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-Eclampsia as we know is a very serious condition that may or may not be present during pregnancy and is mostly known to be characterized by seizures due to excessively high blood pressure.
-Signs and symptoms are: Visual disturbances, epigastric pain (right upper abdominal quadrant), edema, and significantly high blood pressure.
-Magnesium sulfate is the initial treatment of convulsions associated with pregnancy in which Magnesium acts as a smooth muscle relaxant and may reverse vasospasm due to eclampsia.
**Special precautions should be taken into consideration when administering Magnesium Sulfate:
- NOT administered to patients with heart block, in shock, persistent/severe HTN, undergoing hemodialysis TX, or with hypocalcemia.
- Known to cause hypotension, circulatory collapse leading to cardiac and respiratory depression.
- In case of respiratory depression, calcium chloride via IV must be administered as an antidote.
- Frequent cardiac and vital sign monitoring is required after Magnesium Sulfate is administered considering the above mentioned precautions.
- Standard dosage to manage convulsions due to eclampsia is: 4-6g SLOW IV over 30 mins followed by an infusion of 1-2g/hr. When unable to obtain IV access, Magnesium Sulfate may also be administered IM by 4-5g/5 hrs. Volume of med is 5-10mL therefore dose should be divided in half and administered in 2 separate sites (both glutes).

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Trade name: Zofran
Class: Antiemetic
Mechanism of Action: Acts as a serotonin antagonist to prevent serotonin-mediated nausea.
Indications in pregnancy: Zofran is commonly used off-label to treat both morning sickness and hyperemesis gravidarum.

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All in all Terbutaline is a last line of defense when it comes to being used to stop or prevent premature labor in pregnant women. This is for the reason that it has caused serious side effects, including death, in pregnant women who took the medication for this purpose. A paramedic MUST be very careful when administering this medication to the patient. Make sure that the CORRECT/RIGHT dose is given.

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Naturally secreted by the posterior pituitary

Trade Name: Pitocin
Class: Hormone/Uterine Stimulant
Mechanism of Action:
-Causes uterine contraction (smooth muscle)
-causes lactation
-slows postpartum vaginal bleeding
Indication:
-postpartum vaginal bleeding
Contraindications:
-any conditions other than postpartum bleeding
-Cesarean Section (C-Section)
Side Effect:
-Hypotension
-Anaphylaxis
-Cardiac arrhythmias
-tachycardia
-seizures
-coma
-N&V
Dose:
IV - 10-20 unites in 500 mL of D5W (administer according to uterine response)
IM - 3-10 units
Route:
-IV drip
-IM

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Mechanism of Action: causes antiemetic effects by inhibiting dopamine D2 and serotonin 5-HT3 receptors in the chemoreceptor trigger zone in the central nervous system. (Prevents N&V triggered by most stimuli) used to treat Gastroesophageal reflux disease (GERD), N&V caused by chemotherapy and after surgery
Indications in pregnancy: morning sickness, hyperemesis gravidarum (severe type of n&v during pregnancy)
Contraindications: patients with depression and seizures (result in longer and more frequent seizures
Side Effects: restless, exhaustion, dizzy, headache, confusion, uncontrolled muscle spasms, jerky eye and extremity movement
Risks: thought to be safe but has not been fully proven and can maybe cause specific malformations and fetal dearth
Dosage: GERD 10-15mg (Oral) (also up to 20mg) N&V 10-20mg (IM) chemotherapy n&v 1-2 mg/kg (IV)

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Trade Name: Hydralazine
Class: Vasodilator
Mechanism of Action: relax the blood vessels so that blood can flow more easily through the body.
Indication: High blood pressure; to control high blood pressure in a mother during pregnancy (pre-eclampsia or eclampsia) or in emergency situations when blood pressure is extremely high (hypertensive crisis).
Contraindications: heart attack within the last 30 days, coronary artery disease, a stroke, low blood pressure, a condition with symptoms that resemble lupus, high pressure within the skull, decreased blood volume.

Side Effect: flushing, headache, upset stomach, vomiting, loss of appetite, diarrhea, constipation, eye tearing, stuffy nose, rash

Dose: Tablet (10/25/50/100mg), 5-10 mg IV/IM initially, THEN 5-10 mg q20-30min PRN, OR, 0.5-10 mg/hr IV infusion
Route: Tablet, IV/IM

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Class: antiemetic, antihistamine
Mechanism of action: Antagonism of histamine H1, muscarinic, and dopamine receptors in the medullary vomiting center which is useful for early pregnancy sickness.
Indications in Pregnancies: This is mostly used to treat pregnancy sickness.
There are no concerns of birth defects when used in the first trimester, but after 12 weeks which is when most internal organs are formed, some medicines are known to cause birth defects.

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Class: Nonselective beta-blocker (Class II antiarrhythmic)

MOA: Blocks B1 and B2 receptors without preference. Its unique feature is that it also blocks A1 receptors inhibiting peripheral vasoconstriction. This is useful in OB patients experiencing pre-eclampsia.

Indications: Acute management of hypertensive emergency. (symptomatic hypertension)

Contraindications: Bronchial asthma, CHF, heart block, bradycardia, or cardiogenic shock

Side effects: bradycardia, hypotension, lethargy, CHF, dyspnea, wheezing, and weakness

Dose: 20 mg by slow IV infusion over 2 minutes; doses of 40 mg can be repeated in 10 minutes until desired BP is obtained OR until 300 mg.
200 mg in 500 mL D5W to deliver 2 mg/min

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- WHAT IS IT ?  Is a mixture of sodium chloride and sodium lactate potassium chloride and sodium chloride. Is mainly used for replacing fluids and electrolytes for those in  low BP or low blood volume
- PRECAUTIONS   A down side to using LR’s is the risk having  Hyperkalemia  (high potassium in the blood)
- MOA  restores fluid and electrolyte balance produces diuresis and acts as a alkalizing agent
-DOSAGE. The dose for LR varies depending on the seriousness of the case either a “TKO” or “KVO” which means keep vein open is around 30ml per hour or if severely dehydrated 1L a hour
- WHEN NOT TO  give LR is when the patient has
•liver disease
•kidney failure
•and Ph higher then 7.5
-USES IN LABOR.    LR is commonly used in OB patients when in delivery since the process of a child being born is very taxing on the mother fluids are used to replenish her and provide electrolytes to rehydrate her

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Its usually used after postpartum hemorrhage, whole blood can also be used for patients with placenta abnormalities. There is also a unique blood transfusion know reconstituted whole blood that's mainly used for neonatal exchange transfusion, its commonly used for hemolytic disease of newborn.

In pregnancy
- use different alternatives, the risks outweigh the benefits
- use in extreme life-threatening conditions