[Drugs most frequently used during pregnancy and labor and their effects]

Abstract

It is rather difficult to draw up a list of the drugs most frequently used during pregnancy, and to specify their action on the mother, the uterus ans the fetus bearing in mind the differences between them. This difficulty results in particular from the high number of drugs owing to: the frequency of prescriptions and selfmedication in the pregnant woman who suffers from numerous disorders, and the possibility of a pathology associated with the pregnancy or a pathology due to the pregnancy itself thereby defining the "high risk" pregnancy. On this background already modified by pregnancy, under the hold of numerous drugs, an anesthetic can be necessary in addition during labour or delivery, the frequency of which can be estimated as being approximately 20 per cent. It is not possible to study all therapeutic agents in a single communication. One can only evoke the influence of the most currently used drugs; analgesics, antibiotics, diuretics, sleeping tablets, anti-hypertensives and those aimed at the neuropsychiatric system (anti-depression agents, neuroleptics, tranquillizers) which are so frequently used at present. Finally, during labour the number of parturients who receive no drugs is rare: ocytocic and anti-spasmodic agents can also interfere with an anesthetic. All of these ideas which are more and more difficult to acquire are important to know. In fact the person in charge of the delivery must prescribe as little drugs as possible (in order to avoid multiple drug interference which is rather difficult to predict) knowing the possible action of drugs on the fetus (in order to allow best adaptation to life in our atmosphere after delivery) and foreseeing the possible necessity for an anesthetic. In his turn, the anesthetist should have a good knowledge of obstetrical physiology and pathology and the drugs capable of being used during pregnancy and labour in order to be able to choose the best adapted anesthetic. This emphasized the importance of a well integrated obstetrico-anesthetic team in which each member knows the problems of the other, with the aim of being the least possible noxious for the mother, and the future newborn, the fetus. This also emphasizes the necessity for anesthetists attached to the ostetrical unit, knowing like the obstetrician the histories of those women with "high risk" pregnancies. Obstetrical anesthetics cannot be improvised.