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Vinca rosea (Madagascar Periwinkle) and Adhatoda vesica (Malabar Nut)
Published in Azamal Husen, Herbs, Shrubs, and Trees of Potential Medicinal Benefits, 2022
Rajib Hossain, Md Shahazul Islam, Dipta Dey, Muhammad Torequl Islam
The uterotonic action of vasicine, a quinazoline alkaloid found in A. vasica, was investigated in-depth both in vitro and in vivo, using uteri from various species of animals with diverse hormonal effects. Similar to oxytocin and methyl ergometrine, uterotonic action was observed. Under the priming impact of estrogens, the abortifacient action of vasicine, as well as its uterotonic effect, was more pronounced. Vasicine-induced abortion in rats, guinea pigs, hamsters, and rabbits was investigated. According to the findings, vasicine works by releasing PGs. In vitro experiments showed that synthesized vasicine and vasicinone derivatives have oxytocic action at doses greater than 1 mg/ml (Rao et al., 1983).
Third Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Alyssa R. Hersh, Jorge E. Tolosa
Recent evidence suggests that numerous regimens of uterotonic agents, including oxytocin with ergot alkaloids, carbetocin alone, or oxytocin with misoprostol, are more effective at reducing blood loss at delivery than oxytocin alone. Furthermore, there is high-quality evidence that oxytocin with TXA is more effective in reducing PPH and improves outcomes compared with oxytocin alone. If just one agent is to be used for routine prophylaxis during the third stage of labor, oxytocin is recommended. Based on safety and side effect profiles, TXA with oxytocin is the recommended regimen to be considered to be used routinely during the third stage of labor whenever possible.
Complications of Obstetric Anaesthesia
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Bhaagya Gunetilleke, Asantha de Silva
Anaesthetic drugs including inhalational agents, e.g. isoflurane, contribute to uterine hypotonia and can cause postpartum haemorrhage. Volatile anaesthetic agents should be used at a minimum concentration which will prevent awareness. Uterotonic agents (e.g. oxytocin, ergometrine, misoprostol), with or without surgical measures, should be used in its treatment. Management of uterine hypotonia is further described in Chapter 14.
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.
Cost-effectiveness analysis of carbetocin versus oxytocin for the prevention of postpartum hemorrhage following vaginal birth in the United Kingdom
Published in Journal of Medical Economics, 2022
Suzette Matthijsse, Fredrik L. Andersson, Michael Gargano, Yum L. Yip Sonderegger
PPH is the most commonly occurring form of obstetric hemorrhage and has been increasing in prevalence over time in many developed and developing countries, driven by an increase in uterine atony, which causes almost 80% of PPH events10. Uterotonics are the standard of care for the prevention of PPH events following vaginal birth and oxytocin is the most widely used among them. Carbetocin is a synthetic oxytocin analogue; when compared with oxytocin for PPH prophylaxis following vaginal birth, carbetocin was found to cost-effective from a UK NHS perspective, leading to savings of £55 and 0.0342 less PPH events per woman in the deterministic base case. In addition, per an exploratory analysis, it led to a marginal increase of 0.0001 QALYs per woman. Carbetocin may provide a less costly alternative while preventing more PPH events following vaginal birth.
Molecular and endocrine mechanisms involved in preterm birth
Published in Gynecological Endocrinology, 2022
Elena Pisacreta, Paolo Mannella
Regarding fetal stressful events, compromised uterus-placental perfusion is one of the main causes. It elicits local production of PGs and the activation of the fHPA with the series of events described above. In these cases, there is a particular stress-trigger factor and marker: thrombin. It has been demonstrated that thrombin (measured using thrombin-antithrombin as a marker) increases during pregnancy and it appears to be elevated in PTB, hence it has a role in inducing PTB [71]. Elovitz et al. [72] demonstrated that it acts as a uterotonic agonist, activating myometrial contractions. The administration of clotting blood in the myometrium of rats causes the release of cytosolic calcium comparable to the levels induced by oxytocin or PGs [73]. Recent research has shown that gestational complications, such as pPROM, could be preceded by thrombin activation. In fact, thrombin has been implicated in enhancing matrix metalloproteinases activity and in weakening membranes [74]. In this way, thrombin may be used as a marker of PTB during the second and third-trimesters [75] in the same way as CRH.