distress Syndrome (RDS) in premature infants at high risk.

---

Adverse Reactions (suctioning or reintubation may be required)

• Bradycardia (slow heart rate)

• Oxygen desaturation

• Reflux of drug into endotracheal tube

• Airway or endotracheal tube obstruction

Continue therapy only when infant is stable

Indomethacin (Indocin) - NSAID

(Neonatal)

Purpose

• Closure of patent ductus arteriosus (PDA)

  • Decreases prostaglandin production

---

Monitor RR, BP, HR, ECG, S1/S2, I&Os

Caution

• Increased risk of:

  • Necrotizing enterocolitis

  • Bowel perforation

Caffeine Citrate (Cafcit)

(Neonatal)

Purpose

• Respiratory stimulation in premature infants between 28-33 weeks.

  • Decreases periods of apnea.

---

Increased risk of toxicity in neonates with:

• Impaired hepatic fx

• Impaired renal fx

Gentamicin (Garamycin, G-mycin)

(Neonatal)

Purpose

• Infection with gram-negative organisms and staphylococci.

---

Caution

• Risk of neuromuscular blockade.

Difficulty in assessing auditory and vestibular function due to immature renal function.

Dose Adjustments Needed

• Neonates on ECMO (Extracorporeal Membrane Oxygenation)

Ampicillin

(Neonatal)

Purpose

• Bacterial infection

---

Complication

• May cause a false-positive direct Coombs' test result.

Contraindication

• Penicillin allergy

Clindamycin (Clinda-derm)

(Neonatal)

Purpose

• Infection

---

Complication

• Increases risk of pseudomembranous colitis

  • Report diarrhea, abdominal cramping, fever, and bloody stools (possible signs)

  • May appear weeks after cessation of therapy

Magnesium Sulfate (MgSO₄) IV

(High Risk Antepartum)

Purpose

• Anticonvulsant (increases seizure threshold)

  • Includes seizures r/t Preeclampsia (PIH)

• Neuroprotection in preterm labor

---

Caution

• Impaired renal function (common in Pregnancy-Induced Hypertension).

• May stop contractions & relax muscles (STOP or TURN DOWN if):

  • DTR (Deep Tendon Reflex) = 0 or 1

    • Fetus may have hypotonia or lethargy lasting 1-2 days.

  • Respiratory rate <12/min

Contraindication

• Myasthenia gravis

Calcium Gluconate

Antidote for Magnesium Sulfate (MgSO₄)

Labetalol Hydrochloride (Normodyne)

(High Risk Antepartum)

Purpose:

• Hypertension

  • 160/105-110 diastolic for 15 minutes

---

Start with a low dose, increasing gradually if BP remains high.

• Check BP every 5 minutes for 30 minutes.

Contraindication

• Asthma

• Heart Failure

Brethine (Terbutaline)

(High Risk Antepartum)

Purpose

• Tachysystole (excessive uterine contractions).

• Tocolytic/Bronchodilator

  • Delays preterm labor

---

Caution

• Cardiac disease

• Diabetics

  • Increases blood sugar

Contraindication

• HR above 100

Nifedipine (Cardene)

(High Risk Antepartum)

Purpose

• Calcium channel blocker

  • Smooth muscle relaxant

  • Antihypertensive

---

Adverse Effects

• Severe hypotension

• Pulmonary edema

Contraindication

• BP below 100 sys (or 90/50)

Nifedipine (Adalat, Procardia)

(High Risk Antepartum)

Purpose

• Calcium channel blocker (smooth muscle relaxant & antihypertension)

  • Preterm labor contractions

  • Preeclampsia

---

Contraindication

• BP below 100 sys (or 90/50)

Betamethasone (Celestone) IM

(High Risk Antepartum)

Purpose

• Prevents respiratory distress syndrome in preterm delivery

  • Increases surfactant

---

Both doses are required for full benefit.

• Must be given 2 days before delivery for effectiveness.

Contraindications

• MORE THAN 34 weeks gestation

  • Some hospitals extend to 37 weeks IF mother has infection

  • If mom is diabetic, given @ 37 weeks BUT INCREASE GLUCOSE

Hydralazine (Apresoline)

(High Risk Antepartum)

Purpose:

• Moderate to severe hypertension

  • Preeclampsia.

---

Monitor BP every 5 minutes until stable.

Penicillin G (Na+ or K+ salt)

(High Risk Antepartum)

Purpose

• Group Beta Strep (GBS) positive

• Chorioamnionitis

• Fever of unknown origin during labor.

---

Monitor for anaphylaxis

• Rash, pruritus, wheezing, laryngeal edema

May cause a false-positive direct Coombs’ test.

Change IV site every 48 hours to prevent phlebitis.

• Causes pain at the IV site

Contraindication

• Penicillin allergy

Zovirax (Acyclovir)

(High Risk Antepartum)

Purpose

• Prophylactic treatment for HSV+ mothers

  • Prevent an outbreak during delivery.

  • 34-35 weeks gestation and continued until delivery.

---

Monitor for active Herpes infections throughout labor.

If lesions are present

• C-section will be necessary

Nifedipine Comparisons

Mechanism of Action (How They Work)

• Both drugs block calcium from entering the smooth muscle cells in blood vessels, causing vasodilation (widening of blood vessels) and reducing blood pressure.

  • However, Cardene (Nicardipine) has a stronger effect on blood pressure, while Adalat/Procardia (Nifedipine) is often preferred for pregnancy-related conditions.

---

Nifedipine (Adalat/Procardia) PO

• Commonly used for hypertension in pregnancy (especially in preeclampsia).

• Also used for preterm labor contractions to relax the uterus.

Nicardipine (Cardene) IV

• Used for severe hypertension, especially in critical care settings.

• NOT used for preterm labor due to its stronger cardiovascular effects.

Prostaglandin E (Cervidil, Cytotec, Prepidil, Prostin E2 gel)

(Intrapartum)

Purpose

• Cervical ripening (softening)

  • At or near term when induction of labor is indicated.

---

Not given concurrently with oxytocin.

• Wait at least 30 minutes

Monitor uterine contractions (UCs) and fetal heart rate (FHR) for 1 hour after

Have patient lie flat for 30 minutes to 2 hours after

Caution

• Asthma

Misoprostol (Cytotec)(Vaginal/Oral)

(Intrapartum)

• Cervical ripening (softening)

• Labor induction.

(Prostaglandin E analog)

---

Assess dilation of cervix periodically during therapy.

Monitor for tachysystole (excessive contractions).

Adverse Effect

• Fever & Diarrhea (infant/mother)

Contraindication

• Patient has 3 or more contractions in a 10-minute period.

Oxytocin (Pitocin) Intrapartum

(Intrapartum)

Purpose

• Stimulates uterine contractions.

• Induction and augmentation of labor.

• Control of postpartum bleeding after placental expulsion.

---

Turn down infusion if:

• Contractions are closer than 2 minutes apart.

  • Last longer than 120 seconds each

  • No 60-second rest period between each

• Significant change in FHR or fetal distress

Adverse Effects

• Water intoxication

  • Listless, drowsiness, confusion, headache

Contraindication

• Within 4 hours of Misoprostol administration

Terbutaline

Stop Infusion & Left Side positioning

Antidote for Oxytocin (Pitocin)

Fentanyl Citrate (Sublimaze)

(Intrapartum)

Purpose

• Moderate to severe pain.

---

Fast-acting

• Ideal in preventing opioid side effects in NBN

Concurrent use with Nubain / Stadol further decreases pain

Caution

• Diabetes

• Grape juice (increases blood levels)

Atropine

Antidote for Fentanyl Citrate (Sublimaze) induced Bradycardia

Nubain (Nalbuphine)

(Intrapartum)

Purpose

• Moderate to severe pain.

---

Can cause a high-pitched “cat-like” cry if used near delivery

Phenergan (Promethazine)

(Intrapartum)

Purpose

• Nausea

---

Caution

• Hypertension

Zofran (Ondansetron)

(Intrapartum)

Purpose

• Nausea

• Post-anesthesia itching (off-label use)

---

Contraindication

• Oral route with PKU (contains aspartame)

Dilaudid (Hydromorphone)

(Intrapartum)

Purpose

• Moderate to severe pain

---

Opioid Side Effects

• Antidote: Narcan (Naloxone) 0.4-2.0 mg IV/SC/IM

Butorphanol Tartrate (Stadol)

(Intrapartum)

Purpose

• Moderate to severe pain relief

---

Opioid Side Effects

• Antidote: Narcan (Naloxone) 0.4-2.0 mg IV/SC/IM

Contraindication

• Opioid drug dependency (causes withdrawals)

• Giving immediately before birth

Hydroxyzine (Vistaril)

(Intrapartum)

Purpose

• Anxiety

• Vomiting

• Itching

(Often combined with opioid analgesics)

---

Use Z-Track technique

Safety precautions during administration

Adverse Effects

• Drowsiness, dry mouth, pain at IM site

Contraindication

• Pregnancy

  • Can be used safely in labor

Cefazolin (Ancef)

(Intrapartum)

Purpose

• GBS prophylaxis

• Chorioamnionitis

• Pre-surgery prophylaxis

---

Caution

• Penicillin allergy

Ephedrine Sulfate

(Antidote)

Purpose

• Increases blood pressure

  • Usually from hypotension due to epidural or spinal anesthesia

---

MUST DILUTE

MUST PREPARE AT BEDSIDE (epidural)

Adverse Effects

• Possible fetal tachycardia

• Possible fetal decreased variability

Contraindication

• BP above 130/80

Naloxone (Narcan)

(Antidote)

Purpose

• Reversal of narcotic-induced respiratory depression.

---

Contraindication

• Giving for respiratory depression NOT CAUSED BY OPIOIDS

Calcium Gluconate

(Antidote)

Purpose

• Magnesium sulfate toxicity

  • DTR = 0-1 or respiratory rate <12

---

GIVE SLOWLY

• Prevents cardiac arrest

Calcium Gluconate Antidote

Magnesium Sulfate

Neonatal Naloxone (Narcan)

(Antidote)

Purpose

• Reversal of NEWBORN CNS and respiratory depression

  • Due to late administration of maternal narcotics during labor.

---

Contraindication

• Respiratory depression NOT CAUSED BY OPIOIDS

Cefoxitin (Mefoxin)

(Anti-Infectives)

Purpose

• Pelvic Inflammatory Disease (PID)

---

Educate patient to have partner treated

Caution

• High PID Risk first 3 weeks after IUD placement

Contraindication

• Sex until course completion

Ceftriaxone (Rocephin)

(Anti-Infectives)

Purpose

• Gonorrhea

---

Educate patient to have partner treated

Contraindication

• Sex until course completion

Flagyl (Metronidazole)

(Anti-Infectives)

Purpose

• Bacterial Vaginosis

• Vulvovaginal Candidiasis

• Trichomonas Vaginalis

---

First Trimester

• CANNOT BE TREATED

Educate patient to have partner treated

Contraindication

• Sex until course completion

Penicillin (Amoxicillin)

(Anti-Infectives)

Purpose

• Syphilis

---

Monitor for allergic reaction

• Observe 15 minutes post-injection

Site: Deep IM in dorsolateral or ventrogluteal

Educate patient to have partner treated

Contraindication

• Sex until course completion

Oral Acyclovir and Famciclovir

(Anti-Infectives)

Purpose

• Herpes Genitalis

---

Breastfeeding SAFE

Educate patient to have partner treated

Contraindication

• Sex until course completion

Azithromycin (Zithromax)

(Anti-Infectives)

Purpose

• Chlamydia

---

Educate patient to have partner treated

Contraindication

• Sex until course completion

• Anticoagulants

Permethrin Cream 5% (Acticin, Elimite)

(Anti-Infectives)

Purpose

• Pediculosis Pedis (Lice/Scabies Treatment)

---

Avoid contact with orifices

Wash after 8-14 hours

May cause itching (up to 4 weeks)

Clomid (Serophene, Clomiphene)

(Infertility)

Purpose

• First line for infertility

  • Oral taken with prescribed intercourse

• Male infertility

• Menstrual abnormalities

• Fibrocystic breasts

• Abnormal milk production

---

Adverse Effects

• Multiple pregnancy, bloating, pain, breat discomfort

• n/v, visual disturbances, HA, dryness, hair loss

Intercourse must be timed

Danocrine

(Infertility)

Purpose

• Infertility issues

• Endometriosis treatment

---

Synthetic steroid

• Androgen-like effects, similar to testosterone.

Must take consistently (3-9 months)

Metformin

(Infertility)

Purpose

• Polycystic Ovary Syndrome (PCOS)

---

Contraindication

• Alcohol

Parlodel (Bromocriptine, Cycloset)

(Infertility)

Purpose

• Hyperprolactinemia (high prolactin levels)

  • Inhibits pituitary secretion of prolactin (milk production)

---

Contraindication

• Breastfeeding

• Fetal loss or stillbirth

Progesterone (Vaginal)

(Infertility)

Purpose

• Luteal phase support (suppresses FSH & LH)

  • Restores menstruation & ovulation

---

Caution

• Breastfeeding = Serious / Fatal Reactions

Medications for Postpartum Hemorrhage

Please Make Hemorrhage Cease Today

1) Pitocin (Oxytocin):

• Induces labor, augments contractions, or controls postpartum bleeding.

• Administered as an IV bolus after delivery to clamp the uterus.

• Monitor for hypotension, water intoxication, or swelling.

2) Methergine (Methylergonovine):

• Avoid in hypertensive or smoking patients due to vasoconstrictive properties.

3) Hemabate (Carboprost Tromethamine):

• Last-resort medication due to side effects like severe diarrhea and cramping.

• Avoid in asthma, cardiac, renal, or liver disease.

4) Cytotec (Misoprostol):

• Uses: Cervical ripening, postpartum hemorrhage, uterine atony.

• Administered rectally for hemorrhage (1,000 mcg) or vaginally/orally for induction (25–50 mcg).

5) Tranexamic Acid (Lysteda):

• For hemorrhage or bleeding disorders.

• Contraindicated in patients with a history of DVT, PE, or clotting disorders​.

Medications for Constipation

Docusate Sodium (Colace):

• Stool softener that draws water into the stool.

Bisacodyl (Dulcolax):

• Suppository

• Contraindication: 4th-degree tears (to avoid suture irritation​)

Pain Management Medications

NSAIDs (e.g. Ibuprofen (Motrin)):

• Used postpartum for mild pain

• Avoid during pregnancy due to the risk of persistent pulmonary hypertension in the infant.

  • Increases mother’s BP and constricts newborn’s ductus arteriosus

• Avoid in preeclampsia or HELLP syndrome due to increased bleeding risk.

Narcotics for Moderate to Severe Pain (Mnemonic: STOP Feeling Discomfort Now):

• Stadol (Butorphanol Tartrate): Avoid in individuals with a history of drug dependency.

• Fentanyl (Sublimaze): Fast-acting opioid for labor pain.

• Dilaudid (Hydromorphone): Used for severe pain.

• Nubain (Nalbuphine): Can cause a high-pitched “cat-like” cry in newborns if used near delivery.

• Key Points:

  • Avoid administration close to delivery to prevent neonatal respiratory depression.

  • Antidote for opioids: Naloxone (Narcan)​.

Medications for Preterm Labor (Tocolytics)

Terbutaline (Brethine):

• Fast-acting administered subcutaneously.

• Avoid in patients with cardiac issues, HR >120, or diabetes due to increased heart rate and glucose levels.

CCB: Nifedipine (Procardia):

• Use: Preterm labor and hypertension.

• Avoid if BP <90/50​.

Neonatal Medications

Vitamin K (Phytonadione):

• Prevents neonatal bleeding due to a sterile gut lacking bacteria to produce Vitamin K.

• Administered in the newborn’s left thigh (Kick Left).

Erythromycin Ointment:

• Prevents neonatal eye infections caused by gonorrhea or chlamydia.

Hepatitis B Vaccine:

• Given in the newborn’s right thigh (Be Right). Parental consent required​.

Preterm and High-Risk Pregnancy Medications

Magnesium Sulfate:

• Uses: Seizure prevention in preeclampsia and neuroprotection in preterm infants.

• Monitor for toxicity (slurred speech, absent DTRs, respiratory depression).

• Antidote: Calcium Gluconate.

Betamethasone (Celestone):

• Action: Increases surfactant production.

• Use: Promotes fetal lung maturity

• Administered in two doses 24 hours apart if gestation is <34 weeks​.

Labor Induction Medications

Cytotec (Misoprostol): Prostaglandin E for cervical ripening.

Cervidil (Dinoprostone):

• Tampon-like insert placed near the cervix for 12 hours

• Remove before starting Pitocin.

• Use caution in asthma patients​.

Oxytocin (Pitocin)

(Postpartum)

Purpose:

• Postpartum hemorrhage

• Uterine atony

Complications

• Coma

• Hypotension

• Water intoxication

• Vasopressor & Antidiuretic Effects

---

(Intrapartum)

Purpose

• Stimulates uterine contractions.

• Induction and augmentation of labor.

• Control of postpartum bleeding after placental expulsion.

Turn down infusion if:

• Contractions are closer than 2 minutes apart.

  • Last longer than 120 seconds each

  • No 60-second rest period between each

• Significant change in FHR or fetal distress

Adverse Effects

• Water intoxication

  • Listless, drowsiness, confusion, headache

Contraindication

• Within 4 hours of Misoprostol administration

Misoprostol (Cytotec)

(Postpartum) - Rectal

Purpose:

• Postpartum hemorrhage

• Uterine atony

• Reduces NSAID-induced gastric ulcers

Adverse Effects

• Severe diarrhea (infants)

• Fever and diarrhea (mother)

---

(Intrapartum) - Oral/Vaginal

• Cervical ripening (softening) if no ROM

• Labor induction.

Assess dilation of cervix periodically during therapy.

Monitor for tachysystole (excessive contractions).

Contraindication

• Patient has 3 or more contractions in a 10-minute period.

Contraindication: Breastmilk

Methylergonovine Maleate (Methergine)

If a patient has asthma and is experiencing postpartum hemorrhage, would you give Carboprost (Hemabate)

NO! Choose a different medication like Methylergonovine (Methergine) or Misoprostol (Cytotec) instead.

If a patient is HYPERTENSIVE is experiencing postpartum hemorrhage, would you give Methylergonovine (Methergine)?

NO! Instead, give Oxytocin (Pitocin) or Carboprost (Hemabate) (if no asthma)