• enhances uterine contractions 
• provides stimulation of contractions with uterine inertia
• helps reduce labor in clients with maternal diabetes, preeclampsia, eclampsia, and erthroblastosis fetalis 
• use only after cervix has dilated and presentation of fetus has occurred 
• Stimulates letdown reflex 
• relieves pain from breast engorgement
• controls postpartum hemorrhage
• promotes postpartum uterine involution

• dilute as ordered in IV solution and hang as titratable IV drip, using IV pump
• Use NS as primary line, with med IVPB at secondary port or stopcock
• monitor effects on contractions while titrating dosage
• Nasal spray may be used to promote milk ejection
• keep magnesium sulfate on hand for use if needed to relax myometrium
• DO NOT confuse pitocin with pitressin

• increased pain with contractions from increased uterine motility
• hypersensitivity
• cardiac dysrhythmias
• hypotension
• hypertension (if given after vasopressors)
• water intoxication (hyponatremia, hypochloremia)
• N&V

• intracranial hemorrhage
• hypoxia
• asphyxia

• shut off IV drip
• turn client onto left side
• increase rate of NS IV
• apply oxygen via face mask PRN

• sudden onset of intense occipital h/a
• palpitations
• hypertension
• stiff neck
• n&v
• fever & sweating
• photophobia & dilated pupils
• constricting chest pain
• bradycardia or tachycardia

• drowsiness
• h/a
• confusion
• anuria
• weight gain
• decreasing urinary output w/adequate intake

• inhibit contractions and arrest labor for at least 48hrs so corticosteroids can be given to facilitate fetal lung maturity
• used for cessation of contraction to allow intrauterine fetal resuscitation when uterine hyperstimulation occurs
• used to delay delivery in preterm labor

• Terbutaline sulfate (Brethine)
• Ritodrine (Yutopar)--> increased incidence of pulmonary edema
• Nifedipine (Procardia)--> may cause oligohydramnios
• Indomethacin (Indocin)-->increased risk of fetal complications 

• start at lowest possible dose & increase PRN until contractions cease
• be CERTAIN about recommended dose
• take med with food to prevent GI upset
• Dilute IV terbutaline by adding each 5mg to 1000mL D5W or NS to yield concentration of 5mcg/mL
• Infuse med via microdrip using infusion pump

• maternal & fetal tachycardia
• palpitations
• tremors
• jitteriness and anxiety
• pulmonary edema

• constipation (cause or exacerbate)
• N&V
• oligohydramnios (Nifedipine & Indomethacin)
• premature closure of ductus arteriosis, leading to fetal death (Indomethacin)
• Refer to beta-adrenergic side effects

• used to control postpartum hemorrhage
• DO NOT use before placental delivery
• cause clonic contractions of uterus
• produce arterial vasoconstriction and possible vasospasm of coronary arteries

• Ergonovine (Ergotrate)
• Methylergonovine (Methergine)

• contraindicated in pregnancy, hypersensitivity, and hypertension
• use cautiously in unstable angina and recent MI
• Significant increase in S&D BP
• decrease in milk production
• uterine cramping
• Ergotism or overdose

• N&V
• weakness
• muscle pain
• insensitivity to cold
• paresthesia of extremities 

• closely monitor BP, withhold dose & notify prescriber if hypertension noted
• monitor lochia and uterine contractions
• Assess and report hypertension, chest pain, ergotism, or hypersensitivity (SOB, itching)
• Admin analgesics PRN to control pain of uterine contractions caused by ergot

• Prostaglandin E2 AKA Dinoprostone (Prepidil, Cervidil)
• Prostaglandin F2 AKA Carboprost tromethamine (Hemabate)

• diarrhea, N&V, increased BP
• uterine cramping
• tension h/a
• flushing, cardiac dysrhythmias
• uterine tetany
• uterine rupture
• Contraindicated: acute PID & hx of pelvic surgery
• Use cautiously w/hypertension & hx of asthma

• follow manufacturer;s instructions for placement of medication
• client must remain recumbent for 20-30 min
• continuous fetal monitoring while recumbent

• monitor lochia and BP
• prepared for client do develop diarrhea

• report long or continuous contractions (uterine atony)
• count fetal movement (indicates fetal well-being)

• Acts as CNS depressant and depresses smooth, skeletal, & cardiac muscle function when given parenterally
• Used to arrest preterm labor
• Prevents/treats seizures with preeclampsia and eclampsia 

• use in conjunction with beta-adrenergics increases risk of pulmonary edema
• a 4g loading dose is often utilized, which must be given over 20-30 min via infusion pump

• flushed warm feeling, drowsiness
• decreased/absent deep tendon reflexes
• decreased strength or absence of hand grasp
• fluid & electrolyte imbalance, hyponatremia
• N&V
• respiratory depression leading to respiratory arrest

• fetal anomaly incompatible with life
• pulmonary edema or CHF
• anuria
• renal failure
• organic CNS disease

• report signs of preeclampsia (h/a, epigastric pain, visual disturbances)
• report signs of confusion
• side effects of medication

• check patellar reflex prior to dose (risk for respiratory arrest)
• hand grasps & deep tendon reflexes hoursly for signs of toxicity
• V/S every 30-60 min (especially RR)
• Notify physician if RR <12/min
• Ensure calcium gluconate is bedside
• IV infusion flow rate adjusted to maintain urine flow of 30-50 mL/hr
• Monitor IV site for extravasation
• Monitor serum magnesium levels
• take accurate daily weight

• Meperidine (Demerol)
• Fentanyl (Sublimaze)
• Sufentanil (Sufenta)

• Butorphanol tartrate (Stadol)
• Nalbuphine (Nubain)

• fentanyl (Sublimaze)
• Sufentanil (Sufenta)

• DON'T admin in early labor, could slow labor
• Birth should occur >4hr or <1hr after dose of meperidine to min neonatal CNS depression
• DON'T use agonist-antagonists for women with opioid depedence

• provide adequate analgesia
• less resp depression
• less N&V
• equal or > sedation when compared to meperidine 

• irritability
• hyperactive reflexes
• tremors
• seizures
• yawning
• sneezing
• vomiting
• diarrhea
• excessive crying (in neonate)

• N&V
• sedation
• drowsiness or confusion
• tachycardia or bradycardia
• hypotension
• dry mouth
• urinary retention
• pruritis
• respiratory depression

• confusion
• sedation
• N&V
• sweating
• respiratory depression (< likely to occur)

• monitor FHR and uterine contractions
• assess for resp depression (<12 bpm)
• assess NB for resp depression if born in 1-4hr of dose
• keep naloxone available
• keep siderails raised for safety 
• supp pain relief using nonpharm methods

• similar to opioid analgesics
• watch for withdrawal Sx if admin to opioid-dependent women and neonates

• erythromycin ophthalmic ointment
• tetracycline ophthalmic ointment or solution

• apply up to but within 1 hr of delivery
• cleanse eyes before application of dose
• admin 0.5-1 cm ribbon of ointment into each conjunctival sac
• DON'T rinse eyes following dose
• use new tube of for each neonate

• admin w/in 72hrs of potential or actual exposure to Rh+ blood
• Readminister with each possible/actual exposure
• DON'T admin if client has developed + antibody titer to Rh antigen
• Admin at 28 wks gestation 
• DON'T admin to NB

• tenderness at injection site
• slight elevation in temperature
• contraindicated with hypersensitivity, isoimmunization, or Rh+ women

• improves gas exchange
• stabilizes alveoli against collapse at resting pressures
• prevents/treats RDS in premature infants

• Give by intratracheal route into endotracheal tube using #5 French catheter with end hold
• DON'T suction within 1 hr after dose unless significant airway obstruction occurs

• oxygen desaturation
• transient bradycardia
• crackles and moist breath sounds; does not necessarily indicate need for suctioning

• Ensure proper endotracheal tube placement prior to dosing
• Monitor heart rate, chest expansion, facial expression during administration
• monitor O2 sat 
• monitor arterial or transcutaneous O2 and CO2 levels

• synthetic glucocorticoid (corticosteroid)
• prevention of neonatal RDS (unlabeled use)
• enhances production of surfactant

• admin to client in preterm labor btw 28-32 wks
• used if client & fetus can safely tolerate inhibition of labor for 48 hrs
• admin as once-daily dose IM

• contraindicated during lactation
• risk of infection and delayed wound healing with coadministration of other corticosteroids

• monitor maternal V/S and fetal well-being
• monitor for increased temp and WBC count

• fat-soluble vitamin that aids synthesis of clotting factors II, VII, IX, and X in immature NB liver
• prevents/treats hemorrhagic disease of NB until NB has intestinal flora to absorb vit K from GI tract

• Give IM at time of delivery in vastus lateralis muscle of leg
• Protect from light

• monitor for signs of bleeding (bruising at injection site or actual bleeding from umbilical cord)
• Assess for jaundice and monitor results of Bilirubin levels to detect hyperbilirubinemia

• RN administration
• rapid onset of pain relief
• ease of administration relatively short duration

• may decrease contraction frequency and intensity
• crosses placenta resulting in neonatal respiratory depression
• short duration may not give adequate pain control during nulliparous or prolonged labor

• undesirable for rapidly progressing labor or transition phase
• may eliminate urge to push
• must be injected by anesthesia personnel
• injection is uncomfortable
• laboring client must hold very still during injections
• spinal h/a may occur from leakage of CSF through dura at injection site

• nausea
• pruritis
• urinary retention 
• muscle spasms at site of injection

• bupivacaine hydrochloride (Marcaine)
• lidocaine hydrochloride (Xylocaine)

• excellent pain relief
• re-dosing possible
• no neonatal respiratory depression results
• may provide a few hours of postpartum pain relief as well as during L&D

• undesirable for rapidly progressing labor or transition phase
• must be inserted by anesthesia personnel
• usually causes numbness of lower extremities, limiting mobility
• decreases contraction frequency and intensity
• reduces or eliminates urge to push
• relaxation of musculature below site of injection often results in failure of fetus to accomplish internal rotation, necessitation an operative birth

• monitor urinary output because retention requiring indwelling urinary catheter may result
• monitor BP because maternal hypotension commonly results from vasodilation
• avoid supine position

• rapid onset of pain relief
• no neonatal respiratory depression
• can be administered during transition
• relative ease of administration

• systemic absorption of medication through vascular cervix
• excessive bleeding from cervix
• decreased or absent urge to push

local anesthetic agent injected into lateral vaginal walls near ischial spines to anesthetize pudendal nerve

• excellent anesthesia or perineum
• rarely needs readministration
• provides a few hrs of postpartum pain relief

• must inject along presenting part
• creating increased vaginal pressure and discomfort for client
• eliminates urge to push

• ease of administration
• provides a few hours of postpartum pain relief