Drugs in pregnancy and breastfeeding, and postnatal contraception Flashcards
What broad drug classes should be avoided in pregnancy?
BOWS - NAILS - TAN - CAT
Beta-blockers, Opiates, Warfarin, Sodium valproate
NSAIDs, ACEis, Isotretinoin, Lithium, SSRIs
Trimethoprim (1/3), ARBs, Nitrofurantoin (term)
Co-amoxiclav, Tetracyclines
What effects do beta-blockers have in pregnancy?
-IUGR
-Neonatal hypoglycaemia
-Neonatal bradycardia
What effects can opiates cause?
-NAS - irritability, tachypnoea, high temperature, poor feeding
-Generally can be considered safe
What effects can warfarin cause?
-Crosses placenta and is teratogenic
-Stillbirth / miscarriage
-Congenital malformations especially craniofacial
-APH, PPH, foetal haemorrhage, intracranial bleeding
What effects can sodium valproate cause?
-Neural tube defects
-Developmental delay
What effects can NSAIDs cause?
-Block prostaglandins so can cause premature closure of the DUCTUS ARTERIOSUS
-Can also DELAY LABOUR due to blocking of uterine contractions and cervical ripening
What effects can ACEis and ARBs cause?
-Cross the placenta
-Affect the kidneys leading to reducing urine production by the foetus –> OLIGOHYDRAMNIOS
-HYPOCALVARIA (reduced bone formation)
-Miscarriage / skill birth
-Neonatal renal failure and hypotension
What effects can Isotretinoin cause?
-Teroatogenic
-Miscarriage
What effects can lithium cause?
-Congenital heart defects especially EBSTEIN’S ANOMALY (tricuspid valve leaflet on the right side is set lower than it should be –> large RA, small RV)
What effects can SSRIs cause?
FIRST TRIMESTER
-Congenital heart defects
-Congenital malformations especially with paroxetine
THIRD TRIMESTER
-Neonatal persistent pulmonary hypertension
-Withdrawal in the neonate
What effects can trimethoprim cause?
-Folic acid antagonist
-Neural tube defects
-Cleft lip / palate
-Congenital heart defects
What effects can nitrofurantoin cause?
-Avoided at term
-Neonatal haemolytic disease
What effects can co-amoxiclav cause?
-Risk of NEC in the baby
What effects can tetracyclines cause?
-Neonatal tooth discolouration
What common drugs are contraindicated in breastfeeding?
-Warfarin
-Lithium
When is contraception needed from after birth?
After 3 weeks (earliest ovulation occurs 28 days after birth)
When can the POP / depo provera be started after birth?
Immediately
When can the COCP (+ring, patch) be started after birth?
-After 3 weeks if not breastfeeding
-After 6 weeks if breastfeeding
When can the implant be fitted after birth?
-Immediately
When can IUS / Cu-IUD be fitted after birth?
-Either immediately (within 48h) after birth / C-section
OR
-4 weeks postpartum
When can emergency contraception be used after birth?
-Ullipristal / levonorgestrel after 21 days
-Cu-IUD after 28 days
Under what circumstances is lactational amenorrhoea an effective method of contraception?
-Exclusively breastfeeding
-<6 months postpartum
-Feeding every 4h
-Amenorrhoeic
