Pharmacists aren't typically trained to respond to obstetric and neonatal emergencies, but their front-line medication expertise makes them essential in treating such conditions as preeclampsia in women and sepsis in newborns, said speakers at a Tuesday session of the 2025 Midyear Clinical Meeting & Exhibition.
Pharmacists practicing in emergency departments can expect to encounter these patients, particularly in areas with limited maternal care, said Morgan King, a clinical pharmacist at Cleveland Health Clinic. More than 35% of counties in the United States are considered “maternity care deserts,” she noted at the session, When the Birth Plan Goes Off Track: Pharmacist Preparedness for Obstetric and Neonatal Emergencies.
Pharmacists should be aware of pregnancy’s impact on drug therapies, King said. Pregnant women, for example, experience increased gastric pH, which affects absorption of certain medications, and increased glomerular filtration rate, which causes the body to eliminate medications more quickly.
King urged the audience to ensure their organizations have pre-packaged kits that contain medications and supplies to manage complications. She also discussed medications typically used to treat postpartum hemorrhaging, including oxytocin and misoprostol, and considerations for dosing.
Shelby Shemanski, a clinical pharmacist at Saint Luke’s Hospital in Kansas City, Missouri, elaborated on factors to consider when treating hypotension in pregnant women, including the risks of fetal tachycardia.
She also explored the treatment of sepsis in pregnant women. Though fundamental management of sepsis is the same as in non-pregnant patients, there are risks of over-resuscitation with fluids due to the physiology of pregnant women and the interacting therapies they receive, she said.
Shemanski, a postgraduate year 2 critical care residency program director, told the audience she suspected most of them are comfortable treating sepsis but may feel less confident when their patients are pregnant. That’s because most pharmacists receive minimal formal training in caring for pregnant patients.
But that must change, she said, citing an AJHP article that surveyed pharmacy residents and found a significantly higher level of comfort in treating pregnant patients after receiving some high-risk obstetric training.
“We have an opportunity for increasing training of our pharmacists,” she said.
Mary Petrea Cober, a professor of pharmacy practice at Northeast Ohio Medical University, also encouraged pharmacists who work in critical care and emergency medicine to take on pediatric rotations.
“You never know what might happen in your emergency room,” said Cober.
Cober provided a scenario that could easily play out in small rural hospitals around the country. An infant has just been born in the emergency department parking lot and is gasping to breath.
“How would you prepare for neonatal resuscitation for this patient?” she asked.
Cober discussed a treatment algorithm and key considerations, including hypothermia, delayed cord clamping, and optimal doses of epinephrine.
She also sorted through the complications in treating sepsis in newborns, including the different pathogens and treatments associated with early-onset sepsis (less than 72 hours after birth) and late-onset sepsis (three to 28 days after birth).
Cober also urged pharmacists working in hospitals with no obstetrics department never to hesitate to call other institutions that may be able to help. “You can call the children’s hospital or a nearby ob-gyn department and reach out to them for information,” she said.
