Patient Group Directives for Midwives (GGC)
Maternity & Gynaecology Guidelines
Warning
Objectives
Below is the list of locally agreed PGDs for use by midwives in GG&C.
*Available on request from Patient.GroupDirections@ggc.scot.nhs.uk
|
GGC PGD Medicine |
Arrangement for supply or administration |
Legal |
Version of page |
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. |