INSTITUTION PROGRAMME SUBJECT UNIT TOPIC VENUE STUDENT TEACHER PARTICIPANTS DATE TIME METHOD OF TEACHING TEACHING AIDS

GUIDE

: COLLEGE OF NURSING MADRAS MEDICAL COLLEGE : M.Sc (N) I Year : OBSTETRICS AND GYNAECOLOGY : : UNIT VI

EFFECT OF DRUGS DURING PREGNANCY, LABOUR AND PUERPERIUM

: Pc.B.Sc I YEAR CLASS ROOM : P.GAJALAKSHMI

: Pc.B.Sc I YEAR STUDENTS : : : : 14-03-2012 2.00 pm 4.00 pm Lecture Cum Discussion PPT , Chart, OHP,Balck board,Handout

: Mrs.J.ALPHONSA M.Sc (N) LECTURER CON,MMC Mrs.R.SAROJA M.Sc (N) LECTURER CON, MMC Dr.Mrs.V.KUMARI M.Sc (N)., Ph.D LECTURER CON,MMC : Mrs. R.SAROJA M.Sc (N) LECTURER

EVALUATOR

CENTRAL OBJECTIVE

Most women assume that the drugs offered them by their obstetricians during pregnancy, labor, birth and lactation have been approved as safe use The fact is, there is no maternally administered drug that has been proven safe for the fetus. Nor is there any law or regulation that prohibits a physician from prescribing or administered to a childbearing woman a drug that has never been approved as safe for such use.

CONTRIBUTORY OBJECTIVE: At the end of the class the students will be able to

Explain the effect of maternal Medications on Fetus Enlist the Maternal medications with established teratogenic properties List the Fetotoxic drugs Explain the effect of maternal drug intake and breast feeding

INTRODUCTION During the early embryogenesis,the drug taken by the mother reach the conceptus through the tubal or uterine secretions by diffusion.The harmful effect on the blastocyst is usually. death.Fron 2nd to 12th week,drugs taken by the mother can cause serious damages.Drugs are prescribed only when the benefits outweigh the potential risks.Prior counselling is mandatory and minimum therapeutic dosage is used for shortest possible duration.

S. No 1

Contributory Time objective 5 mins Able to explain the effect of maternal medication on fetus

Content Matenal medication and their effect on the fetus Cytotoxic drugs-Multiple fetal malformations and abortions Androgenic steroids-Hydroxy progesterone Masculinization of the female offspring Lithium-Increased congenital malformations when used in the first trimester,neonatal goiter,hypotonia and cyanosis. Diethyl stillbesterol-Vaginal stenosis,cervical hoods and uterine hypoplasia in female fetuses. Possible Teratogens Antithyroid drugs- Goiter,Mental retardation Oral antidiabetic drug- Abnormalities in the eyes,central nervous system,skeletal system and neonatal hypoglycaemia Vitamin D Cardiopathies,hypercalcemia and Mental retardation LSD (lysergic acid diethylamide)-Chromosomal abnormality and stunted growth. Anti convulsants (Phenytoin,Valporate)- Mental retardation,cardiac abnormalities,limb defects,neonatal bleeding ,epilepsy

Student Teacher Activity Lecturing cum Discussion

Student activity Listening

AV aids Blackboard

5 mins

Enlist the possible teratogens

Lecture cum discussion

Listening

Black board

S.No 3

Time 10 mins

Contributory Objective List the Fetotoxic drugs

Content Fetotoxic drugs Aspirin High doses in the last few weeks can cause premature closure of ductus arterious,persistent pulmonary hypertension and kernicterus in the newborn. Corticosteroids (Prednisolone)-Doses above 10 mg daily may produce fetal and neonatal adrenal suppression. Aminoglycosides (antibiotics e.g. amikacin,streptomycin)-auditory or vestibular damage. Chloramphenicol- Peripheral vascular collapse (gray baby symdrome) Tetracycline-Dental discolouration and deformity,inhibition of bony growth Long acting sulphonamides-Neonatal hemolysis,jaundice and kernicterus Nitrofurantoin (furadantin)-Hemolysis in newborn with G6PD deficiency,if used at term Vitamin K Hyperbilirubinemia and kernicterus Alcohol and smoking-IUGR,preterm labour,mental retardation Narcotics-Depression of CNS-Apnea,bradycardia and hypothermia Anesthetic agentsConvulsion,bradycardia,acidosis,hypoxia,hypertonia Antihistamines-Tachycardia,vomiting,diarrhea Anticoagulants-Optic

Student Teacher Activity Lecturing

Learner Activity Listening

AV Aids Hand out

atrophy,microcephaly,chondrodysplasia punctuate

S.no

Time

Contributory Objective

Content Diuretics-Fetal compromise due to diminished placental perfusion Beta Blockers (antihypertensive drugs)-IUGR,fetal bradycardia and impaired featl responses to hypoxia Maternal drug intake and Breast feeding Genrally Breast feeding is discouraged for mothers on medications that are harmful for the infant. Transfer of drug through breast milk depends on the following factors : Chemical properties

Teacher Activity

Student Activity

AV Aids

20

Explain the effect of maternal drug intake and Breast feeding

Lecturing

Listening

PPT

Molecular weight Degree of protein binding Ionic dissociation Lipid solubility Tissue Ph Drug Concentration Exposure time

Drugs identified as having effects on lactation and the neonate are listed below : Bromides Rash,drowsiness and poor feeding Iodides - Neonatal hypothyroidism

S.no

Time

Contributory Objectives

Content Chloramphenicol-Bone marrow toxicity Oral pill (combined preparations)- Suppression of lactation Bromocriptine (parlodel)- Suppression of lactation Ergot- Suppression of lactation Metronidazole Anorexia,blood dyscariasis,irritability,weakness,neurotoxic disorders Antocoagulants Hemorrhagic tendency Isoniazid Anti DNA activity and hepatotoxicity Antothyroid drugs and radioactive iodine-Hypothyroidism and goitre Antimetabolites Anti DNA activity,immunosuppression Diazepam,opiates,phenobarbitone - sedation effect with poor

Teacher Activity

Learner Activity

AV Aids

sucking reflex

SUMMARY:

Thus so far we have been discussing about the effect of drugs during pregnancy,labour and puerperium
CONCLUSION:

Hence to conclude that drugs administered with the very best of intentions to the pregnant woman near or at term may limit the exposed offspring's ability to achieve his or her full potential in life.
EVALUATION: Questioning technique 1. List the possible teratogens 2. Enlist the factors responsible to transfer the drug through breastmilk ASSIGNMENT: Write an Assignment on Physiology of drug transfer to the fetus (Submit on 19-03-12) TEST Unit Test on 26-03-12 TIME SECTION A Essay 1. Explain in detail about the Fetotoxic drug SECTION B 2x 5 = 10 1x 15 = 15 : 1 Hour MARKS : 25

Write short notes on any one 1.Effect of Maternal medication during pregnancy 2.Maternal drug intake and breastfeeding X. BIBLIOGRAPHY: 1. Fraser, Diane. M. and Cooper, Margaret. A. (2009). Myles Textbook for Midwives. Fifteenth Edition. Elsevier: Churchill Livingstone publishers. 2. Jacob, Annamma (2009). A Comprehensive Textbook of Midwifery. Second Edition. New Delhi: Jaypee Brothers Medical Publishers. 3. Linda Anne Silvestri, Comprehensive Review NCLEX RN, Third edition, Saunders publications, India, Page no: 1111 - 1112.

ON Effect of drugs during pregnancy, labour and puerperium

SUBMITTED TO Mrs.R.SAROJA M.Sc (N) LECTURER -MMC,CON SUBMITTED ON 14-03-2012

SUBMITTED BY P.GAJALAKSHMI M.Sc (N) I YEAR