Kerala State Drug Formulary.pdf

Obstetrics and Gynecology
Transfer the patient to a referral centre with facilities for
anaesthesia and caesarean section and intensive care unit facilities as
quickly as possible.
PRETERM LABOUR
1. Confirm that the patient is in labour by recording the regular
intermittent and painful uterine contractions.
2. If pregnancy is less than 34 weeks, give tocolytics - drugs which
inhibit uterine contractions.
Terbutaline sulphate 250 mcg subcutaneous hourly till contraction
subsides and thereafter 5 mg oral 4 th hourly.
3. Give glucocorticoids IM
a. Betamethasone 12mg IM 12 h 2 doses or
b. Dexamethasone 6 mg IM 6 h and 4 more doses may be
given further.
Transfer the patient as quickly as to a centre with good facilities
for managing preterm babies.
If the patient cannot be monitored properly, tocolytics should not
be given in the peripheral hospitals. Instead, after giving glucocorticoids,
patient should be transferred to a tertiary care centre.
If pregnancy is more than 34 weeks the patient should be transferred
to the nearest First Referal Unit (FRU). If the patient is in advanced labour,
conduct the delivery. Keep the baby as warm as possible and transfer
immediately to a referal hospital.
PRE- LABOUR RUPTURE OF MEMBRAN ES
1. Confirm diagnosis by giving a sterile pad, looking at the liquor or if
needed, by speculum examination.
2. Make sure whether the liquor is clear, mature blood-stained or
meconium stained.
3. Give parenteral antibiotics:A combination of Inj.ampicillin 500 mg
IM 6 h with Inj.gentamicin 80 mg IM. 8 h is satisfactory. Metronidazole
500mg IV 8 h may be added if anaerobic infection is suspected or if
pre-labour rupture of membrane is more than 24 hours duration.
4. If the gestational period is 37 weeks or more, induction of labour
can be done by giving oxytocin drip or PGE2 gel. 2.5 to 5 units of
oxytocin is given in 5% dextrose or normal saline infusion .
PGE2 gel is applied to the cervical canal under aseptic precautions.
This may have to be supplemented with oxytocin.
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