Safety guidelines for cold medication for pregnant women

1. What are the physiological characteristics of pregnant women during pregnancy?

1. Circulatory system: Increases heart volume, increases heart rate, and increases heart stroke volume in the late pregnancy. Blood pressure is low in the early and middle pregnancy, and mildly increases in the late pregnancy.

2. Urinary system: In the early stage of pregnancy, due to the increase in renal blood flow, the clearance rate increases. In the late stage, the supine position increases, the renal blood flow decreases, and the drug is discharged slowly.

3. Digestive system: The secretion of gastric acid and pepsin during pregnancy is reduced. The gastric emptying time is prolonged, intestinal peristalsis is weakened, oral drug absorption is delayed, and the peak is pushed back, which is relatively low. The gallbladder emptying time is prolonged, and the drug removal rate from the liver is slowed down.

2. What are the effects of drugs on different pregnancy periods?

1. Early:

1-2 weeks after fertilization, the effects of drugs are usually only at the extremes of "full" or "non-free", that is, either spontaneous miscarriage or no effect.

3-8 weeks are the stages of differentiation, development and formation of most organs, and are most susceptible to drugs and severe deformities.

During the 10-14 weeks, some structures and organs are still not fully formed, which will cause certain deformities.

It should be noted that early pregnancy is the differentiation stage of various parts and organs of the fetus' body, and drug teratogenicity is likely to occur at this stage.

2, middle and late stages:

After 14 weeks, the effects of drugs are mainly manifested as abnormal function or poor survival after birth. The nervous system continues to differentiate and develop throughout the pregnancy, so the effects of drugs always exist. For example, taking aspirin for a long time in the late pregnancy can lead to severe fetal bleeding or fetal death.

In the middle, the safety of medication for late pregnancy increases, but some drugs, such as ethanol, are harmful to the fetus, especially the nervous system, throughout the entire stage of pregnancy.

3. What are the reasonable choices for cold medications during different pregnancy periods?

1. Decongestant

Currently, pseudoephedrine is commonly used, and the pregnancy grade is C. The impact on human fetus is still lacking sufficient case reports and reliable control studies. Its chemical structure suggests that this product can pass through the blood fetal barrier. It is banned in the early and second trimesters. Antihistamines can be selected for nasal congestion during pregnancy.

2. Antipyretic and analgesic drugs

It is mainly acetaminophen and ibuprofen. Acetaminophen pregnancy grade B. This medicine can be used through the placenta and can be used throughout the pregnancy to analgesic and reduce fever. Acetaminophen can be selected for the first 3 months of pregnancy. ibuprofen pregnancy grade B/D.

3. Antimicrobial drugs

Commonly used are central antitussive drugs such as codeine, dextromethorphan, and peripheral antitussive drugs such as nactin and phenpropiline.

Codeine pregnancy grade C is easily passed through the blood-fetal barrier. Rodent studies have shown that there is no teratogenic effect. Intrauterine development delays in fetal development will occur at doses lower than maternal poisoning. There are reports of neonatal withdrawal syndrome.

Dextromethorphan pregnancy grade C, there are no large number of cases of pregnant women using this drug or strictly controlled studies. Dextromethorphan is prohibited from using dextromethorphan in the first three months of pregnancy.

4. Expectant medicine

Commonly used expectorants include guaifeldgum powder glycerine ether, ambroxol, bromhexin, etc. Among them, guaifeldgum powder glycerine ether is a commonly used compound cold medicine ingredient. Guaifeldgum powder glycerine ether is a C-grade pregnancy grade, and guaifeldgum powder glycerine ether is prohibited within the first three months of pregnancy.

Preclinical trials of ambroxol and a large amount of clinical experience after 28 weeks of pregnancy show that it has no adverse effect on pregnancy. However, during pregnancy, especially in the first three months of pregnancy, the drug should be used with caution. Broxixine is a prodrug of ambroxol. It can be metabolized in the body to exert expectorant effect. Pregnant women should use it with caution.

5. Antihistamines

The second-generation antihistamine loratadine pregnancy grade B. The Centers for Disease Control recently analyzed the national birth defect prevention research data. Among mothers who use loratadine in the early stage of pregnancy, the risk of urethral hypothyroidism in male offspring has not increased. Therefore, loratadine is safe when used for prescribed indications during pregnancy.

The second-generation antihistamine cetirizine pregnancy grade B, and the results of research on rodent pregnancy animals were shown to be safe, although the dose used was higher than the clinically applied dose, and there were no signs of teratogenicity or fetal intrauterine development delay.

4. What are the guidelines for safe medication use during pregnancy?

1. Drug risk classification

The US Food and Drug Administration divides pregnancy medication into five levels: A, B, C, D, and X according to the harm of drugs to the fetus. The teratogenic effects of grades A to X are increasing, for clinical reference for safe medication use during pregnancy.

Generally speaking, the principle of choosing drugs is to choose AB but not CD, and choose CD only if there is no medicine instead. X is absolutely forbidden to choose.

A and B grade drugs are not harmful to the fetus or have no side effects. They can generally be used safely during pregnancy, such as multiple vitamins, some antibiotics, etc.

C and D grade drugs are harmful to the fetus but are beneficial to pregnant women. They need to weigh the pros and cons before using them with caution. For example, some antiviral drugs, antibiotics, and hormone drugs.

Level X, which is harmful to the fetus and is not beneficial to pregnant women. This type is a banned drug during pregnancy, such as anti-cancer drugs, sex hormone ribavirin, statins, etc.

2. Basic principles of medication

No matter what kind of cold you have, there must be clear indications and adaptations for medication. You must choose drugs that have proven to be harmless to the fetus under the guidance of a pharmacist.

Use old drugs with certain efficacy, small adverse reactions and clear adverse effects to avoid using new drugs with difficult to determine adverse effects.

Small doses are effective in avoiding the use of large doses, and single doses are effective in avoiding the use of combined drugs.

When taking medication, you need to clearly understand the number of pregnancy cycles. The first 3 months of pregnancy are the embryonic organ formation period, so drugs should be avoided as much as possible.

1. Pre-labor assessment

1-1 A comprehensive assessment of the mother and fetus before delivery: a comprehensive assessment of the mother and fetus through medical history inquiries, relevant information on pregnancy care and physical examinations.

1-2 Risk rating is performed based on the evaluation results.

1-3 Pregnant women who have been evaluated as high-risk should be referred to the appropriate gestational week before delivery in accordance with the local hospital's pregnant women and newborn treatment conditions.

2. The first course of labor

2-1 The first stage of labor is also called the cervical dilation period, which refers to the beginning of labor until the cervix is ​​completely expanded, that is, the cervix is ​​completely opened. The important sign of labor is regular and gradually enhanced uterine contraction, which lasts for 30 seconds or more, with a 5-6 minute interval, and is accompanied by progressive cervical canal disappearance, cervical dilation and fetal premature decline. The first stage of labor is divided into incubation period and active period.

2-2 Incubation period refers to the period from regular contractions to uterine expansion <5cm. Active period refers to the period from uterine expansion 5cm to the entire uterine opening.

2-3 Recommend midwife to provide mental comfort to pregnant women, patiently explain that childbirth is a physiological process, and enhance pregnant women's confidence in childbirth.

2-4 Recommend midwife to explain the relevant knowledge of delivery, drug efficacy and adverse reactions, risks and effects of analgesic methods to pregnant women.

2-5 It is recommended to conduct a rapid assessment of pregnant women admitted to the hospital, including the pregnant woman's vital signs, fetal heart rate, uterine contractions, fetal position, fetal size, amniotic fluid, etc., and to evaluate whether there are high-risk or acute obstetrics for emergency treatment.

2-6 It is recommended to perform a ** test every 4 hours during the incubation period and a ** test every 2 hours during the active period; if pregnant women experience suspicious symptoms of rapid cervix such as bloating perineum, increased blood secretions, and sensation of defecation, they should perform a ** test immediately.

2-7 For those who are progressing smoothly, routine artificial membrane rupture during labor is not recommended.

2-8 Once the fetal membrane ruptures, it is recommended to auscultate the fetal heart immediately, observe the color, characteristics and outflow of amniotic fluid, and perform ** checks when necessary, and record them at the same time.

2-9 Definition of prolonged incubation period: 20 hours for primary mothers and 14 hours for male mothers. Slow but progressive prolonged incubation period is not an indication for cesarean section except for cesarean pelvis is not a sign of cesarean section.

2-10 Diagnostic criteria for stagnation during active period: When the membrane ruptures and the cervix dilation is ≥5cm, if the uterine contraction is normal, the uterine stops dilation for ≥4 hours can be diagnosed; if the uterine contraction is poor, the uterine stops dilation for ≥6 hours can be diagnosed. Stagnation during active period can be used as an indication of cesarean section.

2-11 For low-risk pregnant women, it is recommended to use Doppler intermittent auscultation of fetal heart and combined with electronic fetal heart monitoring to evaluate the fetal intrauterine condition during labor. After routine electronic fetal heart monitoring, it is recommended to auscultate the fetal heart rate once in 30 minutes during the first labor process and record it. According to local medical conditions, the incubation period should be at least 60 minutes auscultated once in 30 minutes during the active period.

2-12 For pregnant women with abnormal conditions, the frequency of fetal heart auscultation can be appropriately increased. Whether to perform continuous electronic fetal heart monitoring should be determined based on the medical institution and the situation of the pregnant woman.

2-13 When fetal heart rate abnormality is found during intermittent auscultation, it is recommended to use electronic fetal heart monitoring for testing.

2-14 It is recommended to evaluate contractions based on the frequency of contractions.

2-15 Overfrequency of contractions refers to the frequency of contractions 5 times/10min, which lasts for at least 20 minutes.

2-16 When excessive uterine contractions are found, it is recommended to stop using oxytocin, and if necessary, uterine contraction inhibitors can be given.

2-17 According to the pain of pregnant women, non-drug methods are encouraged to reduce labor pain, and if necessary, use intra-spinal analgesia or other drugs according to their wishes.

2-18 Pregnant women with low risk of general anesthesia can eat and drink water according to their wishes during delivery.

2-19Drinking carbohydrate drinks cannot improve the outcome of mother and child. You can choose the drinks during labor according to the needs of pregnant women.

2-20 It is not recommended to routinely prepare the perineal skin before delivery.

2-21 It is recommended to choose a comfortable position according to the wishes of pregnant women during labor.

2-22 It is recommended that pregnant women with low risk exercises be appropriate during labor.

3. Secondary labor

3-1 The second delivery process, also known as the fetal delivery period, refers to the entire process from the opening of the cervix to the fetal delivery.

3-2 Midwifery personnel should inform the pregnant woman that the duration of the second delivery varies from person to person.

3-3 Midwives should fully inform pregnant women of the benefits and risks of various delivery positions during the second period of labor, and assist pregnant women in choosing delivery positions according to their own wishes.

3-4 During the second labor period, pay attention to monitoring the fetal intrauterine status, and evaluate the degree of fetal premature decline. Especially when fetal premature declines slowly, be careful not to exclude uterine contractions and fatigue. If necessary, oxytocin will be used to strengthen uterine contractions. At the same time, the fetal orientation needs to be evaluated. If necessary, turn the fetal head to the appropriate fetal orientation.

3-5 It is safe to encourage medical staff to conduct midwifery training.

3-6 For first-time mothers, if there is no intravertebral analgesia in the spinal canal, the second labor period can be diagnosed for more than 3 hours; if there is intravertebral analgesia in the spinal canal, it can be diagnosed for more than 4 hours. For new mothers, if there is no intravertebral analgesia in the spinal canal, it can be diagnosed for more than 2 hours; if there is intravertebral analgesia in the spinal canal, it can be diagnosed for more than 3 hours.

3-7 It is not recommended to use uterine fundus to assist the fetus in the second labor process.

3-8 Pregnant women who have given birth after ** are not recommended for routine episiotomy, but perineal protection should be taken to reduce damage.

3-9 It is recommended for 100 women who use intra-spinal analgesia to exert force under guidance at the beginning of the second labor process.

4. The third stage of labor

4-1 The third stage of labor is also called the placental delivery period. From the fetus’ delivery to the placental membrane delivery, that is, the entire process of placental dissection and delivery, it takes 5 to 15 minutes, and should not exceed 30 minutes.

4-2 During the third period of labor, you should pay attention to monitoring the vital signs of the mother, coagulation of the uterine contraction, check the placenta and soft birth canal, accurately estimate the amount of bleeding from the **, and identify postpartum bleeding as early as possible.

4-3 If the third labor period exceeds 30 minutes, or if the placenta is not completely peeled off and bleeding is long, it is recommended to perform manual placenta removal when preparing to prevent postpartum bleeding.

4-4 It is recommended to delay ligation of the umbilical cord for normal term and premature infants who do not require resuscitation.

4-5 Conditional medical institutions recommend routine umbilical artery blood and blood qi analysis.

46 It is recommended that newborns without comorbidities should have skin contact with their mother as soon as possible after birth to prevent the newborn from having a low body temperature and promote breastfeeding.

47 For newborns whose amniotic fluid is clear at birth and have established spontaneous breathing after birth, or who are vibrant despite amniotic fluid pollution but are not recommended to use oral and nose attraction to routinely clean the respiratory tract.

4-8 It is recommended to conduct a full body examination after the basic vital signs of a newborn are stable, including checking whether there are any deformities in appearance, measuring the length, weight, etc., and accurately recording.

5. Postpartum evaluation and monitoring

5-1 Postpartum evaluation includes the maternal vital signs, bloodshed, uterine contractions, etc., pay attention to the main complaints of maternal discomfort, and early identification and discovery of postpartum high-risk or acute postpartum conditions for timely handling.
Chapter completed!