Page content

Page breadcrumb

7.5 Obstetrics

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

7.5.1 Induction of labour

 

Dinoprostone

  • Prostin E2® Pessary Vaginal tablets 3mg
  • Propess® Vaginal delivery system 10mg
  • Prostin E2® IV injection 10mg/ml, 1mg/ml

Note:

 

Oxytocin

  • Injection 5 units in 1mL, 10 units in 1mL

 

7.5.2 Postpartum haemorrhage 

Ergometrine

     Injection 500micrograms in mL

 

Ergometrine and oxytocin

    Injection containing ergometrine maleate 500micrograms and oxytocin 5 units in 1 mL

 

Carboprost

    Injection 250 micrograms  in 1mL

Notes:

  • Carboprost is only indicated for postpartum haemorrhage due to uterine atony in patients unresponsive to ergometrine and oxytocin.
  • Misoprostol [unlicensed] can be used in postpartum haemorrhage when oxytocin, ergometrine, and carboprost are not available or are inappropriate.
  • Tranexamic acid is used to decrease blood loss in surgery and health conditions associated with increased bleeding. There have been some reviews that have found that tranexamic acid is also effective in reducing blood loss postpartum.

 

7.5.3 Premature labour 

Terbutaline

 Note:

  • Terbutaline (Off-label use) in emergency situations

Nifedipine 

Note:

  • Nifedipine (unlicensded indication, off-label use)

 

Atosiban  

  • Injection 7.5mg/mL (0.9mL vial)
  • Concentrate for IV infusion 7.5mg/mL (5mL vial)

Notes: 

  • Atosiban is included for use second line if the patient has side effects with beta2-agonists
  • For termination of pregnancy, a single dose of mifepristone is followed by administration of a prostaglandin (gemeprost or misoprostol [unlicensed]).
  • Guidelines from the Royal College of Obstetricians and Gynaecologists; The Care of Women Requesting Induced Abortion (November 2011) include the following [unlicensed] regimens for inducing medical abortion as detailed in the BNF:

 

Magnesium Sulfate  

Notes:

  • Magnesium Sulfate  (unlicensed indication, off-label use) 
  • Prevention of seizures in pre-eclampsia
  • Treatment of seizures and prevention of seizure recurrence on eclampsia

 

 

7.5.4 Termination of Pregnancy

 

Gemeprost

  • Pessary 1mg

 

Misoprostol

  •  Tablets  200 micrograms

 

Mifepristone

  •  Tablets  200mg

Notes:

  • For termination of pregnancy, a single dose of mifepristone is followed by administration of a prostaglandin (gemeprost or misoprostol [unlicensed]).
  • Guidelines from the Royal College of Obstetricians and Gynaecologists; The Care of Women Requesting Induced Abortion (November 2011) include the following [unlicensed] regimens for inducing medical abortion as detailed in the BNF:

 

 

Miscellaneous

Drugs affecting the ductus arteriosus

 

Indometacin

(Closure of the ductus arteriosus) 

o    Injection 1mg vials

 

 

Myometrial relaxants

 

Salbutamol 

o    Solution for IV Infusion 5mg/5ml (48 hours maximum for authorised obstetric indications) 

o    Injection 500micrograms/ml (48 hours maximum for authorised obstetric indications)

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

 

 

Return to Chapter: 7. Obstetrics, Gynaecology and Urinary-tract Disorders

Last updated by: Dupe Fagbenro on 12-03-2019 19:35