ASSESSMENT OF PRESCRIPTION PATTERN IN HIGH-RISK PREGNANCY AT A TERTIARY CARE HOSPITAL

Objective: Pregnancy is a special physiological condition where drug treatment presents a special concern. The aim of the study is to evaluate the pattern of drug use and WHO prescribing indicators in high-risk pregnancies. Methods: A prospective observational study was carried out for a period of six months. A self-designed data collection form was used to collect the data from the prescriptions. The collected data was entered and analyzed using Microsoft Excel. Results: A total of 200 patients were included in this study. Preeclampsia (45, 22.5%) was the most frequently recorded complication, followed by eclampsia (43, 21.5%), anemia (34, 17%), and PIH (32, 16%). Antimicrobial agents (435, 32.5%) were the most frequently prescribed class of drug, followed by hematinics (194, 14.4%). A total of 1,338 drugs were prescribed in 200 patients. The average number of drugs per prescription was 6.69, the percentage of drugs prescribed by generic name was 88.04%, the percentage of drugs prescribed from EDL was 83.10%, the percentage of prescriptions with an antibiotic prescribed was 88%, and the percentage of prescriptions with an injection prescribed was 76%. Conclusion: During pregnancy, as we see, every complication need treatment and different class of drugs in, which some drugs may cause serious side effect to both mother and fetus. The prescription pattern was suboptimal when compared to the WHO core prescribing indicators' suggested values. Studying drug prescribing patterns in high-risk pregnancies can help improve practices, leading to safer and more effective medication use and, ultimately better health outcomes for both mothers and fetuses.


INTRODUCTION
Pregnancy complicated by variables that may negatively impact the mother's and/or the fetus's outcome is referred to as high-risk.70% to 80% of perinatal mortality and morbidity are caused by the 10-30% of pregnant women who are deemed high risk throughout the prenatal period [1,2]."The marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences" is how the WHO described drug usage research in 1977.Drug usage research's main goal is to promote drug use that is logical among the populace, which will improve health outcomes.Because it is linked to physiological changes in the pharmacokinetic and pharmacodynamic properties of the medications and because it puts the life of the mother and fetus in danger, the pattern of drug use during pregnancy is particularly concerning [3,4].
Pregnant women who use drugs run the danger of causing teratogenic effects to their unborn child.On the other hand, it is unsafe and impracticable to advice against using any drugs while pregnant.Clinicians should not let their patients' pregnancies stop them from receiving the proper care for their diseases.Medicines are essential for maintaining and regaining health.Thus, prescribing in pregnancy is a unique case of risk-benefit [5].
The FDA of the United States implemented a system in 1979 to rate the risk of pregnancy associated with pharmaceutical agents.This system assigned a pregnancy risk category to all pharmaceuticals approved after 1983.It suggests the level of caution that should be used with each medication and shows the effect of the agent on the fetus based on data from humans and animals [6].
It is impossible to avoid taking medication while pregnant because some pregnant women have long-term medical conditions that need to be treated, such as respiratory tract diseases, asthma, anemia, gastrointestinal irritations, hepatitis, jaundice, diabetes mellitus, hypertension, thyroid disorders, and urinary tract infections.A doctor's job is to weigh the pros and cons of medication therapy when a patient is pregnant.The use of medications during pregnancy has implications for the development of the fetus in addition to the health of the mother [7,8].
More emphasis should be placed on female patients in the OBGYN department, as a small mistake can lead to congenital malformations of the fetus.Considering the essential role of prescribing practices in OBGYN practice, the current study was conducted to study the pattern of drug prescribing among high-risk pregnancies in the OBGYN Ward.

Study design
This was a prospective observational study.

Study site
This study was conducted at a Tertiary care hospital, Chitradurga.

Study period
This study was conducted for a period of six months.

Study subject
Pregnant women who were admitted to the OBGYN department of Tertiary Care Hospital, Chitradurga.

Study criteria
The study was carried out by considering the following criteria

Inclusion criteria
• Patients of high-risk (complicated) pregnancy who are admitted to the OBGYN ward.
• Patient prescribed with at least one medication.
• Pregnant women who are willing to participate in the study.

Exclusion criteria
• Patients who provide incomplete information.
• Pregnant women who are not willing to cooperate.

Ethical approval
The study was approved by the "IEC" of SJM College of Pharmacy, Chitradurga.

Source of data
• Treatment chart.
• Medical reports of patients.
• WHO model list of essential medicines.

Study procedure
A six-month prospective observational study was conducted on pregnant women who were admitted to the OBGYN department of Tertiary Care Hospital, Chitradurga.The study was started after the approval from the IEC.First of all, details about the study were explained to the patients and those patients who are willing to sign the informed consent form were only included in the study.Patient data were collected in the self-designed data collection form.The details included name, age, medical and medication past history, diagnosis, and drug therapy data like drug name, dose, route of administration, and frequency.The data was evaluated for prescribing patterns.Confidentiality of collected data was maintained.

Statistical analysis
All the relevant data was entered and analysed by Microsoft Excel.

RESULTS
A total of 200 patients of pregnant women with high-risk conditions were included in this study.The mean age of pregnant women was 26±4.5.The following are study results in the view of complications, different classes of drugs, and prescribing indicators by the objectives of the study.