Managing Complications in Pregnancy and Childbirth: - IAWG

Abdominal pain in later pregnancy and after childbirthS-125If preterm labour continues despite use of tocolytic drugs,arrange for the baby to receive care at the most appropriateservice with neonatal facilities.TABLE S-17Tocolytic drugs a to stop uterine contractionsDrugInitialDoseSubsequent DoseSide Effects andPrecautionsSalbutamolIndomethacin10 mg in 1 LIV fluids.Start IVinfusion at10 dropsper minute.100 mgloading doseby mouth orrectumIf contractionspersist, increaseinfusion rate by 10drops per minuteevery 30 minutesuntil contractionsstop or maternalpulse rate exceeds120 per minute.If contractions stop,maintain the sameinfusion rate for atleast 12 hours afterthe last contraction.25 mg every 6 hoursfor 48 hoursa Alternative drugs include terbutaline, nifedipine and ritodrine.ALLOWING LABOUR TO PROGRESS• Allow labour to progress if:- gestation is more than 37 weeks;- the cervix is more than 3 cm dilated;- there is active bleeding;If maternal heartrate increases (morethan 120 per minute),reduce infusion rate; Ifthe woman isanaemic, use withcaution.If steroids andsalbutamol are used,maternal pulmonaryoedema may occur.Restrict fluids,maintain fluid balanceand stop drug.If gestation is morethan 32 weeks, avoiduse to preventpremature closure offetal ductus arteriosus.Do not use for morethan 48 hours.