antepartum complications Flashcards
Tocolytic - stops contractions but relax uterine muscles and inhibits
•Relaxes uterine muscles and inhibits uterine contractions
•Exerts beta-adrenergic agonist effects on uterine smooth muscles
•Indication: Preterm labor and prior to procedures such as external version
•Metabolism: Unknown
Use for short term care, like dehydration
Terbutaline (Brethine)
preterm labor
Adverse Effects:
•Cardiac arrhythmia esp. tachycardia*, hypotension and electrolyte imbalances
•Fetal transient cerebral ischemia, chorioamnionitis and IUGR, tachycardia
Terbutaline (Brethine)
preterm labor 2
Nursing Actions: •Assess heart rate prior to administration –hold if >100 bpm •Monitor patient and fetus closely •Drugs should only be used if benefits outweigh risks •Oral terbutaline is contra-indicated Patient teaching: •Pain relief lasts approximately 2 hours •Report pain, swelling at injection site
Terbutaline (Brethine)
preterm labor 3
Tocolytic
•Decreases arterial smooth muscle contractility and subsequent vasoconstriction by inhibiting the influx of calcium ions. Relaxes uterine muscles and inhibits uterine contractions.
•Indication: Preterm labor (off-label use - for their heart)
•Metabolism: Hepatic
Nifedipine (Procardia)
Adverse Effects:
•Dizziness, headache, tachycardia, hypotension & pulmonary edema
•Flushing, Nasal congestion & Nervousness,
•Nausea & Bowel changes
Nursing Actions:
•Assess VS, EFM
•Monitor patient and fetus heart rate closely
•Drugs should only be used if benefits outweigh risks
Patient teaching:
•Notify HCP if contractions continue or increase & if decreased fetal movement
Nifedipine (Procardia) 2
preterm labor
Tocolytic and anti-inflammatory
• Inhibiting the synthesis of prostaglandins . Relaxes uterine muscles and inhibits uterine
contractions.
• Indication: Preterm labor (off-label use)
• Metabolism: Hepatic
Indomethacin (Indocin)
Adverse Effects:
• Headache,
• Peptic ulcer, GI upset, Fluid retention, Bowel changes
• Fetal effects: Early ductus arteriosus closure, oligohydramnios
Indomethacin (Indocin) 2
Nursing Actions:
• Assess VS, EFM
• Monitor patient and fetus closely
• Drugs should only be used if benefits outweigh risks – not recommended after 32 weeks due torisk for ductus arteriosus closure*
Patient teaching:
• Notify HCP if contractions continue or increase & if decreased fetal movement
Indomethacin (Indocin) 3dg
Corticosteroid - Glucocorticoid
• Glucocorticoid receptor agonist which increases production of surfactant.*
• Indication: Fetal Lung Maturity
• Metabolism: Hepatic
Betamethasone (Celestone)
preterm labor
Adverse Effects:
• Fluid and sodium retention*
• Hypertension
• May effect glucose level control in GDM or Type 1 IDDM (hyperglycemia in mother &
hypoglycemia in neonate leading to increased risk for sepsis)
Betamethasone (Celestone)
preterm labor 2
Nursing Actions:
• Women with diabetes will require careful blood sugar monitoring for three to four days
after receiving steroids
• May be administered up to 34 weeks*
• Contra-indicated with serious infections
Patient teaching:
• Need 48 hours after administration to receive best effect
Betamethasone (Celestone)
preterm labor 3
Anticonvulsant - relaxes muscle/nerves (prevents seizures/depression of muscles)
• Causes direct inhibition of action potentials in myometrial muscle cells which blocks
acetylcholine from being used. It has a depressant effect on the central nervous system
(CNS)
• Indication: Pre-eclampsia, Eclampsia and Pre-term labor
• Metabolism: None
Magnesium sulfate
Preeclapsia
Adverse Effects:
• Lethargy, weakness, visual changes, slurred speech, decreased LOC
• Respiratory and cardiac depression/arrest, circulatory collapse
• Sweating, hot flushes, nasal congestion, diminished reflexes, pain at IV site
• GI distress, constipation, oligura
• Fetus: Bradycardia, reduced FHR variability and respiratory depression
Magnesium sulfate
Preeclapsia 2
Nursing Actions:
• Contract indicated with Myasthenia gravis, heart block and heart block
• Assess VS, LOC, Vision, I&O, EFM, DTR, LS & Cardiac minimum every 1-2
hours
• Must infuse as IVPB on infusion pump
• Must keep Calcium Gluconate at bedside
• Assess for signs of Mag Toxicity: hypotension, depressed reflexes, flaccid
paralysis, hypothermia, circulatory collapse, cardiac and CNS depression
proceeding to respiratory paralysis
Patient teaching:
• Infusion will continue for 24 hours after delivery
Magnesium sulfate
Preeclapsia 3
Calcium Salt/Electrolyte
• Balances concentration of magnesium
• Indication: Treatment of Magnesium Toxicity
• Metabolism: Hepatic
• Adverse Effects:
• Vasodilation, cardiac arrhythmias, hypotension, bradycardia
• Dry mouth, increased thirst, GI distress, constipation & increased urination
• Nursing Actions:
• Infuse slowly over 1-3 minutes
• Patient teaching:
• Report any pain at injection site as soon as possible
Calcium gluconate
preeclampsia
Peripheral Vasodilating Antihypertensive
• Lowers blood pressure by exerting a peripheral vasodilating effect through a direct relaxation of
vascular smooth muscle by altering cellular calcium metabolism
• Indication: Severe hypertension secondary to pre-eclampsia/eclampsia
• Metabolism: Hepatic, tissues and red blood cells
Hydralazine (Apresoline)
Adverse Effects:
• Fluid retention, tachycardia, orthostatic hypotension, severe hypotension, angina,
palpitations, headache and severe pericardial effusion Nursing Actions:
• Closely monitor the patient for fluid volume excess
• Monitor B/P every 5 minutes at start then every 15 minutes until stable*
• Monitor EFM continuously
Patient teaching:
• Change position slowly, call for help if dizzy/light-headed
Hydralazine (Apresoline) 2
Alpha-and beta-adrenergic blocker Antihypertensive
• Lowers blood pressure by competitively blocking selective alpha-1 and non-selective beta which
slows sinus heart rate, decreases peripheral vascular resistance, and decreases cardiac output
• Indication: Severe hypertension secondary to pre-eclampsia/eclampsia
• Metabolism: Hepatic
• Contraindicated: History of asthma
Labetalol Hydrochloride (Normodyne, Trandate)
Adverse Effects:
• Bradycardia, bronchospasm, hypotension, AV block, heart failure, stroke
• GI distress, diarrhea
Nursing Actions:
• Monitor B/P every 5 minutes at start then every 15 minutes until stable
• Monitor EFM continuously
Patient teaching:
• Change position slowly, call for help if dizzy/light-headed
• Notify HCP if history of asthma or diabetes (masks hypoglycemia)
Labetalol Hydrochloride (Normodyne, Trandate) 2
