Common Drugs Used In Labor This document provides an overview of several common drugs used during labor including oxytocin, prostaglandins, methergin, pethidine, xylocaine, and dospa, primperan, and bisolvon. It describes the actions, indications, contraindications, side effects, and important nursing considerations for each medication. The goals of using these drugs are to facilitate labor, relieve pain, and control postpartum hemorrhaging while closely monitoring for any adverse effects on the mother or fetus.

1. Common Drugs
Used In Labor
Obstetric and Gynecological nursing department
Division 3 - Group 1
Cairo University
Faculty of Nursing
2022-2023

2. Prepared by
1- Ibrahim Hassan Abdel-Fattah 9-Menna Gaber Samir
2- Aya Atya Gomaa 10- Hassan Dawood
3- Merna Abu Al-Saad Mikhael 11- Ayat Ibrahim lsmill elsyed
4- Hajar Ragab Bayoumi 12-Mahmoud Mohamed Mahmoud Gaballah
5- Omnya Ismail Muhammad 13-Eslam Mahmoud Mohamed Mahmoud
6- Eman Ramadan Muhammad 14-Ekramy Ashraf Maher
7- Ahmed El sayed Abdullah 15-Alshimaa shaban Abdelmotaleb
8-Mariam Mahmoud Abdel Salam 16-Mahmoud Mohamed shabaan

3. Outlines
Oxytocin
prostaglandin
Methargin
Pethidine
Xylocian
Dospa, Primperan & Bisolvon
• Actions, indications, contraindications, adverse
effects, nursing care for each medication.

4. Introduction
Introduction
Labor is defined as regular and painful uterine contractions that cause
progressive dilation and effacement of the cervix. The World Health
Organization (WHO) defined normal birth as "spontaneous in onset, low-
risk at the start of labor and remaining so throughout labor and delivery.
to make sure labor is smooth and less painful there are several
medications that the mother can take it to facilitate and help during the
process of labor and when we used this medications the health care
provider need to consider the effect of medication on both mother and
fetus.

5. Oxytocin
oxytocin

6. Oxytocin
oxytocin
Induction & augmentation:-
Induction of labor is defined as the artificial process of initiating labor
before spontaneous onset, using mechanical or pharmacological
methods. Augmentation of labor, however, is the stimulation of
uterine contractions once the woman has spontaneously initiated
labor, but the progress is considered inadequate.
Augmentation with synthetic oxytocin may result in uterine
hyperstimulation, with adverse effects such as fetal asphyxia and
uterine rupture
Oxytocin plays a vital role in labour and delivery. The hormone is produced
in the hypothalamus and moves to pituitary where it is stored.

7. Oxytocin
oxytocin
Action
• The concentration of oxytocin receptors on the myometrium
increases significantly during pregnancy and reaches a peak in
early labor. Activation of oxytocin receptors on the myometrium
leads to increased intracellular calcium in uterine myofibrils
which strengthens and increases the frequency of uterine
contractions.
• In humans, most hormones are regulated by negative feedback;
however, oxytocin is one of the few that is regulated by positive
feedback.The head of the fetus pushing on the cervix signals the
release of oxytocin from the posterior pituitary of the mother.
Oxytocin then travels to the uterus where it stimulates uterine
contractions.The elicited uterine contractions will then stimulate
the release of increasing amounts of oxytocin. This positive
feedback loop will continue until delivery
• Causes contraction of the myoepithelial cells around milk-
containing alveoli, resulting in milk ejection during lactation.

8. Oxytocin
oxytocin
Indication :
- oxytocin is indicated in the antepartum period to initiate or improve
uterine contractions for vaginal delivery
- in situations where there is fetal or maternal concern. For example, It
may be used to induce labor in cases of maternal diabetes, preeclampsia
at or near term, and when delivery is indicated due to prematurely
ruptured membranes.
-Importantly, oxytocin is not approved or indicated for elective induction
of labor.
- Oxytocin may be used to reinforce labor in the management of abortion.
- In the postpartum period, oxytocin may be used to induced contractions
in the 3rd stage of labor and to control postpartum bleeding or
hemorrhage.

9. Oxytocin
oxytocin
Contraindication
◇Cephalopelvic disproportion
◇Women at risk of uterine rupture
◇Umbilical cord prolapses
◇In fetal distress where delivery is not imminent;
◇In cases where vaginal delivery is contraindicated, such as invasive cervical
carcinoma, active herpes genitals, total placenta previa, vasa previa, and cord
presentation or prolapse of the cord
◇In abnormal fetal positions or presentations, such as transverse lies, which are
undeliverable without conversion prior to delivery.
◇Where the uterus is already hyperactive or hypertonic
◇In patients with hypersensitivity to the drug

10. Oxytocin
oxytocin
-Side effects
◇Uterine hyper stimulation leading to uterine rupture
◇Cardiovascular reactions including: -increased heart rate
-hypertension
- cardiac arrhythmias
- nausea and vomiting
◇Excessive maternal fluid retention.
◇Vaginal bleeding
◇Fetal effects related to uterine hypo perfusion include:
- fetal hypoxia
-bradycardia and death.
• ◇Neonatal yellowing of skin or eyes

11. Oxytocin
oxytocin
Nursing care
◇ALWAYS administer oxytocin via infusion pump
◇Monitor blood pressure, maternal pulse, respirations, and fetal heart rate
(FHR); contraction pattern every 15 minutes and with each increase in dose.
◇Monitor intake and output.
◇Ensure fetal position and size and absence of complications that are
Contraindicated with oxytocin before therapy
◇Signs/symptoms of water intoxication; e.g., headache, irritability, confusion,
nausea.
◇Monitor any signs of allergies
◇Monitor rate and strength of contractions discontinue drug and notify
physician at any sign of uterine hyperactivity or spasm.

12. Prostaglandins

13. Prostaglandins
Prostaglandins
What are prostaglandins?
Prostaglandins are a group of lipids with hormone-like actions that your body makes primarily at sites of tissue
damage or infection. There are several different types of prostaglandins, and they play several essential roles in
regulating bodily processes

14. Prostaglandins
Prostaglandins
Prostaglandins include , misoprostol, also referred to as PGE1
and dinoprostone, also referred to as PGE2.
MECHANISM OF ACTION
• Stimulates collagenase in the cervix, promoting cervical
ripening
• Increases intracellular calcium within uterine smooth
muscle cells, stimulating uterine contraction
Prostaglandins are produced naturally by the body during the process of labor. Their
role is to prepare the cervix and to help open the cervix in response to contractions.

15. Prostaglandins
Prostaglandins
INDICATIONS
• Induction and management of abortion
• Cervical ripening
• Control postpartum hemorrhage
• Cervical ripening
• Management of spontaneous abortion
• Induction of abortion

16. Prostaglandins
Prostaglandins
CONTRAINDICATIONS
 Previous cesarean section or other uterine surgery
 Grand multiparity
 Cephalopelvic disproportion
 Unfavorable fetal position
 Placenta previa
 Pelvic infection
 Active genital herpes
 Asthma
 Glaucoma
 Hepatic, renal, respiratory, or cardiovascular disease

17. Prostaglandins
Prostaglandins
SIDE EFFECTS
 Uterine hyperstimulation
 Abnormal fetal heart rate
 Nausea
 Vomiting
 Diarrhea
 Diaphoresis
 Cardiac arrhythmias
 Disseminated intravascular coagulation
 Amniotic fluid embolism

18. Prostaglandins
Prostaglandins
Nursing care
When using prostaglandins for cervical ripening
Prior to administration
• Reinforce education provided by obstetrician / midwife
• Assessments: contraindications and precautions; cervical status, fetal lie,
fetal position; baseline uterine and fetal heart monitoring
• If administering misoprostol, have terbutaline readily available
After administration
• Keep client supine 15–30 minutes after receiving gel or for two hours after
receiving vaginal insert
• Assessments: uterine activity, FHR, maternal vital signs; monitor for side
effects
• Therapeutic response: cervical softening, minimal uterine activity, normal FHR
• Undesired outcomes: hyperstimulation; monitor FHR for indeterminate /
abnormal patterns
• Provide comfort measures as needed

19. Prostaglandins
Prostaglandins
Nursing care
When using misoprostol to control postpartum hemorrhage.
• Teaching: expect uterine contractions and decreased bleeding
• Assessments: uterine tone, amount of bleeding, vital signs; monitor for side
effects
• Therapeutic response: increased uterine tone, control of hemorrhage
• Undesired outcomes: continued hemorrhage
• Provide comfort measures as needed

20. Methergin
methargin

21. METHARGIN
methargin
Action
Methergine (methylergonovine maleate) acts directly on the smooth
muscle of the uterus and increases the tone, rate, and amplitude of
rhythmic contractions.
Indications of methergin:
Following delivery of the placenta, for routine management of uterine
atony, hemorrhage, and subinvolution of the uterus. For control of
uterine hemorrhage in the second stage of labor following delivery of
the anterior shoulder.

22. METHARGIN
methargin
Contraindications
• During pregnancy , The first and second stage of labor.
• heart disease
• A stroke.
• Blockage or narrowing of mitral heart valve.
• High blood pressure.
• Coronary artery diseaseA blockage of the arteries called
• arteriosclerosis obliterans.
• Serious numbness or prickling or tingling of fingers and toes.

23. METHARGIN
methargin
❖ More common
1) Abdominal pain
2) headache
3) increased blood pressure
side effect of methargin 10) pain or discomfort in the arms, jaw, back,
orneck
11) pain, tenderness, or swelling of the foot orleg
12) puffiness or swelling of the eyelids or
around the eyes, face, lips, or tongue
13) slow or fast heartbeat
14) skin rash
15) sweating
16) vomiting
❖ Rare
1) Blood in the urine
2) change in skin color
3) chest pain or discomfort
4) difficult or labored breathing
5) difficulty with swallowing
6) dizziness
7) fast, pounding, or irregular heartbeat
orpulse
8) hives
9) lightheadedness, dizziness, or fainting

24. METHARGIN
methargin
NURSING CARE
• Monitor vital signs (particularly BP) and uterine response during and
after parenteral administration of methylergonovine until partum
period is stabilized (about 1–2 h).
• Notify physician if BP suddenly increases or if there are frequent
periods of uterine relaxation
• Give IV slowly over several minutes
• Monitor blood pressure closely
• Monitor uterine contraction

25. Pethidine
Pethidine

26. Pethidine
Pethidine
Action
- Narcotic, analgesic and sedative drug has been traditionally used
during childbirth.
- Decrease moderate to sever pain.
- Can taken IV slowly diluted on 10cm ringer's lactate,or IM and oral
as tablet
Indication
-Used to relief of moderate to sever pain.
- given before 2 hour of second stage of labor

27. Pethidine
Pethidine
Contraindication*
- breastfeeding mothers.
- Hypersensitivity to medication.
- Respiratory problem
side-effects:
The most common side-effects are feeling dizzy or sleepy, sweating and nausea .
Other common side-effects include headache, dry mouth, skin rash , drowsiness ,dizziness ,
constipation , vomiting , urinary retention ( difficulties passing urine ) , dyspnea ( difficulty in
breathing ).
• CNS : Nervousness, headache, restlessness, uneasiness, fatigue, confusion, depression,
hallucinations, tremors, muscle twitches, increased intracranial pressure and fits.
• CV : Hypotension ,tachycardia , palpitation.
• GIT :Loss of appetite, stomach cramp, muscle spasm, spincture muscle dysfunction ,
vomiting, constipation.
• Skin :Flushed, dry skin, skin rash.
• Other side effects: Weakness, General hypersensitivity reactions, and pain at injection site

28. Pethidine
Pethidine
✓Monitor blood pressure prior to administration. Hold if systolic BP < 100 mm
Hg or 30 mm Hg below baseline.
✓ Monitor patient's respiratory rate prior to administration.
✓Monitor for respiratory depression and hypotension frequently up to 24 hours
after administration of pethidine.
✓Using appropriate pain scale to document whether this durg is successful in
helping manage the patient's pain.
✓Identifying patients at risk for unintended advancing sedation and respiratory
depression.
✓Implementing plans of care to assess and monitor patients.
✓Intervening to prevent the worsening of adverse events.
✓Monitor psychological status if there confusion .
✓Be alert seizures or increased seizure activity especially at the onset of drug
treatment , document the number, duration and severity of seizures and
reporting these findings immediately to the physician.
NURSING CARE

29. Xylocaine
Xylocaine

30. Xylocaine
Xylocaine
Lidocaine
-Trade names: Xylocaine
Class:
-Local anesthesia, and anti arrhythmic
Action:
Local anesthesia: blocks the generation and conduction of action
potentials in sensory nerves by reducing sodium permeability,
reducing height and rate of rise of the action potential , increasing
excitation threshold and slowing conduction velocity.
indications in labor: in normal delivery with episitomy we use it S.C

32. Xylocaine
Xylocaine
-Contraindication:
allergy to lidocaine or amide-type local anethetic.CHF.cardiogenic
shock.second-or third degree heart block.
-Side effect:
CNS:dizziness.light
headedness.fatigue.drawsiness.unconsciousness.tremors
twiching.vision change.may progress to seziures.convulsions.
-GI:nausea.vomiting
-Cv:cardiac arrhythmias cardiac arrest .vasodilation.hypotension
-Respiratory:respiratory depression and arrest
-Hypersensitivity:rash anaphylactic reaction
-Other: malignant hyperthermia

33. Xylocaine
Xylocaine
*Nursing considration:
-don't aded lidocain to blood transfusion.
-make certain that vials "for cardiac arrhythmia".
-assess for history of hypersensitivity.
-use 5%dexterouse solution to prepare drug (stable for 24 hours ).
-use electronic infution devics to regulare the infution of the drug.
-obtain Bp .pulse .Resp.rate as basedline data to evaluate response to treatment.
-drug shold be given in a monitored environment.
-assess Bp frequently during adminstration.
-assess for respiratory depression.
-if advers reaction occur discontinue infusion&prepare for emergency management.

34. Dospa, Primperan
& Bisolvon
The main action of this drugs is:
Soften of the cervix.Effacement of the cervix
Dospa,
Primperan
&
Bisolvon

35. Dospa, Primperan & Bisolvon
● Dospa :Antispasmodic
It is used to relieve pain caused by irritable bowel syndrome, headaches,
menstrual periods
also Used to smooth muscle spasm highly effective in reducing the duration
of active phase of labor by hastening cervical dilatation.
Primperan: Antiemetic
is a medicine that relieves symptoms of nausea, vomiting,
heartburn, and a feeling of fullness.
Bisolvon : Mucolytic
This medicine is used in the treatment of cases of cough
accompanied by sputum, as it helps to dissolve sputum and
reduce its viscosity, and thus helps to treat the following

36. Dospa
●contraindications:
1] Liver, kidney and heart diseases
2] pregnancy
3] breast feeding
4] hypersensitivity
5] other medications as Antimuscarinics, analgesics .
6] Diabetes
7]Bedridden or immobile for a long time
● Side effects:
1) Nausea, Vomiting
2) Diarrhea
3) Dryness in mouth 4)Nervousness, Dizziness, Drowsiness
5) blurred vision
6) Photophobia 7)Abdominal pain
8)Insomnia
9) Anorexia
10) Confusion, Hallucination 11) Dry skin
12)Reduced bronchial secretions
13) Vertigo, Flatulence.

37. Dospa
● Nursing action for this drug:
1} Monitor vital signs esp.(HR and BP)
2} Monitor blood pressure during I.V administration
3} don't chew this drug
4} monitor intake and output
5} monitor characteristics of pain
(monitor uterine contraction duration,frequency,intensity)
6} monitor skin for any circulatory abnormalities (allergy, flushing)
7} Monitor the patient for any side effect.
8}Make sure that the monitor does not sensitive to the drug.
9} Stay alert for any depression and some effect of CNS.

38. References
Lippincott.W,Nursing2022 Drug Handbook (Nursing Drug Handbook)
Pharmacology Made Incredibly Easy 4th Edition
Arrowsmith, S., & Wray, S. (2014). Oxytocin: its mechanism of action and receptor
signalling in the myometrium. Journal of neuroendocrinology
Helliwell, R. J., Adams, L. F., & Mitchell, M. D. (2013). Prostaglandin synthases:
recent developments and a novel hypothesis. Prostaglandins, Leukotrienes and
Essential Fatty Acids