MEDICATIONS

MAGNESIUM SULFATE

  • 500mg /ml solution

FOR ECLAMPSIA

  • 4 g intravenous loading dose
  • Immediately followed by 10 g intramuscularly – 5 mg in each buttock
  • Followed by 5 g intramuscularly every 4 hours in alternating buttocks
  • Check patellar reflexes before each injection
  • If weak or absent wait another 4 hours before giving next injection

MISOPROSTOL

  • Tablet Cytotec 200 µg

FOR INDUCTION IN IUFD

Gestational age < 26 weeks

  • ORAL ADMINISTRATION (preferred)
    • One tablet diluted in 10 cc
      • 2 cc orally every 6 hours
  • VAGINAL ADMINISTRATION
    • ½ tablet in vagina every 6 hours

Gestational age > 26 weeks

  • ORAL ADMINISTRATION (preferred)
    • One tablet diluted in 10 cc
      • 1 cc orally every 4 hours
  • VAGINAL ADMINISTRATION
    • ¼ tablet in vagina every 4 hours
    • One tablet diluted in 10 cc
      • 1 cc in vagina every 4 hours

Use only exceptionally and with greatest precaution for induction with alive fetus

FOR POSTPARTUM BLEEDING

ORAL ADMINISTRATION (preferred)

  • 2 to 3 tablets orally

RECTAL ADMINISTRATION

  • 2 to 4 tablets rectally

VALIUM

For Eclampsia:

  • 5 to10 mg i.v. or rectally
  • Repeat after 10 to 15 minutes up to a maximum dose of 30 mg
  • If needed repeat after 2 to 4 hours.
  • Keep a syringe loaded with 10 mg at bedside
  • Give immediately i.v. when a seizure is noted

OXYTOCIN

FOR INDUCTION OF LABOUR

  • 10 units in 500 cc Normal Saline solution
  • Start i.v. infusion with 10 ml per hour
  • increase by 20 ml every 20 minutes until contractions occur

FOR POSTPARTUM HEMORRHAGE

  • 30 units in 500 CC Normal Saline
  • Infused over 2 to 4 hours

NEFIDIPINE

For Hypertension:

  • 10 mg 3 times daily

For Premature Labor:

  • 10 to 40 mg
  • Followed by 10 to 20 mg every 6 to 8 hours

LIDOCAINE

For Eclampsia:

  • 2mg/kg i.v. as a bolus

2mg/kg/h i.v. as maintenance

SALBUTAMOL

  • Tablets 4 mg

For Premature Labor:

  • 4 mg four times daily

PREMATURE LABOUR

PREMATURE CONTRACTIONS

  • Bed rest in left lateral position
  • Salbutamol
    • Tablets 4 mg four times daily
  • Nifedipine
    • Initial dose of 20mg
    • Followed by three further doses of 20mg every 30 minutes
      • As long as contractions continue
    • Maintenance dose is 20-40mg orally every 4 hours for 48 hours
      • No more than 160mg/24 hours
  • Potent corticosteroids
    • Accelerates lung maturity of fetus
      • Betamethasone 1 ampule i.m. 2 doses 12 hours apart
      • Dexamethasone 6 mg i.m. 4 doses 12 hours apart

INSUFFICIENT CERVIX

  • Cerclage with heavy non-resorbable suture
  • Remove suture when contractions start
    • Or deliver by C/S

PREMATURE DELIVERY

  • Maintain body temperature
    • Incubator is questionable high tech
    • Kangaroo method is more appropriate technology
      • No significant difference in survival rate between the two methods
    • Cover head
  • Feed with breast milk
    • Cup
    • Spoon
    • Gastric tube