Drug therapy during labor and delivery, part 1

The drug therapy of common conditions and complications during labor and delivery and the fetal and neonatal effects of this therapy are examined.

The pharmacologic therapy of common conditions that occur in labor and delivery primarily involves oxytocin and prostaglandins for cervical ripening and labor induction and systemic and regional narcotic analgesics for pain. Because most medications used in women during labor and delivery do not have Food and Drug Administration-approved labeling, pharmacists should understand the benefits and limitations of medications used in the mother. Although induction and augmentation of labor and the control of pain often require drug therapy, other, less frequent, complications may occur in labor. Drug therapies for these complications include anti-infective agents to treat maternal infection and prevent neonatal diseases; antiretrovirals to reduce perinatal HIV-1 transmission from the mother to the fetus; corticosteroids to prevent fetal lung immaturity; antihypertensives to treat preeclampsia; anticonvulsants to treat eclampsia; antibiotics to prolong pregnancy and improve neonatal outcomes after premature rupture of the membranes; tocolytics for premature labor; and oxytocin, ergot alkaloids, and prostaglandin analogues for postpartum hemorrhage. The fetal and neonatal effects of therapy for the conditions that occur during labor and delivery are usually benign, but significant morbidity and mortality involving the mother, the fetus, and the newborn are ever-present risks.

Awareness of the conditions and complications requiring drug therapy during labor and delivery will allow hospital pharmacists to make knowledgeable decisions about the rapid accessibility of critical medications in the labor and delivery unit.