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Third Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Alyssa R. Hersh, Jorge E. Tolosa
Prostaglandin F2α (Hemabate/carboprost) causes contraction of uterine smooth muscle cells. Administration is either 0.25 mg IM or as a direct injection into the myometrium, which may be repeated every 15–20 minutes for a maximum of eight doses or 2 mg. Side effects are secondary to smooth muscle constriction and include bronchoconstriction, venoconstriction, and constriction of GI smooth muscle. Common side effects are nausea, vomiting, diarrhea, pyrexia, bronchospasm, and case reports of hypotension and intrapulmonary shunting with arterial oxygen desaturation. It is contraindicated in patients with cardiac and pulmonary disease. There is no high-quality evidence to support the use of carboprost for PPH prophylaxis.
Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Carboprost (15-methyl analogue of prostaglandin F2α) can be repeated at intervals not less than 15 minutes and up to a total dose of 2 g. However, it would be advisable to intervene surgically if the bleeding is not controlled after three doses of carboprost. The duration of action of carboprost is up to six hours, and therefore, it is a useful agent when a prolonged uterotonic effect is required. Nonetheless, it can also cause severe bronchospasm, and therefore, should be avoided in women with bronchial asthma.
Practice exam 4: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Most experienced surgeon.Oxytocics.Carboprost.IOCS.
Peripartum anesthetic management in patients with Ebstein anomaly: a case series
Published in Baylor University Medical Center Proceedings, 2023
Carmelina Gurrieri, Emily E. Sharpe, Heidi M. Connolly, Carl H. Rose, Katherine W. Arendt
Vaginal delivery is the preferred option for patients with EA; CD is typically reserved for obstetric indications.12,13 Induction of labor, if required, can be performed in the conventional manner (e.g., oxytocin, misoprostol, amniotomy) and is usually well tolerated. An alternative to the traditional management of labor is the colloquially described cardiac vaginal delivery, in which neuraxial anesthesia is administered early in labor, and fetal descent occurs as a passive process in the second stage (as in patients 7 and 8 in our series). However, conflicting reports about potential risk of obstetric or neonatal complications exist.9,10,14 If uterotonic medications are needed, such as in the case of postpartum hemorrhage, special considerations should be taken. Cautions should be used, for example, with methylergonovine in patients with preexisting systemic or pulmonary hypertension because of its vasoconstrictor effects.15 Carboprost may worsen intracardiac shunt and reduce cardiac output. Oxytocin is usually well tolerated in EA patients unless concomitant aortic stenosis, hypertrophic obstructive cardiomyopathy, or ischemic heart disease are present.16 In our cohort, we used oxytocin as a first-line uterotonic medication. The one patient who had postpartum hemorrhage required no further uterotonics besides oxytocin and misoprostol.
Prostaglandin E1 overdose in a term neonate with congenital heart disease
Published in Clinical Toxicology, 2019
Rachel M. Gorodetsky, Bethany M. Toole, Rachel F. Schult, Timothy J. Wiegand
This is a case in which a medication error resulted in alprostadil overdose in a neonate. The duration of toxicity in this patient was approximately one hour and she was managed with ventilation and IVF alone, indicating that supportive care is likely sufficient for alprostadil overdoses in neonates. Only one previous report of prostaglandin overdose involving a newborn was identified in literature review [3]. In this case, carboprost (Hemabate) 250 mcg was administered intramuscularly instead of hepatitis vaccine. Carboprost is a synthetic 15-methyl analogue of prostaglandin F2a and differs substantially in clinical effects from alprostadil. This patient developed hypertension, hyperthermia, tachycardia, tachypnea, which resolved over 18 hours.
A case of heterozygous factor VII deficiency in pregnancy
Published in Journal of Obstetrics and Gynaecology, 2020
The patient had a spontaneous vaginal delivery complicated by a post-partum haemorrhage from uterine atony and a second-degree laceration. The obstetrics team administered intramuscular carboprost along with the vaginal misoprostol. The uterine tone improved, though the ongoing estimated blood loss exceeded 500 mL. Since the bleeding significantly improved with laceration repairs, Haematology recommended not to administer rFVIIa. After the laceration repairs, good haemostasis was observed, and the final estimated blood loss was 650 mL.