The cord is clamped immediately after birth. The cord clamp is removed once the stump has started drying and is no longer bleeding (Fig. 24-4), typically in 24 hours. The goal of cord care is to prevent or decrease the risk of hemorrhage and infection. The umbilical cord stump is an excellent medium for bacterial growth and can easily become infected. Hospital protocol determines the technique for routine cord care. Common methods include the use of an antimicrobial agent such as bacitracin or triple dye, although some experts advocate the use of alcohol alone, soap and water, sterile water, povidone-iodine, or no treatment (natural healing). A one-time application of triple dye has been shown to be superior to alcohol, povidone-iodine, or topical antibiotics in reducing colonization or infection; the use of alcohol is associated with prolonged cord drying and separation Current recommendations for cord care by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN, 2007) include cleaning the cord with sterile water initially and subsequently with plain water. The stump and base of the cord should be assessed for edema, redness, and purulent drainage with each diaper change. The nurse or parent cleanses the cord and skin area around the base of the cord with the prescribed preparation (e.g., sterile water, erythromycin solution, or triple dye). The stump deteriorates through the process of dry gangrene; therefore odor alone is not a positive indicator of omphalitis (infection of the umbilical stump). Cord separation time is influenced by several factors, including type of cord care, type of birth, and other perinatal events. The average cord separation time is 10 to 14 days. Some dried blood may be seen in the umbilicus at separation. opioid analgesics, Pregnancy Class C (=Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women).
Pregnant/breastfeeding woman: Avoid chronic use; has been used during labor but may cause respiratory depression in the newborn.
IM, IV, Subcut (Adults ≥50 kg): Usual starting dose for moderate to severe pain in opioid-naive patients—4-10 mg q 3-4 hr. MI—8-15 mg, for very severe pain additional smaller doses may be given every 3-4 hr.
Side effects: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, blurred vision, diplopia, miosis, RESPIRATORY DEPRESSION, hypotension, bradycardia, constipation, nausea, vomiting, urinary retention, flushing, itching, sweating, physical dependence, psychological dependence, tolerance.
opioid analgesics, pregnancy class C. It probably crosses the placenta and enters breast milk. Has been used during labor but may cause respiratory depression in the newborn. IM, Subcut, IV (Adults): Usual dose is 10 mg q 3-6 hr (maximum: 20 mg/dose or 160 mg/day).
Side effects: dizziness, headache, sedation, confusion, dysphoria, euphoria, floating feeling, hallucinations, unusual dreams, blurred vision, diplopia, miosis (high doses), respiratory depression, hypertension, orthostatic hypotension, palpitations, dry mouth, nausea, vomiting, constipation, ileus, urinary urgency, clammy feeling, sweating, physical dependence, psychological dependence, tolerance.
calcium channel blocker, for hypertension, angina. Pregnancy Class C. Safety not established in OB/Breastfeeding mothers. Advise patient to notify health care professional if rash, irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent. PO (Adults): 10-30 mg 3 times daily (not to exceed 180 mg/day), or 10-20 mg twice daily as immediate-release form, or 30-90 mg once daily as sustained-release (CC, XL) form (not to exceed 90-120 mg/day). an antiemetic. Safety not established in OB/Breastfeeding mothers. Pregnancy Class B. First dose is administered prior to emetogenic event. Prevention of postoperative nausea/vomiting—16 mg 1 hr before induction of anesthesia.
Side effects: headache, dizziness, drowsiness, fatigue, weakness, TORSADE DE POINTES, QT interval prolongation, constipation, diarrhea, abdominal pain, dry mouth, liver enzymes, extrapyramidal reactions.
): indications-IV: Induction of labor at term. IV: Facilitation of threatened abortion. IV, IM: Postpartum control of bleeding after expulsion of the placenta. Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor. Has vasopressor and antidiuretic effects. Therapeutic Effects: Induction of labor. Control of postpartum bleeding. Pregnancy Category X.
CNS: maternal—COMA, SEIZURES, fetal, INTRACRANIAL HEMORRHAGE.
Resp: fetal—ASPHYXIA, hypoxia.
CV: maternal—hypotension, fetal, arrhythmias.
F and E: maternal—hypochloremia, hyponatremia, water intoxication.
Misc: maternal— uterine motility, painful contractions, abruptio placentae, uterine blood flow, hypersensitivity.
Induction/Stimulation of Labor: IV (Adults): 0.5-2 milliunits/min; by 1-2 milliunits/min q 15-60 min until pattern established (usually 5-6 milliunits/min; maximum 20 milliunits/min), then dose.
Postpartum Hemorrhage: IV (Adults): 10 units infused at 20-40 milliunits/min.
IM (Adults): 10 units after delivery of placenta.
IV (Adults): 10 units at a rate of 20-40 milliunits/min.
• Fetal maturity, presentation, and pelvic adequacy should be assessed prior to administration of oxytocin for induction of labor.
• Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate frequently throughout administration. If contractions occur <2 min apart and are >50-65 mm Hg on monitor, if they last 60-90 sec or longer, or if a significant change in fetal heart rate develops, stop infusion and turn patient on her left side to prevent fetal anoxia. Notify health care professional immediately.
• Monitor maternal BP and pulse frequently and fetal heart rate continuously throughout administration.
• This drug occasionally causes water intoxication. Monitor patient for signs and symptoms (drowsiness, listlessness, confusion, headache, anuria) and notify physician or other health care professional if they occur.
• Lab Test Considerations: Monitor maternal electrolytes. Water retention may result in hypochloremia or hyponatremia.
Treatment of a wide variety of infections including: Pneumococcal pneumonia, Streptococcal pharyngitis, Syphilis, Gonorrhea strains. Treatment of enterococcal infections (requires the addition of an aminoglycoside). Prevention of rheumatic fever. Should not be used as a single agent to treat anthrax. Pregnancy Category B. IM, IV (Adults): Most infections—1-5 million units q 4-6 hr.
OB: Although safety not established, has been used safely; Lactation: Safety not established;
GI: diarrhea, epigastric distress, nausea, vomiting, pseudomembranous colitis.
GU: interstitial nephritis.
Derm: rash, urticaria.
Hemat: eosinophilia, leukopenia.
Local: pain at IM site, phlebitis at IV site.
Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS AND SERUM SICKNESS, superinfection.