Pharmacology in complex childbearing situations by

Resources

jessiejohnsoncash1_2 — 2017-08-14 06:08:35 UTC

http://www.sarawickham.com/topic-resources/anti-d-resources-1-getting-started/

http://www.sarawickham.com/topic-resources/anti-d-resources-2-the-cochrane-reviews/

http://www.sarawickham.com/topic-resources/anti-d-resources-3-the-other-side-of-the-picture/

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2014-PI-03096-1

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000020.pub3/full

Resources

jessiejohnsoncash1_2 — 2017-08-14 06:12:20 UTC

https://www.health.qld.gov.au/__data/assets/pdf_file/0015/140136/g-pph.pdf

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2009-PI-00290-3&d=2017073016114622483

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2014-PI-02336-1

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-05416-3

Resources

jessiejohnsoncash1_2 — 2017-08-14 06:13:54 UTC

https://www.health.qld.gov.au/__data/assets/pdf_file/0020/641423/g-iol.pdf

https://search.tga.gov.au/s/search.html?collection=tga-websites-web&query=dinoprostone

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2009-PI-00290-3&d=2017073016114622483

Resources

jessiejohnsoncash1_2 — 2017-08-14 06:32:29 UTC

http://sarawickham.com/wp-content/uploads/2013/11/em-vitamin-k.pdf

http://www.sarawickham.com/articles-2/a-decade-of-vitamin-k-articles/

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-01043-3

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002776/full

Resources

jessiejohnsoncash1_2 — 2017-08-14 06:44:07 UTC

https://www.health.qld.gov.au/__data/assets/pdf_file/0011/140024/g-vte.pdf

https://tga-search.clients.funnelback.com/s/search.html?query=clexane&collection=tga-artg

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-06999-3

http://tga-search.clients.funnelback.com/s/search.html?query=fragmin&collection=tga-artg&profile=record

http://tga-search.clients.funnelback.com/s/search.html?query=warfarin&collection=tga-artg&profile=record

Resources

jessiejohnsoncash1_2 — 2017-08-14 06:51:08 UTC

https://www.health.qld.gov.au/__data/assets/pdf_file/0034/139948/g-hdp.pdf

Identify drugs and dosages as per guideline
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000025.pub2/full

Resources

jessiejohnsoncash1_2 — 2017-08-14 06:56:18 UTC

https://www.health.qld.gov.au/__data/assets/pdf_file/0026/626732/g-gbs.pdf

http://www.sarawickham.com/research-updates/maternal-antibiotics-e-g-for-gbs-and-imbalance-in-babys-gut-bacteria/

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007467.pub4/full

Resources

jessiejohnsoncash1_2 — 2017-08-14 07:31:27 UTC

https://www.health.qld.gov.au/__data/assets/pdf_file/0019/140149/g-ptl.pdf
Identify drugs and dosages as per guideline
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004661.pub3/full

Jadda & Ellen

2017-08-14 09:11:48 UTC

Emma and Helen

2017-08-14 09:12:00 UTC

Maddie & Lisa

2017-08-14 09:12:05 UTC

Steph & Michelle

2017-08-14 09:12:26 UTC

Ada & Ella

2017-08-14 09:12:34 UTC

Jess & Melinda

2017-08-14 09:13:05 UTC

2017-08-14 09:14:11 UTC

Indication

2017-08-14 09:27:34 UTC

- women has had a "sensitising event" where fetal red blood cells might have entered maternal circulation
- given as a standard to all Rhesus negative women during pregnancy
- given at 28/40 and 34/40

Risks
- Anti D is a blood product
- possibility of allergic reaction
- risk of blood borne disease

Contraindications
- Rh positive women
- IgA deficiency
- coagulopathy, thrombocytopenia

Dosage
- 625 IU at 28 and 34 weeks unless there has been a previous sensitising event

Route
IM

Pharmacodynamics
- 15000 international unit contains sufficient anti-RhD to effectively suppress the immunizing potential of approximately 17mL of fetal cells that have entered maternal circulation.
Human RhD immune globulin therapy prevents immunization to RhD positive red blood cells by inducing antibody-mediated immunosuppression (AMIS) effectively clearing Rh positive RBCs by rapidly binding to them. This prevents Rho-negative mothers to produce alloantibodies to paternally inherited RhD antigen expressed on fetal erythrocytes and cause haemolytic diseases of the newborn. Rho immune globulin increase platelet counts and reduce bleeding in Rh positive patients with ITP by inhibiting autoantibody-mediated platelet clearance

What to share with women
- why they may need it
- risks and benefits
- what happens if they have a sensitising event
- risk for future pregnancies
- it is a blood product, so possibility of an allergic reaction
- contraindications

2017-08-14 10:03:24 UTC

2017-08-14 10:07:03 UTC

Pre-term Labour

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Chase & Maddi

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Michelle & Lauren

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Megan & Marie

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Sarah & Rubie

2017-08-16 00:14:22 UTC

Kate & Cara

2017-08-16 00:14:29 UTC

Monica & Sophie

2017-08-16 00:14:44 UTC

2017-08-16 00:15:12 UTC

VTE Prophylaxis in Childbearing women - visual resource

Anti-D

2017-08-16 00:20:48 UTC

Indications:
- Currently pregnant with a negative blood group
- Administered to prevent the woman's antibodies attacking the foetus in subsequent pregnancies

Risks:
- Allergic reactions
- Side effects can include headaches, tenderness and fever
- Risk of transmission of blood borne disease as it's a blood product

Contraindications:
- Rh positive blood group
- Rh negative individual previously sensitised to the Rh antigen
- Individuals with isolated immunoglobulin deficiency
- Individuals who have severe thrombocytopenia or any coagulation disorder that would contradict IM injection

Dosage:
- 250 IU after sensitising events in the first trimester
- 625 IU after sensitising events beyond the first trimester
- 625 IU routine prophylaxis at 28 and 34 weeks for all Rh negative women

Route:
- Intramuscular Injection

Pharmacodynamics:
-

What we'd share with women:
- Reason for having the injections antenatally and postnatally if required
- What a sensitising event is eg. a fall, or miscarriage
- Risks and adverse effects
- Recommend having influenza vaccine 3 weeks prior to anti-d and 3 months after administration

Tocolysis.

2017-08-16 00:57:04 UTC

Nifedipine.

Indication - <37 weeks gestation, fFn >50ng/ml, cervical dilatation or changes over 2-4 hours, regular painful contractions.

Action - Ca2+ blocker. Stops uterine contractions action on smooth muscle. Antihypertensive.

Statewide Guidelines:
Give initial oral dose 20mg repeat after 30 minutes of cintractions ongoing x 2
Give maintenance dose of 20mg orally every 6 hours for 48 hours or until birth.

Pharmacokinetics - Acts within 30-60 miinutes short half life.

Adverse Events:
Dilates arterioles and lowers BP and increases HR.
Dizziness, headaches, nausea, oedema, vomitting, contipation, reflux.

Practice Points:
Give with fluids.
Women to lie left lateral
Check BP and HR 15min.

Contraindications:

Allergic rections or sensitivity, intra uterine death, lethal fetal anomilies and suspected fetal compromise, maternal bleeding, severe PE, abruption, chorioaminitis.

Magnesium Sulfate

Neuroprotectant for fetus. Reduces incidence of CP and protects gross motor function.

Indication
Given preterm labour 24-30 weeks gestation.
Established labour or imminent birth.

Statewide Guidelines
Commence IV administration 4g over 20 minutes loading dose and maintenance dose 1g/hr over 24 hours or until birth.
Commence IV 4 hours prior to birth best effect shown when given for t least 4 hours within 6 hours prior birth.

2017-08-16 00:58:54 UTC

Benzylpenicillin

Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit.

Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms. Group B streptococcus are particularly found in the gastrointestinal tract, vagina and urethra.

Indications-
Positive GBS swab
In
Preterm labour
PROM
Maternal temperature equaling or exceeding 38 degrees Celsius.

GBS colonisation in current pregnancy.

Positive GBS Bacturiuria.
Previous baby with EOGBSD.

RISKS - Severe allergic reaction to antibiotics has been reported among mothers giving birth (Berthier 2007; Jao 2006). The incidence of postnatal maternal and neonatal yeast infections may increase with the use of intrapartum antibiotics (Dinsmoor 2005). There is a growing concern about antibiotic resistance to erythromycin (3.8% to 21.2%) and clindamycin (2.7% to 20%) (Barcaite 2008). Intrapartum antibiotic prophylaxis (IAP) may increase exposure of neonates to ampicillin resistant Enterobacteriaceae (Edwards 2002b).
Anaphylaxis
Hypersensitivity.
May affect gut flora in mother and baby. Microbiome of baby.

May affect breast feeding.

CONTRAINDICATIONS- Maternal temperature exceeding 38degrees (give a broad spectrum antibiotic)

Dose - 3g at onset of labour then 1.8g every 4hrs until birth
Given intravenously.

PHARMACODYNAMICS- It interferes with the bacterial cell wall - cell walls are vital for bacterium
survival.

PHARMACOKINETICS- Given intravenously it is absorbed through the blood stream and broken down by the liver, excreted in urine.

All of the above information should be shared with the mother focusing on the benefits and risks of having this medication.

Main results

We did not identify any new trials from the updated search so the results remain unchanged as follows.

We included four trials involving 852 women.

Three trials (involving 500 women) evaluating the effects of IAP versus no treatment were included. The use of IAP did not significantly reduce the incidence of all cause mortality, mortality from GBS infection or from infections caused by bacteria other than GBS. The incidence of early GBS infection was reduced with IAP compared to no treatment (risk ratio (RR) 0.17, 95% confidence interval (CI) 0.04 to 0.74, three trials, 488 infants; risk difference -0.04, 95% CI -0.07 to -0.01; number needed to treat to benefit 25, 95% CI 14 to 100, I² 0%). The incidence of LOD or sepsis from organisms other than GBS and puerperal infection was not significantly different between groups.

One trial (involving 352 women) compared intrapartum ampicillin versus penicillin and reported no significant difference in neonatal or maternal outcomes.

We found a high risk of bias for one or more key domains in the study methodology and execution.

2017-08-16 01:05:12 UTC

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2017-08-16 01:14:37 UTC

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Vitamin K Parent Leaflet

2017-08-16 01:19:18 UTC