Midwifery Formulary for Mothers

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Gastro-Intestinal System

Medicine as per BNF category

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Introduction

 

 

V3

 

Antacids

Co-magaldrox (Mucogel®)

ME

GSL

V3

In Patient admission for duration. Out Patient 1 pack on each occasion. Dose 10 to 20ml 3 to 4
times daily oral.

Alginate antacids
(Peptac®, Gaviscon®)

ME

GSL

V2

In Patient admission for duration. Out Patient 1 pack on each occasion. Dose 10 to 20ml 3 to 4
times daily oral.

Peppermint water

ME

GSL

V2

In Patient admission for duration. Dose 20ml PRN oral, for wind up to 4 times daily.

Laxatives

Ispaghula husk
(Fybogel®, Regulan®, Senokot High Fibre®)

ME

GSL

V3

In Patient admission for duration. Out Patient 1 pack on each occasion. Dose 1 sachet BD oral.

Lactulose

ME

P

V2

In Patient admission for duration. Out Patient 1 pack on each occasion. Dose up to 15ml BD oral.

Senna

ME

GSL

V3

In Patient max 7 days. Out Patient 1 pack on each occasion. Dose up to 2 tab or 10ml OD oral.

Glycerol (glycerin)
Suppository

ME

GSL

V2

In Patient or Out Patient. 1 Dose daily PR for maximum of 2 days.

Docusate sodium
microenema (Norgalax®)

ME

P

V2

In Patient or Out Patient. 1 Dose daily PR for maximum of 2 days.

Sodium Citrate
Compound Enema

ME

P

V2

In Patient or Out Patient. 1 Dose only PR.

Preparations for haemorrhoids

Anusol® cream and
suppositories

ME

GSL

V3

In Patient or Out Patient. One pack of cream and suppositories may be supplied on each occasion.
Use in accordance with manufacturer’s instructions.

Anusol HC® ointment

ME

P

V3

In Patient or Out Patient. One pack once only on one occasion. Use topically for maximum of 7
days in accordance with manufacturer’s instructions.

Anusol HC®
suppositories

ME

P

V2

In Patient or Out Patient. One pack once only on one occasion. Use PR for maximum of 7 days in
accordance with manufacturer’s instructions.

Xyloproct®

ME

POM

V3

In Patient or Out Patient. One pack once only on one occasion. Use topically for maximum of 3 weeks in accordance with manufacturer’s
instructions.

Anaphylaxis

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Introduction

 

 

V2

 

Epinephrine
(Adrenaline)
1 in 1000

ME

POM

V2

In Patient or Out Patient. 0.5ml IM repeated after 5 min. if required.

Central Nervous System

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Introduction

 

 

V3

 

Drugs used in nausea

Prochlorperazine
Injection

ME

POM

V3

In Patient. Maximum 2 doses 8 hours apart. For antenatal nausea and vomiting in hyperemesis gravidarum as per local guideline or for control of nausea in conjuction with opiate analgesia in labour. Dose 12.5mg deep IM inj. Repeat once after 8 hours if required.

Cyclizine

ME

POM

V3

In Patient. Maximum 2 doses 8 hours apart. For control of nausea in conjunction with opiate analgesia in labour. Dose 50mg deep IM inj. Repeat once after 8 hours if required.

Analgesics

Paracetamol

ME

GSL / P / POM

V3

In Patient max. 4 days. Out Patient 1 pack of tablets on each occasion. Dose 1-2 suppositories of 500mg PR or 1 – 2 tablets every 4 to 6hrs oral as required. Lower dose in women ≤ 50kg. Max. 4 doses in 24 hours.

Ibuprofen

ME

GSL / P / POM

V3

Practice Alert – postnatal use only.
In Patient max. 4 days. Out Patient 1 pack on one occasion. Dose 200mg to 400mg 3 times daily regularly, or as required allowing a minimum of 4 hrs between doses and up to a maximum of 3 doses in 24 hours oral. Consider lower dose in women ≤ 50kg.

Diclofenac

ME

POM

V3

Practice Alert – postnatal use only.
In Patient max. 4 days. Out Patient 1 pack on one occasion. Dose one 50mg or 100mg supp. On one occasion only at perineal repair if required. 25mg or 50mg 3 times a day oral.
Max. 3 doses in 24 hours. Consider lower dose in women ≤ 50kg.

Equanox® / Entonox®

ME

P

V3

Inhalation analgesia during labour in accordance with local guidelines. Max. duration 24 hours.

Morphine Sulphate

ME

POM (CD)

V3

In Patient. To be used in accordance with relevant local home birth or Labour Ward Guideline.
Dose up to 15mg IM. A further 2 doses may be
given at 4 hour intervals if necessary. Maximum of 3 doses to be given prior to referral to medical staff.

Pethidine hydrochloride

ME

POM (CD)

V3

In Patient. To be used in accordance with relevant local home birth or Labour Ward Guideline.
Dose up to 100mg IM. A further 2 doses may be given at 1 to 3 hour intervals if necessary.
Maximum of 3 doses to be given prior to referral
to medical staff.

Dihydrocodeine

PGD

POM (CD)

V3

Use in accordance with local guidelines.
Antenatal 30mg oral once only.
Postnatal 30mg 4 to 6hrly as required depending on pain score. Do not exceed 180mg in 24 hr period. Maximum of 30 tablets total administered or supplied.

Diamorphine

ME

POM (CD)

V3

In Pt. To be used in accordance with relevant local home birth or Labour Ward Guideline. Dose 5-10mg IM. A further 2 doses may be given at 4 hour intervals if necessary. Maximum of 3 doses to be given prior to referral to medical staff.

Opioid Antagonists

Naloxone - Maternal

ME

POM

V3

In Patient. 400microgram dose IM and can be repeated within 1-2hours depending on the type, dose and frequency of opioids. Observe closely as repeated doses may be required within 1-2 hours as the duration of action of opioids is longer than naloxone. 

Endocrine System

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Drugs used in diabetes introduction

V2

 

Glucagon

Emergency administration

POM

V2

In Patient. One dose only. Dose 1mg IM inj.

Obstetrics

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Introduction to monographs on obstetric medicines

V3

 

Dinoprostone vag
Delivery matrix (Propess® )

PGD

POM

V3

See local guideline for use. Insert one dose (10mg) into the posterior fornix. One dose only, to be removed after 24 hours if not sooner – see PGD and SPC for further information if required.

Dinoprostone vag gel (Prostin®)

PGD

POM

V1

See local guideline for use. Insert one dose (1mg or 2mg) in accordance with guideline high into the posterior fornix. Followed by a second dose (1mg or 2mg) if required, after 6 hours in accordance with guideline; max 3 or 4mg per course.

Dinoprostone vag
tablets (Prostin E2®)

PGD

POM

V3

See local guideline for use. Insert 1 tablet
high into the posterior fornix. A second tablet may be inserted after 6 to 8 hours if labour is not established. The midwife may administer a max.
of 3 doses in GGC – check local arrangements.

Carboprost
(Hemabate®)

ME

POM

V3

See local guideline for use. 250 microgram (1ml)
by IM injection. If necessary, further doses of
250micrograms may be administered at intervals of about 1.5hrs. In severe cases the interval between doses may be reduced at the discretion of the attending midwife, but it should not be
less than 15 minutes. Maximum 8 doses total.

Syntometrine® for PPH

ME

POM

V3

Practice alert - Inadvertent administration to the newborn infant has proved fatal.
See local guidelines for use. In Patient or Out
Patient 1ml one dose only IM for PPH. Note max.
2 doses in total including any doses given in management of third stage of labour.

Oxytocin (Syntocinon®)
for PPH

ME

POM

V3

In Patient Oxytocin injection or infusion to be used in accordance with the applicable home birth or labour ward guidelines for management of third stage, induction or augmentation of
labour or postpartum haemorrhage.

 

Oxytocin (Syntocinon®)
for 3rd Stage

ME

POM

V3

Oxytocin (Syntocinon®)
for induction and augmentation of labour

ME

POM

V2

Ergometrine maleate

ME

POM

V3

See local postpartum haemorrhage guideline for use. 500microgram (1ml) by IV or IM injection
as a single dose. IV route preferred in an emergency, Give slow IV inj. Over 60 seconds.

Medicines for Prevention of Mendelson's Syndrome

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Introduction

V3

 

Omeprazole 20mg capsule

PGD (GGC version)

POM

V1

See local guidelines for use as prophylaxis against acid aspiration (Mendelson’s Syndrome).
Elective Caesarean Section (CS) 20mg oral
to be given the night before and the morning of the elective CS operation. OP pack of 2 doses.
Labour see guideline for inclusion criteria- for “high risk” patients.
20mg every 12 hours until delivery, review after
24 hours. Maximum 3 doses.

Ranitidine Injection

PGD * GGC
Version

POM

V7

Not sent out by editorial board * local GGC PGD – see end

Sodium Citrate

PGD * GGC
Version

POM

V7

Not sent out by editorial board * local GGC PGD – see end


*Available on request from [email protected] Source acknowledged from NHS Greater Glasgow and Clyde by editorial board.

Medicines used for Vaginal and Vulval Infections

Medicine as per BNF category

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Introduction

V2

 

Clotrimazole
(Canesten®) cream

ME

GSL / P

V2

In Patient or Out Patient. One pack of cream may be supplied on each occasion. Use in accordance with manufacturer’s instructions. May be
repeated once without referral to a doctor.

Clotrimazole
(Canesten®) pessary

ME

GSL / P

V2

In Patient or Out Patient. One original pack of pessaries may be supplied on each occasion. Use in accordance with manufacturer’s instructions. May be repeated once without referral to a
doctor if infection returns after 7 days.

Miconazole vaginal/vulval cream (Gyno-Daktarin®)

ME

POM

V2

In Patient or Out Patient. One pack of cream may be supplied on each occasion. Use in accordance with manufacturer’s instructions. May be
repeated once without referral to a doctor.

Iron and Folic Acid

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Introduction

V3

 

Folic Acid
400microgram tablets

ME

GSL 

V2

Out Patient. One tablet daily until 12 weeks of pregnancy in women at low risk of conceiving a child with neural tube defect. One original pack of tablets on each occasion.
N.B. women with a BMI ≥ 30 require 5mg.

Folic Acid 5mg

PGD

POM

V3

In Patient or Out Patient. One tablet daily until 12 weeks of pregnancy in women at increased risk of conceiving a child with neural tube defect (women with established folate deficiency or sickle-cell disease should continue taking their normal dose of folic acid 5mg daily (or to increase the dose to 5mg daily) and continue this throughout pregnancy).
In Patient admission duration. Out Patient one original pack of tablets on each occasion.

Ferrous fumarate with folic acid Galfer FA® Pregaday®

ME

P

V2

In Patient admission duration. Out Patient 1 pack on each occasion. For women during 2nd or
3rd trimester requiring iron and folic acid supplementation.
Dose 1 tablet or capsule daily oral.

Ferrous fumarate
(Fersaday® Fersamal® )
tablets

ME

P

V3

GGC Guideline – note variation from National Midwifery Formulary Monograph. See local guideline.
In Patient admission duration. Out Patient 1 pack on each occasion. Iron deficiency anaemia in accordance with local guidelines.
Dose Fersaday® 1 tablet once or twice daily oral. Fersamal® 1 tablet 3 times daily oral.

Ferrous fumarate syrup
(Fersamal®) and
(Galfer®)

ME

P

V2

In Patient admission duration. Out Patient 1 pack on each occasion. Iron deficiency anaemia in accordance with local guidelines.
Dose 10ml twice daily oral.

Ferrous Sulfate

ME

P

V3

In Patient admission duration. Out Patient 1 pack on each occasion. Iron deficiency anaemia in
accordance with local guidelines. Dose 1 tablet 3 times daily oral.

Sodium feredetate (Sytron ®)

ME

P

V3

In Patient admission. Out Patient 1 pack on each occasion.
Dose 10ml 3 times daily oral.

Intravenous Fluids

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V3

 

Compound Sodium
Lactate IV infusion
(Hartmann’s)

ME

POM

V2

Antenatal or postnatal women requiring resuscitation with IV fluids including hypotension,
haemorrhage.
Diluent for oxytocin infusion for PPH 500ml maximum.
Maternal resuscitation (incl. sudden drop in systolic blood pressure) 500ml or 1 litre by rapid
IV infusion.
Haemorrhage up to 2 litres (unless no colloid or blood is available and woman still haemorrhaging
– continue until help arrives).
If giving for any other reason, maximum 1 litre.

Gelofusine® IV Infusion

ME

POM

V3

Antenatal or postnatal women requiring
resuscitation with IV fluids post haemorrhage.
To be used after initial treatment with crystalloids
or fluid to maintain circulatory volume until blood is available. 500ml may be given over 5 to 10 minutes until signs of hypovolaemia are relieved. Rate of subsequent infusion will depend on clinical state. Maximum of 1.5 litres.
(In its guideline the RCOG recommends a maximum of 1.5 litres to be given, with the simultaneous seeking of urgent medical help. If no blood is available this could be given up to a maximum of 2 litres).

Plasma-Lyte 148® IV Infusion

PGD

POM

V1

Antenatal or postnatal women requiring resuscitation with IV fluids including hypotension,
haemorrhage.
Maternal resuscitation (incl. sudden drop in systolic blood pressure) 500ml or 1 litre by rapid
IV infusion.
Haemorrhage up to 2 litres (unless no colloid or blood is available and woman still haemorrhaging
– continue until help arrives).
If giving for any other reason, maximum 1 litre.

Sodium Chloride 0.9%
IV Infusion

ME

POM

V3

IV flush 5ml to 10ml

Antenatal or postnatal women requiring resuscitation with IV fluids including hypotension, haemorrhage.
Diluent for oxytocin infusion for PPH 500ml maximum.
Maternal resuscitation (incl. sudden drop in systolic blood pressure) 500ml or 1 litre by rapid IV infusion.
Haemorrhage up to 2 litres (unless no colloid or blood is available and woman still haemorrhaging – continue until help arrives).
If giving for any other reason, maximum 1 litre.

Local Anaesthesia

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V3

 

Ametop gel®
(Tetracaine )

ME

P

V2

In Patient or Out Patient. Use topically in accordance with manufacturer’s instructions on
each occasion.

Emla® cream

ME

P

V2

In Patient or Out Patient. Use topically in accordance with manufacturer’s instructions on
each occasion.

Lidocaine hydrochloride
1% inj. (for perineum)

ME

POM

V2

Women requiring an episiotomy or requiring perineal suturing after delivery.
5ml to 10ml for infiltration prior to episiotomy followed by 10ml to 15ml for subsequent repair.
Maximum volume 20ml between the episiotomy and repair.
Up to 20ml for repair of spontaneous perineal
trauma, divided between sites to be repaired.

Lidocaine 1% inj. for
cannulation

PGD

POM

V2

Up to 0.5ml infiltrated at site of cannulation. Maximum of 3 doses on each occasion.

Instillagel®

ME

P

V2

Women requiring urinary catheter insertion. 6ml to 11ml instilled into urethra and wait 3 to 5 min. before catheterisation. May be used prior to each catheterisation.

Immunological Products and Vaccines

Medicine as per BNF category

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Introduction to Anti D

V2

 

Anti D Immunoglobulin
1500 units D Gam® and Rhophylac ® Postnatal
Or alternative product/ strength as supplied by BTS

ME

POM

V3

See local guideline for use. Dose as instructed by BTS. IM injection within 72 hours of delivery but check results of Kleihauer elution test. Blood
Transfusion Service (BTS) will advise on
increased dose(s) if required.
Maximum 1 dose or as advised by BTS.

AntiD Immunoglobulin-
Human 1500 units D- Gam ® and Rhophylac® Routine antenatal

ME

POM

V3

See local guideline for use. 1500 international units at 28 to 30 weeks of pregnancy by IM
injection after a blood sample has been obtained
and sent to BTS for antibody testing.
1 dose only to be given.

Anti D Immunoglobulin
- human (D Gam®) 500 units Routine antenatal

ME

POM

V3

See local guideline for use. 500 international units at both 28 and 34 weeks of pregnancy by
IM injection after a blood sample has been
obtained and sent to BTS for antibody testing.
2 doses only to be given.

Anti D Immunoglobulin
– human (Rhophylac®) Antenatal - for potential sensitising event

ME

POM

V3

See local guideline for use.
Up to 12 weeks gestation 1500 international units by IM injection per incident.
After 12 weeks gestation at least 1500 international units per incident.

A test for the size of the fetal maternal haemorrhage should be performed when anti-D is given after 20 weeks and additional doses of anti-D should be administered.

BTS will advise on dosage. To be given as soon as possible and within 72 hours. Seek further advice if more time has elapsed. Maximum of 1 dose per incident or as advised by BTS.

Anti-D
Immunoglobulin – Human (D-Gam®) Antenatal for potential sensitising event

ME

POM

V3

See local guideline for use.
Up to 20 weeks gestation 500 international units by IM injection per incident.
After 20 weeks gestation 500 international units per incident. A test for the size of the fetal maternal haemorrhage should be performed when anti-D is given after 20 weeks and additional doses of anti-D should be administered.

BTS will advise on dosage. To be given as soon as possible and within 72 hours. Seek further advice if more time has elapsed. Maximum of 1 dose per incident or as advised by BTS.

GGC Patient Group Directives

Below is the additional list of locally agreed PGD’S for use by midwives in GG&C.

*Available on request from [email protected]   Source acknowledged from NHS Greater Glasgow and Clyde by editorial board.

GGC PGD Medicine

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Greater Glasgow and Clyde Midwifery Formulary local arrangements

Antibiotics
Benzylpenicillin 600mg inj. GBS PGD * POM V7 See Local Obstetric Group B Strep guideline and Neonatal GBS Infection guideline. Intrapartum Antibiotic Prophylaxis. During labour: Loading dose – Benzylpenicillin 3g IV infusion , over 30 minutes as soon as possible after the onset of labour and maintenance dose 1.8g every 4 hours until delivery. If patient allergic to penicillin, Teicoplanin to be administered, please refer to Teicoplanin PGD. Note: Refer to medical staff for additional antibiotic cover if GBS with suspected chorioamnionitis or sustained pyrexia.
Teicoplanin PGD * POM V1 Under development at present.
Calcium Gluconate 10% inj. (1g/10mls) PGD * POM V6 Community Midwifery Unit (CMU) Midwives
Emergency treatment for hypermagnesaemia following magnesium sulphate treatment for eclampsia and severe eclampsia in pregnant women. Inclusion criteria: Pregnant women undergoing emergency magnesium sulphate treatment for eclampsia who are experiencing loss of reflexes and respiratory depression. Pregnant women: 1gram in 10mls IV slowly over
10mins by slow IV push. One dose only. Contact medical staff at CLU for advice immediately.
Etonogestrel Single Rod Contraceptive Implant PGD * POM V9 Long acting reversible sub dermal contraceptive implant for women aged 13 years and above requesting contraceptive implant. See PGD on information for use by midwives.
Influenza vaccine (seasonal).
Inactivated TETRA and TRIVALENT 2019-2020
PGD * POM V19 PGD – for individuals for whom live attenuated intranasal vaccine (LAIV) is contraindicated e.g. pregnancy or unacceptable due to porcine gelatin content. See PGD for information on use by midwives.
Labetalol 200mg tablets PGD * POM V6 Community Midwifery Unit (CMU) Midwives in accordance with CMU Protocol – Control of Severe hypertension. Contact Consultant
Obstetrician at CLU for immediate advice prior to
administration.
Pregnant women: 200mg as a single dose oral prior to transfer to CLU.
Note exclusion criteria, if applicable Nifedipine
may be administered as an alternative please refer to Nifedipine 10mgs PGD.
Magnesium sulphate
IM
PGD *
Magnesium
Sulphate IM
POM V4 Community Midwifery Unit (CMU) Midwives
in accordance with CMU Protocol – Eclampsia and Severe Pre-eclampsia. Contact Consultant Obstetrician at CLU for immediate advice prior to administration.
Emergency treatment for eclampsia and severe pre-eclampsia to prevent recurrent seizures prior/during transfer to Consultant Led Unit (CLU). Dose: Magnesium Sulphate 10g IM divided into 2 separate site injections
(5g + 5g).
One dose only. Note warnings and monitoring advice.
Magnesium Sulphate
Infusion
PGD * POM V6 Community Midwifery Unit (CMU) Midwives
in accordance with CMU Protocol – Eclampsia and Severe Pre-eclampsia. Contact Consultant Obstetrician at CLU for immediate advice prior to administration. Pregnant women:
Loading Dose:
4g/8ml given IV diluted in 12ml of 0.9% sodium chloride IV solution over 5 mins. By slow manual infusion.
Maintenance dose:
By syringe driver at a rate of 1g/hour continuous intravenous infusion. i.e. 5mls /hour.
Draw up 20mls (10g) of Magnesium Sulphate
50% inj. Then add to 30mls of 0.9% Sodium
Chloride inj.
Note exclusion criteria and cautions.
Medroxyprogesterone injectable contraception PGD * POM V7 PGD for contraception - Any woman aged 13 years or more to 50 years with no known risk factors or contraindications, who has been informed of the mode of action, method of administration , advantages, disadvantages and potential side effects in particular the effects on bone mineral density. See PGD for information on use by midwives.
Misoprostol PGD * POM V4 See GGC Obstetric Guideline – Post Partum
Haemorrhage (PPH) Management. Emergency treatment of women having a PPH: Misoprostol
200microgram tablets (oral) give 800microgram
(4 tablets) rectal – preferred route, for one dose only as per guideline and CLU advice.
Note exclusion criteria.
Nifedipine PGD * Nifedipine
10mgs capsule
POM V4 Community Midwifery Unit (CMU) Midwives in accordance with CMU Protocol – Control of Severe hypertension. Contact Consultant Obstetrician at CLU for immediate advice prior to administration. Pregnant women: 10mg nifedipine capsule as a single dose oral prior to transfer to CLU. Note exclusion criteria and warnings.
Omeprazole 20mg capsule PGD (GGC version) POM V1 See local guidelines for use as prophylaxis against acid aspiration (Mendelson’s Syndrome).
Elective Caesarean Section (CS) 20mg oral
to be given the night before and the morning of the elective CS operation. OP pack of 2 doses.
Labour see guideline for inclusion criteria- for “high risk” patients.
20mg every 12 hours until delivery, review after
24 hours. Maximum 3 doses.
Pertussis vaccine PGD * POM V8 1 dose for immunisation of pregnant and newly delivered women against pertussis (whooping cough) in line with the latest CMO letter. In accordance with PGD.     
Progesterone only oral contraception PGD * POM V8 PGD for contraception - Any woman aged 13 years or more to 50 years with no known risk factors or contraindications, who has been informed of the mode of action, method of administration , advantages, disadvantages and potential side effects. See PGD for information on use by midwives.
Ranitidine 50mg/2ml
inj.
PGD * POM V7 See local guideline. 50mg as a single dose IM or IV
for all women in labour, or of greater than 20 weeks gestation or less than 3 days postpartum who require emergency general anaesthesia.
Sodium Citrate
0.3Molar Oral Solution in 30ml
PGD * POM V7 To increase the pH of gastric contents before
general anaesthesia. See local guideline. 30ml as a single dose oral for all women in labour, or of greater than 20 weeks gestation or less than 3
days postpartum who require emergency general anaesthesia.

Last reviewed: 27 February 2020

Next review: 31 January 2022

Author(s): June Grant

Version: 2020

Approved By: Heads of Midwifery