19 Miscellaneous
This chapter contains the drugs that are used in midwifery and that do not come under any previous title. Specific pre-existing conditions, e.g. asthma, or pregnancy-related conditions, e.g. obstetric cholestasis, require pharmaceutical treatments that should be familiar to most midwives in clinical practice.
The student should be aware of
the non-pregnant physiology and adaptations during childbearing
the abnormal pathology of pre-existing medical conditions
the abnormal pathology of pregnancy-related disorders
the medical management of these conditions during pregnancy, local protocols, and guidance for medication and monitoring of these conditions during childbearing.
Some medications listed here are complementary/alternative medicines. A recognized and registered practitioner in the complementary therapy should prescribe any such preparation, just as with conventional medicine one would seek the advice of a doctor or pharmacist prior to taking a medicine.
The student is urged to examine Standard 37 of the Code (NMC, 2008) and Standard 23 from the Standards for Medicines Management (NMC, 2007, updated 2010) on complementary and alternative therapies. Specific consideration of these sources is vital before considering the use of alternative or complementary therapies in any aspect of practice.
BP
Zidovudine (azidothymidine, sometimes known as AZT – abbreviation to be used with caution as it is also used for another drug)
Proprietary
Zidovudine (Aurobindo Pharma Ltd)
Retrovir® (ViiV Healthcare UK Ltd)
Group
Antiviral
Uses/indications
Management of HIV, possibly in the prevention of maternofetal HIV transmission
Type of drug
POM
Presentation
Capsules (white/blue band and blue-white/dark blue band), syrup 100 mg/10 mL
Powder for reconstitution, vials 200 mg in 20 mL solution (10 mg/mL)
Dosage
Prevention of maternofetal transmission (over 14 weeks’ gestation): oral – 100 mg 5 times a day until labour
Labour and delivery: IV infusion at 2 mg/kg over 1 h, then 1 mg per kg per h until the cord is clamped. If LSCS planned, commence the regimen 4 h prior to delivery
Route of admin
Oral, IV infusion
Contraindications
Low haemoglobin or neutrophil counts, haematological toxicity: monitor blood levels
Vitamin B12 deficiency
Side effects
Multiple, including gastrointestinal disturbances, headache, rash, fever, anaemia
Interactions
Analgesics – methadone increases the plasma concentration of this drug
Antiepileptics – plasma phenytoin concentrations can increase or decrease; valproate – there is a potential for toxicity as plasma levels are increased
Pharmacodynamic properties
Antiviral agent that acts as a virostatic by disrupting viral DNA to inhibit growth and reduce viral numbers
Fetal risk
Use only if clearly indicated – possible maternal and fetal anaemia
Breastfeeding
Not recommended as HIV infection can be transmitted vertically
BP
Aciclovir (acyclovir)
Proprietary
Zovirax® (GlaxoSmithKlein UK)
Aciclovir (Pharmacia Ltd) (non-proprietary, see BNF for details)
Group
Antiviral
Uses/indications
Treatment of varicella-zoster in pregnancy, herpes zoster, shingles and cold sores
Type of drug
POM
Presentation
Powder for reconstitution, tablets, cream, cold sore cream, suspension
Dosage
Slow IV infusion over 1 h – 5 mg/kg t.d.s.
Oral: 800 mg × 5/day for 7 days
Topical: apply to lesion 4-hrly 5 times/day for 5–10 days – prompt recognition and commencement of treatment is recommended
Route of admin
IV infusion, oral, topical
Contraindications
Renal impairment
Side effects
Multiple, including rash, gastrointestinal disturbances, on IV infusion – local inflammation
Interactions
Ciclosporin and tacrolimus – increased risk of nephrotoxicity
Mycophenolate and probenecid – increased plasma concentration of aciclovir and metabolites of mycophenolate
Pharmacodynamic properties
A virostatic that interferes with the DNA reproduction function of the virus, reducing production and inhibiting its growth
Fetal risk
Use only when the benefits outweigh the risks, as the number of exposures to the drug is too limited to assess the long-term prognosis
Breastfeeding
Significant amount secreted into breast milk
Oral: 5-day course – considered safe
IV: insufficient information to allow classification as safe
BP
Thyroxine (levothyroxine sodium)
Proprietary
Eltorxin™ (Goldshield Group UK Ltd)
Thyroxine (non-proprietary, see BNF for details)
Group
Thyroid hormone
Uses/indications
Hypothyroidism
Type of drug
POM
Presentation
Tablets (25 mcg, 50 mcg, 100 mcg)
Dosage
As indicated by laboratory monitoring and the physician
Route of admin
Oral
Contraindications
Thyrotoxicosis, hypersensitivity
Side effects
These usually occur with overdose – tachycardia, palpitations, muscle cramps and other indications of an increased metabolic rate
Interactions
Antidepressants – tricyclics, amitriptyline – the antidepressant response is increased by the concurrent use of thyroxine
Anticoagulants – the effect of warfarin is enhanced
Antiepileptics – phenobarbital and phenytoin accelerate the metabolism of thyroxine; phenytoin levels are increased by thyroxine
Cimetidine – reduces the absorption of thyroxine from the gut
Cholestyramine – the absorption of thyroxine is reduced
Iron – ferrous sulphate – reduced absorption of thyroxine
Hypoglycaemics – monitor insulin requirements because of increased metabolic rate
Oral contraceptives – may increase plasma levels of thyroxine
Pharmacodynamic properties
A naturally occurring hormone that contains iodine and is produced by the thyroid gland – required for growth, development and the nervous system. It also increases the basal metabolic rate and has stimulatory effects on heart and skeletal muscle, liver and kidneys
Fetal risk
Monitor serum levels closely
Breastfeeding
Maternal dosage may interfere with neonatal screening for hypothyroidism
BP
Salbutamol
Proprietary
Ventolin™ Accuhaler™ (Allen & Hanburys Ltd)
Salbutamol (non-proprietary, see BNF for details)
Group
Selective β2-adrenoceptor agonist – bronchodilator
short acting
Uses/indications
Bronchodilator, immediate relief of asthma
Myometrial relaxant: see
Chapter 18Type of drug
POM
Presentation
Pressurized metered-dose inhaler
Dosage
100–200 mcg (1–2 puffs); for persistent symptoms up to 4 times daily; prophylaxis of allergen or exercise induced bronchospasm, 200 mcg (2 puffs)
duration of action 3–5 h
Premature labour: see
Chapter 18 for regime if used as tocolytic
Route of admin
Inhalation
Contraindications
Placenta praevia, antepartum haemorrhage, pre-eclampsia/eclampsia, threatened miscarriage, hypersensitivity
Side effects
Fine tremor (particularly in the hands), nervous tension, headache, muscle cramps
Palpitation, tachycardia, arrhythmias, peripheral vasodilatation, myocardial ischaemia, hypotension, and collapse
Disturbed sleep and behavioural changes
Paradoxical bronchospasm (occasionally severe)
Urticaria, angio-oedema
High doses associated with hypokalaemia
Interactions
β-blockers, e.g. propranolol
Pharmacodynamic properties
Acts on β2-adrenoceptors of bronchial muscle, with little or no action on β1-adrenoceptors of cardiac muscle
Fetal risk
Benefit should outweigh the risks; animal studies indicate toxicity at high doses
Breastfeeding
Likely to be secreted in breast milk, so benefits should outweigh risks
BP
Beclometasone dipropionate
Proprietary
Easyhaler® Beclometasone 200 mcg (Orion Pharma UK Ltd)
Beclometasone (non-proprietary, see BNF for details)
Group
Corticosteroid
Uses/indications
Management of chronic asthma
Type of drug
POM
Presentation
Inhalation powder administered from multidose powder inhaler
Dosage
Maintenance: 200 mcg b.d.
Severe: starting dose may need to increase to 600–800 mcg per day and reduced once stabilized
Total daily dose may be administered as 2, 3 or 4 divided doses
Route of admin
Oral inhalation
Contraindications
Hypersensitivity
NB: special care in clients with active or quiescent pulmonary tuberculosis
Side effects
Candidiasis of the mouth and throat (clients are advised to rinse their mouth after using the inhaler)
Hoarseness/throat irritation, cough
Interactions
None reported
Pharmacodynamic properties
A pro-drug with weak glucocorticoid receptor binding activity, it is hydrolyzed via esterase enzymes to the active metabolite beclometasone-17-monopropionate (b-17-mp), which has high topical anti-inflammatory activity
NB: clients should be instructed in the correct use of the inhaler, and their technique checked, to ensure that the drug reaches the target areas within the lungs. The inhaler must be used regularly (even when asymptomatic for optimal benefit)
Fetal risk
Corticosteroids given to pregnant animals can cause abnormalities of fetal development including cleft palate and intrauterine growth restriction, hence a possible risk to the fetus
Manufacturer recommends use only if benefits outweighs risk
Breastfeeding
Recommend only if benefits outweighs risk
BP
Loperamide hydrochloride
Proprietary
Imodium® (McNeil Products Ltd)
Loperamide hydrochloride (non-proprietary, see BNF for details)
Group
Antidiarrhoeal
Uses/indications
Acute/chronic diarrhoea
Type of drug
POM
Presentation
Capsules/caplets, syrup, melts or instants
Dosage
Adjusted according to response: usually 4 mg initially and 2 mg after each loose stool thereafter to max dose of 12 mg in 24 h
Route of admin
Oral
Contraindications
Abdominal distension, acute ulcerative colitis
Side effects
Abdominal cramps, urticaria
Interactions
No data available
Fetal risk
No reports found linking loperamide with either human or animal toxicity, although not advised during first trimester
Breastfeeding
Small amounts of loperamide may appear in breast milk; therefore not recommended in breastfeeding
BP
Dexamethasone
Proprietary
Dexamethasone 4 mg/mL injection (Merck Sharp and Dohme Ltd)
Dexamethasone tablets (500 mcg), solution (2 mg/5 mL) and injection (4 mg/mL) (non-proprietary, see BNF for details)
Group
Glucocorticoid (steroid)
Uses/indications
To promote fetal lung surfactant production under 36 weeks’ gestation and where labour is imminent/probable; can also ameliorate the effects of cholestasis of pregnancy
Type of drug
POM
Presentation
Tablets, IM injection – ampoules
Dosage
RCOG Greentop guidelines 2010: IM 6 mg 12 h apart for 4 doses (do not repeat after max dose) to reduce risk of respiratory distress syndrome (RDS) from preterm birth between 24 and 34 weeks’ gestation; effective from 24 h to 7 days after second dose
Route of admin
Oral, IM
Contraindications
Avoid in suspected chorioamnionitis, tuberculosis, porphyria
Side effects
Rarely anaphylaxis, hypersensitivity, flushing, puerperal rash, fluid retention with repeated doses
Interactions
Analgesics – increases the risk of gastrointestinal bleeding with aspirin and other NSAIDs
Antibiotics – erythromycin may alter the metabolism of corticosteroids
Anticoagulants – alters the effects of anticoagulants, so monitor blood levels closely
Antidiabetics – antagonizes the hypoglycaemic effects
Antiepileptics – phenobarbital, phenytoin and carbamazepine accelerate the metabolism of corticosteroids
Antihypertensives – antagonizes the antihypertensive effect
Pharmacodynamic properties
A glucocorticoid with complex actions, one of which is to promote the production of lung surfactant. It is used to good effect when premature birth is anticipated and ameliorates the effects of cholestasis during pregnancy by reducing serum oestrogen levels. As premature delivery is an outcome of this condition, it also contributes towards reducing neonatal mortality and morbidity
Fetal risk
Overdose can affect the adrenal development of the fetus and neonate, and may contribute to intrauterine growth retardation (IUGR); however, the benefits vastly outweigh the risks of administration
Breastfeeding
No data available – but considered moderately safe if the benefits outweigh the risks
NB: infants of mothers taking high doses of systemic corticosteroids for prolonged periods may have a degree of adrenal suppression
BP
Betamethasone
Proprietary
Betnesol® (UCB Pharma Ltd)
Group
Glucocorticoid (steroid)
Uses/indications
To promote fetal lung surfactant production under 36 weeks’ gestation and where labour is imminent/probable
Type of drug
POM
Presentation
IM injection – ampoules
Dosage
RCOG Greentop guidelines 2010: IM 12 mg 24 h apart, i.e. 24 mg in total (once only) to reduce risk of RDS from preterm birth between 24 and 34 weeks’ gestation; effective from 24 h to 7 days after second dose
Route of admin
IM
Contraindications
Avoid in suspected chorioamnionitis, tuberculosis, porphyria
Side effects
Rarely anaphylaxis, hypersensitivity, flushing, puerperal rash, fluid retention with repeated doses
Interactions
Analgesics – increases the risk of gastrointestinal bleed with aspirin and other NSAIDs
Antibiotics – erythromycin may alter the metabolism of corticosteroids
Anticoagulants – alters the effects of anticoagulants, so monitor blood levels closely
Antidiabetics – antagonizes the hypoglycaemic effects
Antiepileptics – phenobarbital, phenytoin and carbamazepine accelerate the metabolism of corticosteroids
Antihypertensives – antagonizes the antihypertensive effect
Pharmacodynamic properties
A glucocorticoid with complex actions, one of which is to promote the production of lung surfactant. It is used to good effect when premature birth is anticipated
Fetal risk
Fetal teratogenicity at organogenesis; overdosage can affect the adrenal development of the fetus and neonate, and may contribute to IUGR; however, the benefits vastly outweigh the risks of administration
Breastfeeding
Considered moderately safe as there are no controlled studies involving breastfeeding women and their infants
BP
Prednisolone
Proprietary
Prednisolone 1 mg tablet, 5 mg tablet (Wockhardt UK Ltd)
Prednisolone (non-proprietary, see BNF for details)
Group
Corticosteroid
Uses/indications
Suppress inflammatory and allergic response, e.g. asthma, immunosuppressive disorders, rheumatic disease
Type of drug
POM
Presentation
White tablet – centrally scored
Dosage
Lowest effective dose to be advised
Initial: 5 mg to 60 mg in divided doses with or after food, in the morning – often reduced within days, and then continued under medical supervision until symptoms reduce
Maintenance: 2.5 mg to 15 mg daily
Route of admin
Oral
Contraindications
Systemic infection, hypersensitivity to ingredients
Side effects
Adrenal suppression
Suppression of the inflammatory response and immune function, thus increases susceptibility to infections (enhanced severity)
Severe psychiatric adverse reactions
Avoid exposure to measles and chickenpox (or herpes zoster) – seek urgent medical advice, but continue medication regimen
Increased monitoring should be given for clients with diabetes, hypothyroid conditions, epilepsy or hypertension
Interactions
Anticoagulants: efficacy of coumarin anticoagulants may be enhanced or reduced
NSAIDs: gastrointestinal bleeding and ulceration, renal clearance of salicylates is increased, steroid withdrawal may result in salicylate intoxication
Antibiotics – lower plasma concentrations and enhance renal clearance
Vaccines – avoid as impaired immune response
Hypoglycaemic agents (including insulin), antihypertensives and diuretics – effects likely to be diminished owing to antagonistic effect
Sympathomimetics, e.g. ritodrine, salbutamol, salmeterol, terbutaline – increased risk of hypokalaemia for high-dose usage
Intrauterine device – potential for failure of contraception
Pharmacodynamic properties
Glucocorticoid with anti-inflammatory and immunosuppressive action
Fetal risk
Crosses the placenta – variable, but 88% of prednisolone inactivated during transport
Animal studies have shown cleft palate, intrauterine growth restriction, brain growth and development anomalies
Benefits should outweigh the risks
Breastfeeding
Excreted in small amounts in breast milk; monitor for signs of adrenal suppression in infant, although benefits of breastfeeding are likely to outweigh this risk
BP
Clomifene (clomiphene) citrate
Proprietary
Clomid® (Sanofi-Aventis)
Clomifene (non-proprietary, see BNF for details)
Group
Anti-oestrogen
Uses/indications
Anovulatory infertility
Type of drug
POM
Presentation
Tablets
Dosage
50 mg/day for 5 days after the onset of menstruation; if no ovulation occurs after the first cycle then 100 mg for 5 days – use for a maximum of three cycles and under the supervision of a specialist centre
Route of admin
Oral
Contraindications
Pregnancy, hepatic disease, abnormal uterine bleeding, ovarian cysts except polycystic ovaries
CAUTION – with uterine fibroids
Side effects
Menstrual symptoms, hot flushes, abdominal discomfort, withdraw if there are visual disturbances or ovarian hyperstimulation, hair loss, weight gain, rashes, dizziness, rarely convulsions
Interactions
None stated (SPC, 2010)
Pharmacodynamic properties
Non-steroidal agent that stimulates ovulation in a high percentage of appropriately selected clients
Fetal risk
Fetal loss, ectopic pregnancy, risk of multiple pregnancy, multiple effects on fetal development, including neural tube defects and trisomies, reported – although not supported by data from population-based studies and still being investigated – therefore pregnancy should be excluded before the next course is commenced
Breastfeeding
Not known to be excreted in breast milk, but thought to reduce lactation
Name
Witch hazel (Hamamelis virginiana)
Proprietary
Distilled Witch Hazel BPC (Boots Company PLC)
Uses/indications
Varicosities, perineal trauma, haemorrhoids, herpes lesions
Type of drug
Herbal remedy
Presentation
Liquid
Dosage
As directed by practitioner
Route of admin
Topical
Contraindications
Broken skin/dermal tissue
Side effects
Occasional hypersensitivity reactions
Fetal risk
Safety not established – not recommended
Breastfeeding
Safety not established – not recommended
Name
Calendula officinalis (Marigold)
Uses/indications
Perineal trauma, sore nipples, cystitis, thrush, herpes
Type of drug
Herbal remedy
Presentation
Ointment, infusion
Dosage
As directed by practitioner
Route of admin
Oral or topical
Breastfeeding
Possible risk of allergy that can cause anaphylaxis – therefore considered moderately safe as there are no studies showing increased adverse effects in breastfeeding infants
BP
Peppermint water
Uses/indications
To ease colic/flatulence and abdominal cramps
Type of drug
Herbal remedy, also used in aromatherapy
Presentation
Herbal tea: to treat anaemia and mood swings
Herbal suspension/infusion: as indicated above
Essential oil: to treat nausea and vomiting
Dosage
As directed by practitioner
Route of admin
Oral, inhaled
Name
Arnica montana (Leopard’s Bane or Wolf Bane)
Proprietary
Astrogel arnica gel (Bioforce UK Ltd)
Arnica 30c pillules (A Nelson & Co. Ltd)
Uses/indications
First-aid remedy in bruising and soreness, e.g. episiotomy or other perineal trauma
Type of drug
Homeopathic remedy
Presentation
Tablet or suspension
Dosage
As directed by homeopathic practitioner
Route of admin
Oral
Fetal risk
Avoid unless recommended by specialist practitioner
Breastfeeding
No evidence to suggest unsafe
Name
Ursodeoxycholic acid (UDCA)
Proprietary
Ursofalk® 250 mg capsules (Dr Falk Pharma Ltd)
Urdox® 300 mg film-coated tablets (Wockhardt UK Ltd)
Ursodeoxycholic acid (non-proprietary, see BNF for details)
Group
Acts on biliary composition and flow
Uses/indications
Dissolution of bile acids/gallstones; reduces itching and ameliorates liver enzymes; used in treatment of intrahepatic cholestasis of pregnancy (IHCP)
Type of drug
POM
Presentation
Tablets, capsules, suspension
Dosage
Oral: 8–12 mg/kg daily (20–25 g/kg daily – is considered effective and safe)
Route of admin
Oral
Contraindications
Pregnancy
Side effects
Nausea, vomiting, diarrhoea, pruritus
Interactions
Antacids – these bind to bile acids in the gut and have a detrimental effect on mode of action of UDCA
Cholestyramine – binds to bile acids in the gut and has a detrimental effect on mode of action of UDCA
Oestrogens – oral contraceptives – increased bile cholesterol is released, theoretically increasing the effective dose of UDCA
Pharmacodynamic properties
Complex action, but when given orally UDCA dissolves bile acids in the biliary fluid and disperses them, reducing cholesterol and thus ameliorating the cholestasis
Fetal risk
Teratogenic in animal studies and manufacturers’ advise avoidance during early pregnancy; however, the benefits may outweigh the risks in IHCP
Breastfeeding
Manufacturer advises avoidance, but in the absence of controlled study data it is considered moderately safe when treating IHCP
BP
Nicotine
Proprietary
Nicorette® (McNeil); Nicotinell® (Novartis Consumer Health); NiQuitin® (GlaxoSmithKlein UK) – various preparations (tablets, patches, lozenges, chewing gum, inhalator see BNF for details); Champix® (Pfizer Ltd) – varenicline; Zyban® (GlaxoSmithKlein UK) – bupropion hydrochloride
Group
Nicotine replacement therapy (NRT)
Uses/indications
Smoking cessation regimes where other interventions have not been successful and health benefits are predicted from behavioural change
Type of drug
POM, some preparations available on GSL – not Zyban® or Champix®
Presentation
Various – see BNF for detail
Dosage
Under guidance of specialist practitioner with counselling and support available
Zyban® 150 mg prolonged release film-coated tablets
Champix® 0.5 mg film-coated tablets; Champix® 1 mg film-coated tablets (black triangle)
Route of admin
Oral, inhalation, transdermal
Contraindications
Consider risk/benefit assessment before initiating treatment: cardiac conditions (acute myocardial infarction), stroke, renal disease, phaeochromocytoma, hyperthyroidism, other dependencies
Diabetes mellitus – can affect carbohydrate metabolism, thus blood sugar levels should be monitored more closely than usual
Atopic or eczematous dermatitis (due to localized patch sensitivity) – discontinue use and seek medical advice
Side effects
Smoking cessation (general): could suffer from asthenia, headache, dizziness, sleep disturbance, coughing or influenza-like illness. Also depression, irritability, nervousness, restlessness, mood lability, anxiety, drowsiness, impaired concentration and insomnia which may be related to withdrawal
Other: nausea, headaches, faintness, (nicotine) dizziness, coughing or influenza-like illness
Anaphylactic reactions, sleep disorders including abnormal dreams and insomnia, tremor, palpitations, tachycardia, dyspnoea, pharyngitis, cough, nausea, vomiting, dyspepsia, abdominal pain upper, diarrhoea, dry mouth, constipation, sweating increased, allergic dermatitis, contact dermatitis, photosensitivity, arthralgia, myalgia, application site reactions, chest pain, pain in limb, pain, asthenia, fatigue, malaise
Symptoms of acute nicotine poisoning include nausea, salivation, abdominal pain, diarrhoea, sweating, headache, dizziness, disturbed hearing and marked weakness. In extreme cases, these symptoms may be followed by hypotension, rapid or weak or irregular pulse, breathing difficulties, prostration, circulatory collapse and terminal convulsions
Management of overdose: stop therapy immediately and admit to hospital. Monitor vital signs and ECG, maintain airway, ventilation and oxygenation
Interactions
May possibly enhance the haemodynamic effects of adenosine
Pharmacodynamic properties
Nicotine, an alkaloid in tobacco products and a naturally occurring autonomic drug, is an agonist at nicotine receptors in the peripheral and central nervous system and has pronounced CNS and cardiovascular effects
Fetal risk
Safety not established; manufacturers recommend smoking cessation without pharmacotherapy wherever possible
Breastfeeding
Compounds secreted in breast milk; manufacturers recommend that the benefit should outweigh the risk from smoking to either mother or baby
References and Recommended Reading
Baxter K. Stockley’s Drug Interaction Companion. London: Pharmaceutical Press; 2011.
Betnesol® injection 4 mg/mL, UCB Pharma Ltd, updated in the BNF 62, 2011.
Briggs G., Freeman R., Yaffe S. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, eighth ed. Philadelphia: Lippincott Williams and Wilkins; 2008.
Bubimschi C., Weiner C. Medication. In: James D.K., Steer P.J., Weiner C.P., Gonik B., eds. High Risk Pregnancy: Management Options. fourth ed. London: Elsevier Saunders; 2010:579–598.
European Medicines Agency (EMA). HMPC Assessment Report on Hamamelis virginiana. Ref: EMA/HMPC/114585/2008. London: EMA; 2010.
Hofmeyr G.J., Neilson J.P., Alfreirevic Z., Crowther C., Duley L., Gulmezoglu M., Gyte G.M., Hodnett E.D., et al. Pregnancy and Childbirth – A Cochrane Pocketbook. London: Wiley Cochrane Series; 2008.
Joint Formulary Committee. British National Formulary (BNF) 62. London: Pharmaceutical Press; 2011.
Jordan S. Thyroid disorders in pregnancy. In Jordan S., ed.: Pharmacology for Midwives: The Evidence Base for Safe Practice, second ed, Basingstoke: Palgrave Macmillan, 2010.
Koren G. Medication Safety in Pregnancy and Breastfeeding: The Evidence Based A–Z Clinician’s Pocket Guide. New York: McGraw-Hill; 2007.
. Medicines and Healthcare products Regulatory Agency (MHRA). Available http://www.mhra.gov.uk/ (for information on Arnica, Calendula and Peppermint Water)
Nursing and Midwifery Council (NMC). updated 2010 Standards for Medicines Management. London: NMC; 2007.
Nursing and Midwifery Council (NMC). The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: NMC; 2008.
Paediatric Formulary Committee. BNF for Children 2011–2012. London: Pharmaceutical Press; 2011.
Royal College of Obstetricians and Gynaecologists (RCOG). Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality. London: Greentop Guidelines No. 7. RCOG; 2010.
Rubin P.C., Ramsey M. Prescribing in Pregnancy, fourth ed. Oxford: BMJ Books/Blackwell Publishing; 2007.
Schaefer C., Peters P.W.J., Miller R.K., eds. Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment. London: Academic Press/Elsevier, 2007.
SPC from the eMC, Aciclovir, Pharmacia Ltd, updated on the eMC 03/08/01.
SPC from the eMC, Champix® 0.5 mg film-coated tablets, Champix® 1 mg film-coated tablets, Pfizer, updated on the eMC 6/2/12.
SPC from the eMC, Clomid®, Sanofi-Aventis, updated on the eMC 1/9/10.
SPC from the eMC, Dexamethasone® 4.0 mg/mL injection, Merck Sharp and Dohme Ltd, updated on the eMC 27/1/11.
SPC from the eMC, Easyhaler® Beclometasone 200 mcg, Orion Pharma (UK) Limited, updated on the eMC 23/02/12.
SPC from the eMC, Eltroxin™ tablets, Goldshield Group Ltd, updated on the eMC 9/12/10.
SPC from the eMC, Imodium® 2 mg capsules, McNeil Products Ltd, updated on the eMC 10/7/12.
SPC from the eMC, Prednisolone 1 mg tablet, 5 mg tablet, Wockhardt UK Ltd, updated on the eMC 31/3/08.
SPC from the eMC, Retrovir®, ViiV Healthcare UK Ltd, updated on the eMC 10/2/12.
SPC from the eMC, Urdox®, Wockhardt UK Ltd, updated on the eMC 13/4/11.
SPC from the eMC, Ursofalk®, Dr. Falk Pharma UK Ltd, updated on the eMC 7/2/12.
SPC from the eMC, Ventolin™ Accuhaler™, Allen and Hanburys Ltd, updated on the eMC 3/1/12.
SPC from the eMC, Zidovudine 100 mg (or 250 mg) capsules, Aurobindo Pharma Ltd, updated on the eMC 3/3/11.
SPC from the eMC, Zovirax®, 250 mg, 500 mg, GlaxoSmithKline UK, updated on the eMC 09/07/02.
SPC from the eMC, Zyban® 150 mg prolonged release film-coated tablets, GlaxoSmithKlein UK, updated on the eMC 22/3/11.
Volans G., Wiseman H. Drugs Handbook 2012–2013, thirty third ed. Basingstoke: Palgrave Macmillan; 2012.
Further Reading
Andrews J.I. Hepatitis virus infections. In: James D.K., Steer P.J., Weiner C.P., Gonik B., eds. High Risk Pregnancy: Management Options. fourth ed. London: Elsevier Saunders; 2010:469–478.
Bewley C. Medical disorders of pregnancy. In: Macdonald S., Magill-Cuerden J., eds. Mayes’ Midwifery. fourteenth ed. Edinburgh: Baillière Tindall/Elsevier; 2011:771–786.
Centre for Maternal and Child Enquiries, 2011. Saving Mothers’ Lives. Reviewing Maternal Deaths to Make Motherhood Safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. Available http://www.oaa-anaes.ac.uk/assets/_managed/editor/File/Reports/2006-2008%20CEMD.pdf [accessed 2 March 2012]
Tiran D. Complementary therapies in maternity care: responsibilities of the midwife. In: Macdonald S., Magill-Cuerden J., eds. Mayes’ Midwifery. fourteenth ed. Edinburgh: Baillière Tindall/Elsevier; 2011:207–216.
Watts D.H. Human immunodeficiency virus. In: James D.K., Steer P.J., Weiner C.P., Gonik B., eds. High Risk Pregnancy: Management Options. fourth ed. London: Elsevier Saunders; 2010:479–492.
Williamson C., Girling J. Hepatic and gastrointestinal disease. In: James D.K., Steer P.J., Weiner C.P., Gonik B., eds. High Risk Pregnancy: Management Options. fourth ed. London: Elsevier Saunders; 2010:839–860.