24.111.616    USE OF FORMULARY DRUGS

(1) Endorsed midwives may use the drugs in 37-27-302(2), MCA, according to the following protocol describing the indication for use, dosage, route of administration, and duration of treatment: 

 

Drug

Indication

Dose- in conformance ACOG guidelines

Route of Administration

Duration of Treatment

Oxygen

Maternal/Fetal Distress

 

 

 

 

 

Neonatal Resuscitation

10-12 L/min. 10 L/min.

 

 

 

 

 

10-12 L/min. 10 L/min.

Bag and mask Mask

 

 

 

 

 

Bag and mask Mask

Until maternal/fetal stabilization is achieved or transfer to hospital is complete

 

Until stabilization is achieved or transfer to a hospital is complete

Oxytocin (Pitocin)

Postpartum hemorrhage only

10 Units/ml

Intramuscularly only

1-2 doses Transport to hospital required if more than two doses are administered

Lidocaine HCl

1%

 

2%

Local anesthetic for use during postpartum repair of lacerations or episiotomy

  

20 cc

 

10 cc

Percutaneous infiltration only

Completion of repair

Penicillin G (Recommended)

Group B Strep Prophylaxis

5 million units initial dose, then 2.5 million units every 4 hours until birth

IV in ≥ 100 ml LR, NS or D5LR

Birth of baby

Methegrine (Methylergonovine

Postpartum hemorrhage only

0.2mg/ml

Intramuscularly only 1 dose

Transport to hospital required if single dose does not stop hemorrhage

Ampicillin Sodium (Alternative)

Group B Strep Prophylaxis

2 grams initial dose, then 1 gram every 4 hours until birth

IV in ≥100 ml NS or LR

Birth of baby

Cefazolin Sodium (drug of choice for penicillin allergy with low risk for anaphylaxis)

Group B Strep Prophylaxis

2 grams initial dose, then 1 gram every 8 hours

IV in ≥ 100 ml LR, NS or D5LR

Birth of Baby

Clindamycin Phosphate (drug of choice for penicillin allergy with high risk for anaphylaxis)

Group B Strep Prophylaxis

900 mg every 8 hours

IV in ≥100 ml NS (not LR)

Birth of Baby

Epinephrine HCl 1:1000

Treatment or post-exposure prevention of severe allergic reactions

0.3 ml

Subcutaneously or intramuscularly

Every 20 minutes or until emergency medical services arrive

 

Administer first dose then immediately request emergency services

Lactated Ringer's (LR)

 

5% Dextrose in Lactated Ringer's solution (D5LR)

 

 

 

 

0.9% Sodium Chloride (NS)

 

Sterile Water

 

 

To achieve maternal stabilization

 

 

 

Reconstitution of antibiotic powder

I - 2 liter bags

 

First liter run in at a wide-open rate, the second liter titrated to client's condition

 

As directed

Intravenously

 

 

 

 

 

 

 

As directed

Until maternal stabilization is achieved or transfer to a hospital is complete

 

Birth of Baby

Cytotec (Misoprostol)

Postpartum hemorrhage only

Up to 800 mcg

Rectally is the preferred method Orally is allowed

1-2 doses

 

Transport to hospital required if more than one dose is administered

Rho(d) Immune Globulin

Prevention of Rho (d) sensitization in Rho (d) negative women

300 mcg

Intramuscularly

Single dose at any gestation for Rho (d) negative, antibody negative women within 72 hours of spontaneous bleeding or abdominal trauma.

 

Single dose at 26-28 weeks gestation for Rho (d) negative, antibody negative women

 

Single dose for Rho (d) negative, antibody negative women within 72 hours of delivery of Rho (d) positive infant, or infant with unknown blood type

Phytonadione

Prophylaxis for Vitamin K Deficiency Bleeding

 

 

1 dose

0.5% Erythromycin Ophthalmic Ointment

Prophylaxis of Neonatal Ophthalmia

1 cm ribbon in each eye

Topical

1 dose

Tranexamic acid

Postpartum Hemorrhage

1000 mg over 10 minutes given within 3 hours of birth

Intravenous

Initiate transfer after administering first dose. If bleeding continues after 30 minutes or stops and restarts within 24 hours after the first dose, a second dose of 1000mg may be given.

Terbutaline

Stop or prevent premature labor

As per direct order of a licensed physician

As per direct order of a licensed physician

As per direct order of a licensed physician

 

 

History: 37-1-131, 37-27-302, MCA; IMP, 37-1-131, 37-27-302, MCA; NEW, 2023 MAR p. 886, Eff. 8/26/23.