Drugs Used In Obstetrics And Gynecology Pdf

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7.1 Drugs used in obstetrics

A more recent article on this topic is available. Related Editorial. Pregnant women commonly use over-the-counter medications. Although most over-the-counter drugs have an excellent safety profile, some have unproven safety or are known to adversely affect the fetus.

The safety profile of some medications may change according to the gestational age of the fetus. Because an estimated 10 percent or more of birth defects result from maternal drug exposure, the U. Food and Drug Administration has assigned a risk category to each drug. Many drugs have not been evaluated in controlled trials and probably will not be because of ethical considerations. Of the commonly used over-the-counter medications, acetaminophen, chlorpheniramine, kaolin and pectin preparations, and most antacids have a good safety record.

If use of smoking cessation products is desired, the intermediate-release preparations minimize the amount of nicotine while maintaining efficacy. With all over-the-counter medications used during pregnancy, the benefit of the drug should outweigh the risk to the fetus.

A common concern about the care of pregnant women involves the use of over-the-counter OTC medications. Nonprescription drugs account for about 60 percent of medications used in the United States, and more than 80 percent of pregnant women take OTC or prescription drugs during pregnancy.

It is estimated that up to 60 percent of patients consult a health care professional when selecting an OTC product. At least 10 percent of birth defects are thought to result from maternal drug exposures. The medical community's approach to the use of medications during pregnancy has changed dramatically since the early s, largely because of the problems with thalidomide and diethylstilbestrol.

Consequently, extensive testing is required before a drug can be labeled for use during pregnancy. Since , the U. The safety of these medications during pregnancy is outlined in Table 2.

Acetaminophen is widely used during pregnancy. Although there is no known association with teratogenicity, few clinical data are available to support the lack of association. Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester and there is no evidence of risk in later trimesters , and the possibility of fetal harm appears remote. Either animal reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal reproduction studies have shown an adverse effect other than a decrease in fertility that was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk in later trimesters.

Either studies in animals have revealed adverse effects on the fetus teratogenic or embryocidal or other and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus. There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk e.

Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Information from Collins E. Maternal and fetal effects of acetaminophen and salicylates in pregnancy. The controversy surrounding indomethacin for tocolysis.

Am J Obstet Gynecol ;— Oral decongestant of choice 10 , possible association with gastroschisis 9. Food and Drug Administration.

First trimester maternal medication use in relation to gastroschisis. Teratology ;—7, and The use of newer asthma and allergy medications during pregnancy. Ann Allergy Asthma Immunol ;— Salicylates have been associated with increased perinatal mortality, neonatal hemorrhage, decreased birth weight, prolonged gestation and labor, and possible birth defects. Pregnant women should use salicylates only under the guidance of a medical professional.

Physicians may employ indomethacin during pregnancy to treat pain from degenerating leiomyomata, or as a tocolytic agent. Unfortunately, indomethacin use during pregnancy may result in oligohydramnios, premature closure of the fetal ductus arteriosus with subsequent persistent pulmonary hypertension of the newborn, fetal nephrotoxicity, and periventricular hemorrhage.

However, an analysis 8 of 50 pregnant patients who overdosed on ibuprofen revealed no evidence of fetal abnormalities. Because of the possibility of adverse effects of NSAIDs on the fetus, it is our opinion that these medications should be used sparingly during pregnancy.

Women commonly use cold medications during pregnancy. These medications, like most of the other OTC drugs, have not been studied well in pregnancy Table 3. The most commonly used cold medications include decongestants and expectorants such as pseudoephedrine Novafed , guaifenesin Humibid L. The use of vasoconstrictive agents such as pseudoephedrine may activate alpha-adrenergic receptors, elevating blood pressure or causing vasoconstriction in the uterine arteries, and potentially adversely affecting blood flow to the fetus.

This process could explain the reported association between the use of pseudoephedrine in the first trimester and the development of gastroschisis. Diphenhydramine is widely used in pregnancy as a sedative, an antihistamine, and an anti-nausea drug, although few data confirm its safety during pregnancy.

The drug has been shown to have oxytocin-like effects, especially in high dosages. For example, one study 13 showed a significant increase in fetal morbidity when diphenhydramine was taken in combination with temazepam Restoril. In , the American College of Obstetricians and Gynecologists and the American College of Allergy, Asthma, and Immunology released a position statement 10 regarding the use of asthma and allergy medications, including antihistamines and oral decongestants.

Chlorpheniramine and tripelennamine PBZ were recommended as antihistamines of choice. Pseudoephedrine was recommended as the oral decongestant of choice, based on animal studies and a large prospective human experience with the drug during pregnancy. However, because pseudoephedrine may be associated with gastroschisis and because other choices are available, it may be prudent to avoid using this medication during the first trimester unless the benefit outweighs the risk.

Dextromethorphan has been associated with birth defects in chicken embryos. The Collaborative Perinatal Project 14 monitored 50, pregnant women, of whom were exposed to dextromethorphan in the first trimester. Birth defects did not increase above the baseline rate.

Another study 15 of 59 women who had used dextromethorphan in the first trimester documented one malformation. Thus, sufficient evidence indicates a lack of adverse effects of dextromethorphan use during pregnancy. When used during the first trimester in the presence of a febrile illness, guaifenesin has been associated with an increased risk of neural tube defects.

The safety of the various agents is outlined in Table 4. A possible association has been identified between the ingestion of clays containing kaolin and the development of iron deficiency anemia.

Loperamide has not been found to be teratogenic in animals. However, at least one study 4 involving first-trimester exposure in humans showed a possible increase in fetal cardiac malformation. Several antacids are available in OTC forms, including preparations that contain alginic acid, aluminum, magnesium, and calcium. All of these preparations generally are regarded as safe in pregnancy Table 5. There have been sporadic reports of fetal maldevelopment and injury associated with prolonged use of high dosages of aluminum-containing antacids during pregnancy.

Magnesium compounds contain magnesium sulfate, a known tocolytic agent. Despite the minimal magnesium absorption that occurs with antacid ingestion, some clinicians prefer the use of calcium-containing preparations. Simethicone Mylanta Gas is not absorbed. The histamine H 2 -receptor blockers are effective in treating symptoms of heartburn and gastroesophageal reflux disease in pregnancy, 20 but these drugs readily cross the placenta.

Studies of these agents generally have shown significant improvement of symptoms with no significant adverse effects. Animal studies also fail to show an increased fetal risk with the use of these medications in pregnancy, the notable exception being nizatidine Axid. The OTC doses are one half of the prescription strength.

Although studies have indicated that there is probably no increased risk of fetal morbidity or mortality, few studies have evaluated first-trimester use of H 2 blockers. Therefore, most investigators recommend avoiding these drugs in the first trimester. The most common antifungal medications available as OTC drugs include the imidazole agents clotrimazole Mycelex , butoconazole Femstat , miconazole Monistat , and tioconazole Vagistat Table 6 23 , 24 describes the safety of various OTC antifungal agents in pregnancy.

One of the largest studies 24 to date investigated the teratogenicity of clotrimazole. The population-based, case-control study of 18, case pregnancies and 32, control pregnancies did not show an association between fetal malformations and the use of clotrimazole.

Several small trials have indicated that butoconazole and miconazole are likely to be safe during the second and third trimesters. Insufficient data are available regarding the safety of tioconazole in pregnancy. Many clinicians use oral fluconazole Diflucan to treat vulvovaginal candidiasis. A study 26 of women exposed to fluconazole during the first trimester of pregnancy revealed that patients taking fluconazole were no more likely than unexposed control patients to experience miscarriage, stillbirth, or congenital anomalies.

Ketoconazole Nizoral , flucytosine Ancobon , and griseofulvin Grisactin may be teratogenic or embryotoxic in animals. The Centers for Disease Control and Prevention recommends using only topical vaginal antifungal agents including butoconazole, clotrimazole, miconazole, and the prescription medications terconazole [Terazol] and nystatin [Mycostatin] in pregnancy.

Nicotine replacement therapy presents an interesting clinical dilemma. Researchers believe that nicotine and its metabolic byproduct, cotinine, are harmful to the developing fetus because smoking is known to cause harmful fetal effects, including intrauterine growth retardation, premature birth, hyperviscosity in the newborn, spontaneous abortion, fetal neurotoxicity, and pulmonary defects, and an increased risk of sudden infant death syndrome.

The primary mechanism of these deleterious effects is believed to be uteroplacental insufficiency. Reduced perfusion of oxygenated blood through the placenta at various stages of development may cause the various manifestations of fetal maldevelopment and injury. Safe in second and third trimesters human trials , 24 first trimester probably safe Information from Lagace E.

Safety of first trimester exposure to H 2 blockers. No teratogenic effect after clotrimazole therapy during pregnancy. Epidemiology ;— Physicians should educate pregnant patients about the harmful effects of smoking to themselves and the developing fetus, and help these patients develop a plan for smoking cessation. The safety of nicotine replacement products in pregnancy has not been adequately studied.

Medications for Gynecological Conditions

A more recent article on this topic is available. Related Editorial. Pregnant women commonly use over-the-counter medications. Although most over-the-counter drugs have an excellent safety profile, some have unproven safety or are known to adversely affect the fetus. The safety profile of some medications may change according to the gestational age of the fetus. Because an estimated 10 percent or more of birth defects result from maternal drug exposure, the U.

Gynecological Conditions are conditions concerned with diseases of the female genital tract, as well as endocrinology and reproductive physiology of the female. The following list of medications are in some way related to, or used in the treatment of this condition. Drug class: miscellaneous GI agents. For consumers: dosage , interactions , side effects. For professionals: Prescribing Information. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Read terms. El-Sayed, MD. Pain can interfere with a woman's ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Multimodal analgesia uses drugs that have different mechanisms of action, which potentiates the analgesic effect.

Drug Treatment in Obstetrics

Drugs are used in over half of all pregnancies, and prevalence of use is increasing. The most commonly used drugs include antiemetics, antacids, antihistamines, analgesics, antimicrobials, diuretics, hypnotics, tranquilizers, and social and illicit drugs. Despite this trend, firm evidence-based guidelines for drug use during pregnancy are still lacking. However, few well-controlled studies of therapeutic drugs have been done in pregnant women.

Postpartum Pain Management

Read terms. Number Replaces Committee Opinion No.

Over-the-Counter Medications in Pregnancy

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Какие вообще у них есть доказательства, что Танкадо действительно создал Цифровую крепость. Только его собственные утверждения в электронных посланиях. И конечно… ТРАНСТЕКСТ. Компьютер висел уже почти двадцать часов. Она, разумеется, знала, что были и другие программы, над которыми он работал так долго, программы, создать которые было куда легче, чем нераскрываемый алгоритм. Вирусы. Холод пронзил все ее тело.

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 Немец. Какой немец. - Тот, что был в парке. Я рассказал о нем полицейскому. Я отказался взять кольцо, а эта фашистская свинья его схватила.

Уничтожение банка данных АНБ - акт агрессии, на которую, была уверена Сьюзан, Танкадо никогда бы не пошел. Вой сирены вернул ее к действительности. Она смотрела на обмякшее тело коммандера и знала, о чем он думает.

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Marijuana Use During Pregnancy and Lactation

Он слышал приятный голос сеньора Ролдана из агентства сопровождения Белена. У нас только две рыжеволосые… Две рыжеволосые, Иммакулада и Росио… Росио… Росио… Беккер остановился как вкопанный. А еще считаюсь лингвистом. Он не мог понять, как до него не дошло .

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Drug Treatment in Obstetrics