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Hormones

Hormones are the body’s own messenger substances which carry out specific regulating functions in the cells of their respective effector organs and thereby control physiologic processes. Their regulation takes place on three levels, the hypothalamic level (primary releasing function), the stimulator level in the pituitary gland, and the glandular level in the respective organs. The secretion of the hormones is controlled via feedback mechanisms among the…

Uterine contraction agents, tocolytics, vaginal therapeutics and local contraceptives

Uterine contraction agents and tocolytics are among the most frequently used drugs in obstetrics. The former are generally effective but carry the risk of uterine overstimulation and fetal asphyxia in cases of labor induction or augmentation. They should be titrated carefully and the fetal condition should be monitored continuously. Other indications include induction of abortion and prevention/treatment of post-partum hemorrhage. Tocolytic drugs are only moderately effective,…

Antineoplastic drugs

Malignant disease is rare in pregnancy and requires expert interdisciplinary medical and psychosocial support. To give a pregnant woman the best chance for survival, cancer is often treated in the same way that it would be if the woman were not pregnant. Antineoplastic therapy in the first trimester is of greatest concern with respect to possible teratogenic effects, but only a few antineoplastic treatments ( thalidomide…

Immunosuppression, rheumatic diseases, multiple sclerosis, and Wilson’s disease

Immunomodulators include immunosuppressive and immunostimulatory agents. Within the group of immunosuppressants (Sections 2.12.1–2.12.3 ) a differentiation is made between glucocorticoids, conventional synthetic disease-modifying drugs and biologics. The immunostimulatory drugs (Sections 2.12.5–2.12.6 ) basically include the cytokines, interferons, glatiramer and colony stimulating factors. 2.12.1 Azathioprine/6-mercaptopurine Azathioprine (AZA) is an antimetabolite which is 80% metabolized to 6-mercaptopurine (6-MP). 6-MP in turn, is changed into the active metabolite 6-thioguaninenucleotide…

Psychotropic drugs

Women of childbearing age are often affected with depressive, psychotic or other psychiatric disorders, which require medication during pregnancy. Psychopharmaceuticals during pregnancy constitute both a potential risk to the developing fetus as well as a possible benefit through improvement of the disease state. According to the current knowledge there is no strong teratogen among the classical psychopharmaceuticals. The risk for Ebstein’s anomaly with the mood stabilizer…

Epilepsy and antiepileptic medications

Epilepsy affects 0.4–0.5% percent of pregnant women ( ). About 80% of these women take at least one antiepileptic drug (AED) and are able to control their seizures ( ). In addition, antiepileptic drugs are also used to manage other conditions that afflict women of reproductive age, e.g. in psychiatry for manic-depressive symptoms, or in neurology for chronic pain. Children of mothers treated with antiepileptic drugs…

Anticoagulants, thrombocyte aggregation inhibitors, fibrinolytics and volume replacement agents

During pregnancy, the risk for venous thromboembolism (VTE) is substantially increased. Antithrombotic therapy is indicated for the prevention and treatment of VTE, but such treatment is challenging because these medications have the potential to cause adverse effects in the developing fetus. The possibility of increased maternal bleeding is also an important consideration when these medications are used prior to surgical intervention or delivery. Low molecular weight…

Heart and blood medications

Profound hemodynamic changes take place during pregnancy. The blood volume starts to expand at the fifth gestational week, and by the end of pregnancy it has increased by 50%. Vascular resistance and blood pressure decrease, while the resting pulse increases by 10–20 beats This results in a 30–50% rise of the cardiac output. Normally, during the second trimester, blood pressure decreases, and then rises again in…

Vaccines and immunoglobulins

Vaccines protect pregnant women against serious infectious diseases through activation of the immune system. The induced antigen-specific antibodies are actively transferred through the placenta and protect her child as well. There are three types of vaccines: live viral or bacterial vaccines, inactivated vaccines or toxoids. There is no evidence that vaccines have embryo- or fetotoxic effects. Also, live vaccines have not been shown to induce fetal…

Anti-infective Agents

Infections may be hazardous to the health of the mother, the course of pregnancy, and the unborn child. They can lead to premature labor or premature rupture of membranes and thereby increase the risk for spontaneous abortion and prematurity. Furthermore, certain germs can pass to the unborn child and harm it directly. Therefore, an anti-infective treatment which should be both effective and safe for the mother…

Gastro-intestinal medications, hypolipidemic agents and spasmolytics

Gastrointestinal symptoms are common in pregnancy. Approximately 50% of women manifest episodes of heartburn. This is a consequence of the gastro-esophageal reflux due to the physiological reduction in the tone of both the stomach wall and the gastro-esophageal junction. In most cases, symptoms are controlled by a modification in the patient’s diet and lifestyle. However, if a pharmacologic therapy is needed, antacids are the first choice.…

Nausea and vomiting in pregnancy

More than half (50–80%) of pregnant women suffer from nausea and vomiting (NVP), also known as morning sickness – although symptoms may persist the whole day. Usually limited to the first trimester, NVP may continue throughout the entire pregnancy. NVP may range from mild discomfort to hyperemesis gravidarum, causing severe vomiting and nausea, weight loss, severe dehydration, metabolic compromise and in severe cases can be fatal.…

Antiasthmatic and cough medication

Bronchial asthma affects 4–12% of pregnant women worldwide. During pregnancy, asthma should be adequately treated not only for the benefit of the mother but also to safeguard proper fetal oxygenation. Severe, poorly treated asthma is associated with adverse perinatal outcomes ( ), such as a higher risk of prematurity ( ), lower birth weight ( ) or small for gestational age (SGA) children ( ), preeclampsia…

Allergy and hyposensitization therapy

Both antihistamines and glucocorticoids have demonstrated a lack of toxicity when used during pregnancy for the management of allergy symptoms. Some antihistamines are also administered with success in the treatment of hyperemesis gravidarum ( Chapter 2.4 ) or as sleeping medication ( Chapter 2.11 ). For glucocorticoids, see Chapter 2.3, Chapter 2.15 . 2.2.1 Antihistamines (H 1 -blocker) You’re Reading a Preview Become a Clinical Tree…

Analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and antigout medications

Most of the commonly used analgesics can also be used during pregnancy. Paracetamol (acetaminophen) is the first choice and is considered relatively safe in any trimester. Acetylsalicylic acid (ASA) in analgesic doses close to delivery may increase the risk of hemorrhage in both the mother and the infant, and should be avoided. Opiates should be prescribed only with compelling indications and their use should primarily be…

General commentary on drug therapy and drug risks in pregnancy

1.1 Introduction Most prescribers and users of drugs are familiar with the precautions given concerning drug use during the first trimester of pregnancy. These warnings were introduced after the thalidomide disaster in the early 1960s. However, limiting the exercise of caution to the first 3 months of pregnancy is both shortsighted and effectively impossible – firstly, because chemicals can affect any stage of pre- or postnatal…

Normal nutrition

Dietary nutrients required for good health include water, protein, fat, carbohydrates, vitamins, and minerals. Energy is required for normal body function, growth, and repair. Protein is necessary for growth and development and to maintain body structures and function. Protein is the source of essential amino acids and nitrogen needed for the synthesis of nonessential amino acids. Dietary protein replaces the essential amino acids and nitrogen that…

Suggested recommendations for routine cancer screening

Cervical cancer Cervical cancer screening should begin at age 25 (2020 American Cancer Society Cervical Cancer Screening Guidelines). Primary human papillomavirus (HPV) testing every 5 years through age 65 is preferred. If primary HPV testing is not available, individuals aged 25 to 65 should be screened with co-testing (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years. Testing intervals after…

Modified from common terminology criteria for adverse events (Common Terminology Criteria for Adverse Events)

(version 5.0) U.S. Department of Health and Human Services National Institutes of Health, National Cancer Institute Published November 27, 2017 For the complete table containing common terminology criteria for adverse events, go to expertconsult.com . Access your account with the activation instructions found on the inside front cover of this book. Quick reference The National Cancer Institute (NCI) has published standardized definitions for adverse events (AEs),…