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Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
To reduce the risk of/prevent PPH, the WHO recommends:All women giving birth should be offered uterotonics during the third stage of labour to prevent PPH and IM/IV oxytocin (10 IU) is recommended as the uterotonic drug of choice. In some settings it may not be possible to provide oxytocin due to absence of skilled staff and/or lack of cold chain capacity.Other injectable uterotonics (i.e. ergometrine/methylergometrine, or the fixed drug combination of oxytocin and ergometrine) and misoprostol (heat stable uterotonic) are recommended as alternatives for the prevention of PPH in settings where oxytocin is unavailable.
Cellular Regulation of Myometrial Contractility and Essentials of Tocolytic therapy
Published in Gabor Huszar, The Physiology and Biochemistry of the Uterus in Pregnancy and Labor, 2020
The calcium channel blocker nifedipine has been used in clinical practice by European investigators. In nonpregnant patients, the drug was beneficial in dysmenorrhea.56,57 In patients with preterm labor nifedipine has been used in tocolysis, either alone or in combination with β-adrenergic agonists.58 Stimulation of contractility in the post partum uterus by methylergometrine, OT, and prostaglandin F2a has also been inhibited.59 At the present time, published data are not extensive enough to make a judgment, but anecdotal information indicates a major potential for the use of calcium blockers for tocolysis. It is not clear whether they will be used in stopping active premature labor, or whether the major indication will be for prevention and maintenance in reduced doses. Clinical research with calcium channel-blocking agents is just beginning, but interest in these agents is rapidly growing.
Prejunctional Dopamine Receptor Stimulants
Published in M.D. Francesco Amenta, Peripheral Dopamine Pathophysiology, 2019
Hypotension and bradycardia occur in the anesthetized dog at the same doses found active in the rat. Both effects are enhanced by sino-aortic denervation, and markedly attenuated by pretreatment with sulpiride or methylergometrine, confirming an effect on peripheral DA2 receptors as the major mechanism responsible for the compound’s cardiovascular actions in this species also. A peripheral site of action is substantiated by the compound’s inhibitory effect on heart rate increases in response to postganglionic electrical stimulation of the accelerator nerve in cats, and on pressor responses to cord stimulation in rats.134
Bakri Balloon: an easy, useful and effective option for the treatment of postpartum haemorrhage
Published in Journal of Obstetrics and Gynaecology, 2022
Maria-Jesús Puente-Luján, Maria-Pilar Andrés-Orós, Leticia Álvarez-Sarrado, Andrea Agustín-Oliva, Isabel González-Ballano, Belén Rodríguez-Solanilla, Sergio Castán-Mateo
As soon as subjective excessive bleeding is observed, a manual uterine cavity and birth canal revision are made. When bleeding persists, uterotonic drugs are dispensed progressively as first-line treatment associated with bimanual uterine massage including the addition of 10 IU of oxytocin, up to five tablets of misoprostol 200 mcg (taking into account the prophylactic dose if previously dispensed), slow blood perfusion of 0.2 mg of methylergometrine, intravenous prostaglandins diluting 5 mg in 500 cc of physiological saline solution with an infusion rate of 15 ml/h (to a maximum of 60 ml/h), up to 1 g of tranexamic acid and 1 g of human fibrinogen (factor I).
Pyroptosis and inflammasomes in obstetrical and gynecological diseases
Published in Gynecological Endocrinology, 2021
The smooth muscle constrictor methylergometrine mostly acts on the uterus, and it is currently used during postpartum hemorrhage to prevent or control excessive bleeding [95]. However, methylergometrine is also considered an inhibitor of the inflammasome complex in ASC-mediated pro-caspase-1 activation screening, it can inhibit the activation of NLRP1 and NLRP3 inflammasomes in cellular models upon different pro-inflammatory stimuli [96]. Thus, further research could lead to a promising future of methylergometrine and its anti-inflammatory effects to suppress pyroptosis in certain diseases.
Comparison of the benefits and hemodynamic side effects of oxytocin between intravenous infusion with and without bolus injection during caesarean section
Published in Journal of Obstetrics and Gynaecology, 2021
Yasuhiro Miyoshi, Shohei Kaneko, Sachie Suga, Megumi Koga, So Sugimi, Hiroshi Yamashita, Michiko Yamaguchi, Ichiro Yasuhi
The management of anaesthesia during CS did not differ between the groups. In the operating room, pulse oximetry, electrocardiography, and non-invasive blood pressure (NIBP) monitoring were performed. All women received a combined spinal–epidural anaesthesia in the right lateral recumbent position. After the epidural catheter had been secured in position, hyperbaric bupivacaine 0.5% (1.8–2.2 mL) and fentanyl (15–20 μg) were administered intrathecally. The patients were subsequently placed in the supine position with left uterine displacement. Then a rapid iv bolus of 500 mL of crystalloid or colloid solution was administered, with the additional iv fluids given at the discretion of the anaesthesiologist. In the case of hypotension, phenylephrine or ephedrine was infused. Once the patient was placed in the supine position, measurement of NIBP was taken at 1 minute intervals. Once the operation started, measurement of NIBP was taken at 2.5 minutes intervals until the return of hemodynamic stability after delivery had been confirmed. The last measurements of systolic blood pressure (BP) and heart rate (HR) before the administration of oxytocin were recorded as baseline values. Surgery was initiated once the neuraxial block height had reached T4 to cold perception using ice. If the neuraxial block height did not reach T4, postural change with the head down and/or infusion of a local analgesic (e.g. 2% mepivacaine) through an epidural catheter were performed. Additional analgesic or anxiolytic medications were administered at the discretion of the anaesthesiologist. Oxytocin was administered immediately after the delivery of a baby and umbilical cord clamping. Uterine tone was assessed by the attending obstetricians after oxytocin administration by manual palpation of the uterus. When requested by obstetricians, additional uterotonic medications were administered: 5 U of oxytocin via intramyometrial injection, iv infusion of another 10 U of oxytocin plus 500 mL of normal saline, and/or iv or intramuscular injection of 0.2 mg of methylergometrine maleate.