Page 860 - Saunders Comprehensive Review For NCLEX-RN

CHAPTER 28

Maternity and Newborn Medications

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Priority Concepts
Health Promotion, Safety

The Food and Drug Administration has initiated the Pregnancy and Lactation
Labeling Rule (PLLR). This is a revision to the previous system that used Category
A, B, C, D, and X. The PLLR provides more information on the risks and benefits of
using medications during pregnancy. The PLLR also provides more information to
assist the provider and pregnant mother to make informed decisions together, so as
to not deter medication use during pregnancy when it is necessary.

I. Tocolytics
A. Description: Tocolytics are medications that produce uterine
relaxation and suppress uterine activity (Table 28-1).
B. Uses: To halt uterine contractions and prevent preterm birth;
dihydropyridine calcium channel blockers such as nifedipine and
magnesium sulfate may be prescribed to achieve this goal.
Terbutaline is another medication used for this effect.
C. Adverse effects and contraindications
1. See Table 28-1 for a description of adverse effects.
2. Maternal contraindications include severe
preeclampsia and eclampsia, active vaginal bleeding,
intrauterine infection, cardiac disease, placental
abruption, or poorly controlled diabetes.
3. Fetal contraindications include estimated gestational
age greater than 37 weeks, cervical dilation greater
than 4 cm, fetal demise, lethal fetal anomaly,
chorioamnionitis, acute fetal distress, and chronic
intrauterine growth restriction.

D. Interventions for the client receiving tocolytic therapy

1. Position the client on her side to enhance placental
perfusion and reduce pressure on the cervix.
2. Monitor maternal vital signs, fetal status, and labor
status frequently according to agency protocol.
3. Monitor for signs of adverse effects to the medication.
4. Monitor daily weight and input and output status, and

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