Obstetrics

Page 2: Learning Objectives

  • Apply knowledge of medications to patient care:

    • Drug class and spectrum

    • Mechanism of action

    • Side/adverse effects

    • Warnings/contraindications

    • Dosing schedules

    • Drug interactions

    • Patient counseling

  • Describe uses and precautions of gynecological/obstetrical medications and nursing roles.

  • Prepare and administer medications accurately.

  • Verify medication orders for appropriateness.

  • Identify patient allergies and intervene as needed.

  • Review pertinent data (vital signs, labs) before administration.

  • Predict and manage drug interactions effectively.

  • Evaluate drug treatment effectiveness, document responses, and act accordingly.

  • Prioritize medications for patients.

  • Assess readiness to learn and deliver education clearly.

Page 3: Overview of Chapter Content

  • Focus on drug therapy for infertility and uterine function.

  • Refer to Chapter 11 Tables for fetal risk in maternal pharmacology.

Page 5: Infertility

  • Definition: Decrease in reproductive ability; may be due to dysfunction in either partner.

  • Sterility: Complete lack of reproductive ability.

Page 6: Ovarian Cycle

  • Overview of ovarian phases and hormone actions:

    • Mature follicle releases ovum.

    • Division into Follicular Phase, Ovulation, and Luteal Phase.

  • Hormones involved:

    • Estrogen and Progesterone from corpus luteum.

    • Gonadotropins from pituitary (FSH, LH).

Page 7: Causes of Infertility

  • Female Infertility:

    • Anovulation, cervical mucus issues, hyperprolactinemia, endometriosis, polycystic ovarian syndrome.

  • Male Infertility:

    • Hypogonadotropic hypogonadism and erectile dysfunction.

Page 8: Drug Therapies for Female Infertility

  • Drugs Promoting Follicular Maturation:

    • Clomiphene, menotropins, follitropins, lutropins.

  • Drugs that Stimulate Ovulation:

    • Human Chorionic Gonadotropins, choriogonadotropin alpha.

Page 9: Additional Drug Therapies for Female Infertility

  • Drugs Preventing Premature Ovulation:

    • GnRH antagonists: ganirelix, cetrorelix.

  • For Hyperprolactinemia, Endometriosis, and PCOS:

    • Cabergoline, bromocriptine, GnRH agonists, danazol, lifestyle changes, oral contraceptives.

Page 10: Clomiphene Overview

  • Usage: Promotes follicular maturation and ovulation in women with functioning ovaries.

  • Mechanism of action: Estrogen receptor blockade, leading to increased secretion of LH and FSH.

  • Adverse effects: Hot flashes, nausea, bloating, visual changes, risk of multiple gestations.

  • Nursing Considerations: Monitor via serial ultrasounds for follicular enlargement, be aware of signs of ovarian hyperstimulation.

Page 12: Case Study - Jasmine

  • Scenario:

    • 34-year-old pregnant woman at 30 weeks gestation with abnormal discharge and contractions.

    • Cervical dilation at 3 cm suggests potential complications.

Page 13: Preterm Labor

  • Defined as cervical changes before 37 weeks.

  • Tocolytic Drugs:

    • Beta 2 Adrenergic Agonist: Terbutaline suppresses uterine activity; watch for maternal side effects.

    • Calcium Channel Blockers: Nifedipine, safer than terbutaline.

Page 14: Tocolytic Drugs

  • Cyclooxygenase Inhibitors: Indomethacin may have effects on both mother and fetus.

    • Risks include renal insufficiency and gastrointestinal issues.

Page 15: Protecting the Preterm Fetus

  • Magnesium Sulfate: Does not stop labor but offers neuroprotection. Significant nursing concerns for both mother and fetus.

    • Monitoring for vital signs, magnesium levels, and fetal heart patterns is critical.

Page 16: Protecting the Preterm Fetus Continued

  • Antibiotics for infections that can lead to preterm labor.

    • Glucocorticoids like betamethasone promote lung maturity in the fetus.

Page 17: Prevention of Preterm Labor

  • Hydroxyprogesterone caproate (Makena): Administered for singleton pregnancies with preterm history, dosing details, and nursing considerations.

Page 18: Hydroxyprogesterone Caproate Continued

  • Adverse Effects: Injection reactions and potential serious complications.

    • Contraindications include certain health risks that must be monitored.

Page 19: Case Study - Asma

  • 25-year-old woman with pre-eclampsia needing labor induction.

    • The role of the nurse involves managing care during this critical situation.

Page 20: The Process of Labor

  • Cervical dilation and effacement precede uterine contractions.

Page 21: Drugs for Cervical Ripening

  • Dinoprostone: Overview of use and patient care considerations for cervical softening.

    • Side effects and monitoring protocols highlighted.

Page 22: Misoprostol Use

  • Utilization and nursing considerations for Misoprostol in cervical ripening and postpartum hemorrhage.

Page 23: Induction of Labor

  • Oxytocin: Functions and side effects related to uterine contractions. Critical nursing management points discussed.

Page 24: Oxytocin Administration Protocols

  • Nursing management guidelines during Oxytocin infusion to prevent complications.

Page 25: Case Study - Joy

  • 32-year-old mother with post-birth complications, highlighting the nurse's role in assessment and intervention.

Page 26: First Line Postpartum Hemorrhage Drugs

  • Oxytocin and Misoprostol: Dosing protocols and potential side effects for managing postpartum hemorrhage.

Page 27: Second Line Postpartum Hemorrhage Drugs

  • Carboprost and Methylergonovine: Details on action, side effects, and administration precautions.

Page 28: Rho(D) Immunoglobulin (RhoGAM)

  • Prevents isoimmunization in Rh-negative mothers.

  • Administration timeline and indications for Rh-negative mothers.

Page 29: Final Thoughts

  • Reflection on “AHA” moments, insights gained, and the importance of the material learned.

Ovarian Cycle Overview

The ovarian cycle consists of distinct phases that regulate the development and release of the ovum (egg).

Phases of the Ovarian Cycle:

  1. Follicular Phase:

    • Begins on the first day of menstruation and lasts until ovulation.

    • The pituitary gland releases follicle-stimulating hormone (FSH), stimulating the growth of ovarian follicles.

    • Estrogen levels rise as the follicles mature, leading to the thickening of the endometrium in preparation for potential pregnancy.

  2. Ovulation:

    • Occurs typically around day 14 of a 28-day cycle.

    • A surge in luteinizing hormone (LH), triggered by rising estrogen levels, causes the mature follicle to release the ovum into the fallopian tube.

  3. Luteal Phase:

    • After ovulation, the ruptured follicle transforms into the corpus luteum, which produces progesterone.

    • Progesterone helps maintain the uterine lining.

    • If fertilization does not occur, the corpus luteum degenerates, hormone levels drop, and menstruation begins, marking the end of the cycle.

Hormones Involved:

  • Estrogen: Secreted by the ovaries, important for the development of the reproductive system and secondary sexual characteristics.

  • Progesterone: Produced by the corpus luteum; crucial for menstruation regulation and sustaining early pregnancy.

  • Gonadotropins: Include FSH and LH, produced by the pituitary gland, play vital roles in regulating the ovarian cycle.