Why this topic matters in emergency medical care
Reproductive-system medicines influence ovulation, implantation, uterine contraction, cervical ripening, labour, bleeding, infection, lactation and sexual health. In emergencies, EMTs may encounter postpartum haemorrhage, ectopic pregnancy, eclampsia, sepsis, abortion complications, sexual assault or contraceptive adverse effects. The priorities are respectful assessment, privacy, ABCDE stabilisation, pregnancy-aware medication safety and rapid referral.
This lesson is for EMT and nursing education. Follow current Uganda Ministry of Health, WHO, obstetric and facility protocols; do not improvise doses or routes during pregnancy emergencies.
Learning outcomes
- Explain the hypothalamic–pituitary–gonadal axis and hormone targets in reproductive pharmacology.
- Classify hormonal contraceptives, emergency contraception, uterotonics, tocolytics, fertility medicines, anti-infectives and sexual-health medicines.
- Recognise and initially manage postpartum haemorrhage, ectopic pregnancy, eclampsia, sepsis, abortion complications and anaphylaxis to reproductive medicines.
- Apply pregnancy, breastfeeding, thrombosis, hypertension, liver disease and drug-interaction precautions.
- Provide non-judgemental counselling, protect confidentiality and document medicines and consent accurately.
1. Reproductive physiology and medicine targets
| Axis/target | Physiological role | Medicine examples | Emergency relevance |
|---|---|---|---|
| GnRH–FSH/LH axis | Follicle development, ovulation and gonadal hormone production | GnRH analogues, gonadotropins, combined contraceptives | Ovulation medicines can cause ovarian hyperstimulation and ectopic/multiple pregnancy. |
| Oestrogen/progestin receptors | Cycle control, endometrial stability and pregnancy support | COCs, POPs, implants, injectables, hormone replacement | Oestrogen increases venous thrombosis risk in susceptible patients. |
| Progesterone receptors | Suppress ovulation, thicken cervical mucus and alter endometrium | Levonorgestrel, medroxyprogesterone, progesterone | Irregular bleeding, mood effects and delayed fertility return with some methods. |
| Oxytocin receptors | Uterine contraction and milk ejection | Oxytocin, carbetocin | Prevention/treatment of postpartum haemorrhage; water intoxication and uterine hyperstimulation. |
| Prostaglandin receptors | Cervical ripening, uterine contraction, vasodilation | Misoprostol, dinoprostone, carboprost | Uterotonic effect; fever, diarrhoea, bronchospasm or uterine rupture risk. |
| Calcium/magnesium neuronal transmission | Neuromuscular excitability and seizure threshold | Magnesium sulfate | Prevention/treatment of eclamptic seizures; toxicity depresses reflexes and breathing. |
2. Practical classification of reproductive medicines
| Group | Examples | Main role | High-risk concern |
|---|---|---|---|
| Combined hormonal contraceptives | Ethinylestradiol/levonorgestrel and related COCs, patch, ring | Pregnancy prevention and cycle control | Venous thrombosis, stroke, hypertension and smoking-related risk |
| Progestin-only methods | POP, implant, depot medroxyprogesterone, levonorgestrel IUS | Long-acting or short-acting contraception | Irregular bleeding, injection timing, ectopic pregnancy warning with failure |
| Emergency contraception | Levonorgestrel, ulipristal, copper IUD | Prevent pregnancy after unprotected sex | Timing, drug interactions, vomiting and need to exclude established pregnancy |
| Uterotonics | Oxytocin, carbetocin, misoprostol, ergometrine, carboprost | Prevent/treat postpartum haemorrhage, induce labour under protocol | Hypertension, bronchospasm, hyperstimulation and retained placenta |
| Antihypertensive/eclamptic medicines | Magnesium sulfate, labetalol, hydralazine, nifedipine | Prevent seizures and control severe hypertension | Respiratory depression, hypotension and fetal/maternal monitoring |
| Anti-infectives | Benzathine penicillin, ceftriaxone, metronidazole, azithromycin | STIs, pelvic infection and obstetric sepsis | Allergy, resistance, pregnancy safety and partner management |
3. Combined hormonal contraceptives
Combined oral contraceptives (COCs) contain an oestrogen and a progestin. They prevent ovulation, thicken cervical mucus and alter the endometrium. They are effective when taken consistently but do not protect against STIs; condoms are required for STI prevention.
| Benefit | Common effects | Serious warning | Screening point |
|---|---|---|---|
| Reliable reversible contraception | More predictable bleeding, reduced dysmenorrhoea | VTE: unilateral leg swelling, chest pain, sudden dyspnoea | Blood pressure, migraine with aura, smoking/age, VTE history and postpartum status |
| Cycle suppression | Nausea, breast tenderness, spotting | Stroke or myocardial infarction symptoms | Hypertension, thrombophilia, vascular disease and interacting enzyme inducers |
| Emergency pill backup | Temporary nausea or bleeding change | Persistent abdominal pain or pregnancy symptoms | Confirm timing, vomiting, drug interactions and pregnancy risk |
3.1 When combined methods require caution
- Current or previous venous thromboembolism, thrombophilia, stroke, ischaemic heart disease or severe hypertension.
- Migraine with aura, heavy smoking at older age, active liver disease or breast cancer.
- Early postpartum period, especially when breastfeeding or thrombosis risk is high.
- Enzyme-inducing antiseizure medicines, rifampicin/rifabutin and some antiretrovirals can reduce effectiveness.
4. Progestin-only contraception
| Method | Medicine/action | Advantages | Emergency/teaching point |
|---|---|---|---|
| Progestin-only pill | Daily progestin suppresses ovulation and thickens mucus | Suitable for many people who cannot use oestrogen | Strict timing varies by product; missed-pill guidance is method-specific. |
| Implant | Etonogestrel or levonorgestrel release over years | Highly effective, long-acting and reversible | Irregular bleeding is common; pain or infection at insertion site needs review. |
| Depot injection | Medroxyprogesterone suppresses ovulation for months | Private, effective and less user-dependent | Delayed fertility return, weight/mood changes and bone-density considerations. |
| Levonorgestrel IUS | Local progestin thickens mucus and thins endometrium | Long-acting, lighter bleeding | Severe pain, fever, heavy bleeding or missing strings may indicate complication. |
5. Emergency contraception
Emergency contraception prevents or delays ovulation after unprotected intercourse; it does not terminate an established intrauterine pregnancy. WHO options include levonorgestrel, ulipristal acetate and a copper IUD. A copper IUD inserted within five days is highly effective and provides continuing contraception.
- Ask when unprotected sex occurred, current method, last menstrual period, breastfeeding, vomiting and enzyme-inducing medicines.
- Exclude symptoms of ectopic pregnancy or established pregnancy; emergency contraception does not treat ectopic pregnancy.
- Give the authorised product as soon as possible; ulipristal and levonorgestrel have different interaction and restart rules.
- Advise what to do if vomiting occurs, when to test for pregnancy and how to start or resume ongoing contraception.
- Provide STI and safeguarding assessment when appropriate, with privacy and consent.
6. Contraceptive interactions and missed doses
| Situation | Risk | Response |
|---|---|---|
| Enzyme-inducing antiseizure drug | Reduced hormonal contraceptive levels | Use a method unaffected by enzyme induction or specialist guidance; do not rely on guesswork. |
| Vomiting/diarrhoea after oral dose | Reduced absorption | Follow product-specific missed-dose advice and consider emergency contraception. |
| Missed COC/POP doses | Ovulation and pregnancy risk | Identify number/timing of missed pills and use the correct protocol. |
| Ulipristal then immediate hormonal restart | Progestin can reduce ulipristal effect | Follow the recommended delay and barrier method guidance. |
7. Uterotonics and postpartum haemorrhage
Postpartum haemorrhage requires simultaneous recognition, uterine assessment, resuscitation, uterine massage, search for trauma/retained tissue/coagulopathy and urgent escalation. A quality-assured uterotonic is used according to the national protocol; medicine choice depends on contraindications and availability.
| Medicine | Action | Important contraindication/caution |
|---|---|---|
| Oxytocin | Contracts uterine muscle; common first-line uterotonic | Rapid IV bolus can cause hypotension; excessive infusion may cause water intoxication and hyponatraemia. |
| Carbetocin | Longer-acting oxytocin analogue | Use according to prevention protocol; monitor BP, uterine tone and adverse effects. |
| Misoprostol | Prostaglandin E1 analogue; uterine contraction and cervical ripening | Fever, shivering, diarrhoea; route and indication are protocol-specific. |
| Ergometrine/methylergometrine | Powerful sustained uterine contraction | Avoid in hypertension, pre-eclampsia, eclampsia and significant vascular disease. |
| Carboprost | Prostaglandin F2α analogue for uterine atony | Avoid/caution in asthma; diarrhoea, vomiting and bronchospasm may occur. |
| Tranexamic acid | Antifibrinolytic stabilises clot | Give early in PPH according to protocol; consider thromboembolic history and renal function. |
7.1 EMT response to PPH
- Call for help, quantify bleeding where possible and assess airway, breathing, circulation, mental state and shock.
- Uterine massage if trained and indicated; inspect for retained placenta/trauma without delaying transfer.
- Establish two large-bore IV lines if trained, take blood samples, warm the patient and begin authorised fluid/blood protocol.
- Administer the correct uterotonic and early tranexamic acid only under local protocol; check BP/asthma history before ergometrine/carboprost.
- Transfer urgently to a facility with obstetric, blood-bank and surgical capability; communicate time, blood loss, tone, placenta status and medicines.
8. Magnesium sulfate and eclampsia
Magnesium sulfate is the medicine of choice in many protocols for preventing and treating eclamptic seizures. It depresses neuromuscular transmission and reduces seizure recurrence. It is not an antihypertensive; severe BP requires a separate authorised medicine and urgent obstetric care.
| Check | Before/during magnesium | Toxicity warning |
|---|---|---|
| Respiration | Count respiratory rate and assess work of breathing | Respiratory depression or apnoea |
| Reflexes | Check patellar/deep tendon reflexes when feasible | Absent reflexes may precede severe toxicity |
| Urine output | Monitor renal function and hourly output in hospital care | Accumulation in oliguria/renal failure |
| Antidote readiness | Calcium gluconate/chloride protocol and airway support available | Calcium treats toxicity while ventilation and urgent transfer continue |
9. Medicines for severe hypertension in pregnancy
| Medicine | Role | Safety point |
|---|---|---|
| Labetalol | Rapid BP control through alpha/beta blockade | Bradycardia, bronchospasm, heart failure or fetal effects require assessment. |
| Hydralazine | Direct arteriolar vasodilator | Hypotension, tachycardia and headache; titrate under monitored protocol. |
| Nifedipine | Calcium-channel blocker for urgent oral BP control | Flushing, headache and hypotension; avoid unsafe rapid-release improvisation. |
| ACE inhibitors/ARBs | Not for pregnancy hypertension | Fetal renal injury and oligohydramnios risk; check medication history urgently. |
10. Fertility medicines and ovarian hyperstimulation
Gonadotropins and ovulation-induction medicines are prescribed in specialist fertility care. Ovarian hyperstimulation syndrome (OHSS) can cause enlarged ovaries, abdominal pain, vomiting, ascites, haemoconcentration, thrombosis and renal injury. Severe breathlessness, reduced urine, sudden abdominal distension or chest pain requires emergency referral.
- Ask about recent fertility injections or assisted reproduction in any reproductive-age patient with abdominal pain and vomiting.
- Do not assume pelvic pain is gastroenteritis; pregnancy, ectopic pregnancy, torsion and OHSS are time-critical alternatives.
- Monitor perfusion, urine output, weight, abdominal girth and respiratory status under specialist care.
11. Reproductive tract infection and STI medicines
STIs require confidential, non-judgemental history-taking, testing, treatment and partner services. Antibiotic selection follows current WHO and national guidance, pregnancy status, allergy and local resistance. Condoms reduce STI transmission; contraception alone does not.
| Infection/syndrome | Medicine principles | Safety/teaching |
|---|---|---|
| Syphilis | Benzathine penicillin is central to treatment, including pregnancy protocols | Check allergy and observe for reaction; treat partners and prevent congenital infection. |
| Gonorrhoea | Use current ceftriaxone-based or national regimen | Resistance is increasing; test/treat partners and screen for chlamydia/HIV. |
| Chlamydia | Doxycycline or azithromycin according to site, pregnancy and guideline | Pregnancy changes choice; partner treatment and abstinence until treated matter. |
| Trichomoniasis/BV | Metronidazole or alternatives | Alcohol interaction advice and pregnancy/partner guidance are important. |
| Pelvic inflammatory disease | Broad-spectrum combination treatment | Urgent referral for severe pain, fever, pregnancy, vomiting or tubo-ovarian abscess concern. |
12. Medicines in abortion complications and ectopic pregnancy
Misoprostol and mifepristone have specific indications and must be used within authorised, legally compliant services. EMTs should not improvise termination regimens. Heavy bleeding, shock, severe unilateral pain, shoulder-tip pain, syncope or positive pregnancy with abdominal pain may indicate ectopic pregnancy or haemorrhage.
- Assess ABCDE, pregnancy possibility, bleeding amount, pain, last menstrual period and previous ectopic/sterilisation.
- Keep the patient warm, establish access, monitor and treat shock under protocol.
- Do not give oral medicines or food to an unstable patient or delay surgical referral.
- Communicate any misoprostol/mifepristone, anticoagulant or herbal medicine exposure confidentially and accurately.
13. Lactation and postpartum medicine safety
- Ask whether the patient is breastfeeding before giving sedatives, opioids, antibiotics or hormonal medicines.
- Use prescribed compatible medicines where possible; monitor the infant for sedation, poor feeding, diarrhoea or jaundice when risk exists.
- Opioids can depress both mother and infant; use the lowest effective prescribed dose and avoid unsupervised combinations.
- Postpartum fever, offensive lochia, wound pain, breast infection, severe headache or hypertension require assessment for sepsis or pre-eclampsia.
14. Clinical scenarios
Scenario 1: Postpartum haemorrhage
After delivery, a patient has heavy bleeding and a boggy uterus. Call help, perform ABCDE, massage the uterus if trained, establish access, give protocol uterotonic/tranexamic acid after contraindication checks, resuscitate and transfer urgently.
Scenario 2: Eclampsia
A pregnant patient has a seizure and severe BP. Protect airway and injury, give magnesium sulfate under protocol, treat severe hypertension with an authorised medicine, check glucose and arrange urgent obstetric transfer.
Scenario 3: Ectopic pregnancy
A reproductive-age patient has unilateral abdominal pain, dizziness and light vaginal bleeding. Treat shock, avoid false reassurance, ask pregnancy history and transfer urgently for ectopic assessment.
Scenario 4: Combined contraceptive and thrombosis
A patient using a COC develops sudden dyspnoea and pleuritic chest pain. Consider pulmonary embolism, assess ABCDE and transfer urgently; do not dismiss symptoms as anxiety or a pill side effect.
Scenario 5: Misoprostol exposure with heavy bleeding
A patient reports taking misoprostol and is soaking pads with dizziness. Quantify bleeding, stabilise, protect privacy and refer urgently; do not interrogate or delay care.
Scenario 6: STI with pregnancy
A pregnant patient has pelvic pain, fever and discharge. Treat as possible PID/obstetric infection, use pregnancy-safe protocol and arrange urgent review rather than self-prescribing leftover antibiotics.
15. Documentation, consent and confidentiality
Document pregnancy status, last menstrual period, breastfeeding, method and last contraceptive dose, allergies, sexual-health concerns, medicine name/strength/route/time, bleeding estimate, vital-sign trends, consent and referral. Use private language, avoid judgement, protect records and disclose information only within lawful clinical need.
16. Revision questions
- Compare combined and progestin-only contraceptives.
- Which contraceptive method also protects against STIs?
- What factors reduce emergency contraceptive effectiveness?
- List contraindications/cautions for combined hormonal contraception.
- Explain the roles of oxytocin, misoprostol, ergometrine and carboprost.
- Why is ergometrine avoided in severe hypertension/eclampsia?
- What are the signs of postpartum haemorrhage and shock?
- What observations are needed during magnesium sulfate therapy?
- How is magnesium toxicity managed in principle?
- List emergency symptoms of ectopic pregnancy.
- Why must STI treatment include partner services and prevention?
- What risks should be discussed with breastfeeding patients receiving opioids?
- What is OHSS and which signs require urgent referral?
- Why should ACE inhibitors/ARBs be reviewed urgently in pregnancy?
- How should reproductive emergencies be documented confidentially?
17. Key takeaways
- Privacy, consent, pregnancy status and ABCDE assessment are essential in every reproductive emergency.
- IM/IV uterotonics, tranexamic acid and resuscitation save lives in postpartum haemorrhage; check contraindications and do not delay transfer.
- Magnesium sulfate prevents/treats eclamptic seizures but requires respiratory, reflex and urine monitoring.
- Contraception prevents pregnancy but does not protect against STIs except condoms.
- Heavy bleeding, shock, ectopic symptoms, sepsis and severe hypertension require urgent referral, not symptom-only treatment.
- Use current national/WHO protocols for contraception, STI therapy, pregnancy and breastfeeding.
18. Recommended references for further study
- Reproductive-system pharmacology including contraceptives – SlideShare teaching resource
- WHO: Contraception and family planning
- WHO: Oral contraceptives
- WHO: Emergency contraception
- WHO: 2025 recommendations to reduce postpartum haemorrhage deaths
- WHO: STI treatment recommendations
Clinical note: This page supports EMT learning and revision. It does not replace an authorised prescription, local obstetric protocol, senior supervision or patient-specific advice. In a deteriorating patient, stabilise ABCDE, call for advanced help and transfer urgently.
Complete Reproductive-System Pharmacology Tables
Scope: contraceptive choice should be voluntary, confidential and based on pregnancy intention, medical eligibility, effectiveness, side effects, STI protection and access. Obstetric-emergency medicines are given within a resuscitation pathway—never as a substitute for uterine massage, removal of retained tissue, repair of trauma, blood products, seizure/airway care or urgent referral.
Hormonal and emergency contraception
| Method/medicine | Pharmacodynamics | Pharmacokinetics | Indication and schedule | Contraindications/precautions | Interactions | Common side effects | Serious adverse effects | Nursing counselling/monitoring |
|---|---|---|---|---|---|---|---|---|
| Combined oral contraceptive (ethinylestradiol + progestin) | Suppresses ovulation, thickens cervical mucus and alters endometrium. | Orally absorbed, hepatic metabolism and enterohepatic cycling; daily adherence maintains suppression. | Reversible contraception, cycle control and selected acne/dysmenorrhoea; take one active pill daily according to pack regimen. | Pregnancy, migraine with aura, current/history of VTE or major thrombophilia, severe/uncontrolled hypertension, smoking age ≥35, current breast cancer, severe liver disease; use WHO medical eligibility criteria. | Enzyme inducers such as rifampicin/rifabutin, carbamazepine and phenytoin may reduce efficacy; some antiretroviral interactions require method review. | Nausea, breast tenderness, spotting, mild BP rise, headache. | Venous thromboembolism, stroke, myocardial infarction, severe hypertension. | Measure BP, screen contraindications, explain missed-pill instructions and ACHES warning symptoms; condoms remain necessary for STI protection. |
| Progestin-only pill | Thickens cervical mucus; suppresses ovulation variably by formulation. | Short duration requires consistent daily dosing; hepatic metabolism. | Contraception when estrogen is unsuitable, including many breastfeeding patients; exact timing window depends on product. | Current breast cancer, severe liver disease; unexplained bleeding needs assessment. | Hepatic enzyme inducers may reduce efficacy. | Irregular bleeding, amenorrhoea, acne, headache. | Rare severe allergy; ovarian cysts/ectopic pregnancy remain diagnostic considerations if pregnancy occurs. | Teach product-specific late/missed-pill action and backup contraception; evaluate persistent heavy bleeding or pregnancy symptoms. |
| DMPA injection | Long-acting progestin suppresses ovulation and thickens cervical mucus. | Depot release for about 3 months; effects cannot be rapidly reversed and fertility return may be delayed. | 150 mg IM every 13 weeks (or product-specific SC regimen) after excluding pregnancy. | Current breast cancer, unexplained bleeding, severe liver disease; consider bone-health and cardiovascular risk. | Few clinically important enzyme-inducer interactions. | Irregular bleeding then amenorrhoea, weight change, headache; delayed fertility return. | Bone mineral density loss during use; rare severe reaction. | Record date/site/lot and next due date; explain bleeding change, delayed fertility return and calcium/vitamin D/weight-bearing health measures. |
| Etonogestrel/levonorgestrel implant | Continuous progestin suppresses ovulation and thickens mucus. | Slow subdermal release for several years depending on product; hepatic metabolism. | Highly effective long-acting reversible contraception; insertion/removal by trained provider. | Current breast cancer, severe liver disease, unexplained bleeding. | Enzyme inducers may reduce efficacy. | Unpredictable bleeding, headache, acne, breast tenderness. | Insertion-site infection, migration/deep insertion, nerve/vascular injury; ectopic pregnancy is rare but urgent if pregnancy occurs. | Confirm rod palpability, asepsis and documentation; teach wound care, warning signs and that fertility returns quickly after removal. |
| Levonorgestrel emergency contraception | Delays/inhibits ovulation; does not disrupt an implanted pregnancy. | Rapid oral absorption; hepatic metabolism. | 1.5 mg orally once as soon as possible after unprotected intercourse, within the locally recommended window; effectiveness declines with delay. | No restriction based on most chronic disease; assess existing pregnancy and sexual assault needs. | Enzyme inducers can reduce exposure; copper IUD may be preferred when eligible. | Nausea, fatigue, headache, altered next menses. | Rare severe allergy; ectopic pregnancy must be considered with severe pain after a positive pregnancy test. | Repeat dose per product guidance if vomiting soon after; advise pregnancy test if menses is late/abnormal and start ongoing contraception with backup as recommended. |
| Copper IUD for emergency/ongoing contraception | Copper impairs sperm function and fertilization; local endometrial effect prevents pregnancy. | Local long-term action; no systemic hormone. | Most effective emergency contraception when inserted by a trained clinician within the eligible time window; then provides years of contraception. | Pregnancy, current pelvic infection/purulent cervicitis, unexplained bleeding or distorted uterine cavity; assess post-assault STI risk. | No drug interaction. | Heavier/longer menses and cramps, especially initially. | Perforation, expulsion, pelvic infection around insertion; ectopic pregnancy if method fails. | Aseptic insertion, STI assessment/testing per protocol, teach thread checking and urgent review for pain, fever, discharge, missed period or lost strings. |
Postpartum haemorrhage (PPH) medicines
| Medicine | Mechanism/kinetics | Use and example dose | Contraindications/interactions | Adverse effects | Nursing/midwifery actions |
|---|---|---|---|---|---|
| Oxytocin | Stimulates uterine oxytocin receptors, increasing rhythmic contractions; rapid onset, plasma half-life minutes. | WHO recommends 10 IU IM/IV for PPH prevention after birth. Treatment infusion/bolus regimens are local-protocol specific and require controlled administration. | Caution rapid IV bolus, significant cardiac disease and prolonged high-dose infusion; prostaglandins add uterotonic effect. | Nausea, flushing, hypotension/tachycardia with rapid IV; water intoxication/hyponatraemia with prolonged high dose. | Verify concentration/rate, use pump when available, monitor uterine tone, blood loss, vitals, fluid balance and sodium risk. Maintain cold chain as directed. |
| Misoprostol | PGE1 analogue increases uterine tone; absorbed orally/sublingually/rectally, hepatic activation. | Prevention where injectable uterotonic is unavailable and treatment adjunct according to WHO/local protocol; dose and route vary by purpose. | Hypersensitivity; do not repeat indiscriminately after an adequate prophylactic dose. Interactions with other uterotonics may intensify effects. | Shivering, fever, diarrhoea, nausea. | Record dose/route/time, distinguish expected fever from sepsis, continue full PPH bundle and referral. |
| Ergometrine/methylergometrine | Ergot alkaloid causes sustained uterine and vascular smooth-muscle contraction. | Second-line prevention/treatment only when appropriate and per protocol. | Contraindicated in hypertension, pre-eclampsia/eclampsia and significant cardiac disease. CYP3A4 inhibitors raise ergot toxicity. | Nausea, vomiting, hypertension, headache; severe vasospasm, stroke, myocardial ischaemia. | Measure BP before giving; never give when hypertensive; monitor chest pain, neurological signs and uterine response. |
| Tranexamic acid (TXA) | Antifibrinolytic blocks lysine sites on plasminogen, stabilizing clot; renal elimination. | For clinically diagnosed PPH: 1 g IV over 10 minutes as early as possible and within 3 hours of birth; a second 1 g may be given after 30 minutes if bleeding continues or restarts within 24 hours, following protocol. | Active intravascular clotting, selected thrombotic history; renal dose adjustment. Do not mix through same line with incompatible products. | Nausea, diarrhoea; hypotension if injected too fast; seizures and thrombosis are uncommon. | Time of birth and TXA dose must be documented; infuse over 10 minutes, monitor bleeding/thrombosis/renal function; do not delay surgical/obstetric control. |
Hypertensive emergencies and eclampsia
| Medicine | Role | Key safety points | Nursing monitoring |
|---|---|---|---|
| Magnesium sulfate | Prevents/treats eclamptic seizures by reducing neuromuscular/CNS excitability; renally eliminated. Loading and maintenance regimens follow local obstetric protocol. | Caution myasthenia gravis, renal failure and heart block; toxicity causes loss of reflexes, respiratory depression and cardiac arrest. Calcium gluconate is the antidote. | Before maintenance dose/infusion check respiratory rate, patellar reflexes, urine output and consciousness; monitor fetal/maternal status. Stop and call urgently for toxicity. |
| Labetalol | α1 plus β blockade lowers BP; IV or oral use for severe pregnancy hypertension. | Avoid/caution asthma, bradycardia, heart block and heart failure; interacts with other rate-lowering drugs. | Frequent BP/pulse, respiratory assessment, fetal monitoring and watch for hypotension/bradycardia. |
| Hydralazine | Direct arteriolar vasodilator used IV for acute severe hypertension. | May cause reflex tachycardia, headache and precipitous hypotension; response can be unpredictable. | BP every few minutes during titration, pulse, symptoms, fetal status and fluid balance. |
| Nifedipine immediate release orally | Dihydropyridine calcium-channel blockade reduces vascular resistance. | Oral protocol option for acute severe hypertension; do not use sublingually. Caution hypotension and concurrent magnesium-related weakness. | Measure BP/pulse at protocol intervals and avoid repeated dosing without documented response. |
Safe oxytocic and contraceptive nursing practice
- Before contraception: use a pregnancy checklist, BP where estrogen is considered, migraine/VTE/liver/cancer history, medicines, breastfeeding/postpartum status and STI risk; obtain informed choice without coercion.
- Before uterotonics: identify the cause of bleeding using the 4 Ts—tone, trauma, tissue and thrombin—while summoning help, massaging the uterus, establishing IV access and quantifying blood loss.
- During emergency treatment: monitor airway, oxygenation, BP, pulse, consciousness, uterine tone, ongoing loss, urine output, temperature, clotting and transfusion response.
- After stabilization: debrief, document every dose/time/response, check haemoglobin, support breastfeeding where safe, counsel on anaemia treatment and arrange follow-up.
Never combine errors with urgency: oxytocin is measured in international units, magnesium sulfate and TXA in grams, and adrenaline in milligrams/micrograms. Read the ampoule concentration, calculate independently, label syringes/infusions and use a second checker for high-alert medicines.