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Uterotonic
A uterotonic, also known as ecbolic, are pharmacological agents used to induce contraction or greater tonicity of the uterus. Uterotonics are used both to induce labor and to reduce postpartum hemorrhage. Labor induction in the third trimester of pregnancy may be required due to medical necessity, or may be desired for social reasons. Generally, labor induction is indicated when the risk of carrying the pregnancy outweighs the risk of delivering. These reason include, but are not limited to, pregnancies that are prolonged, prelabor rupture of the fetal membranes, and concerns about the health and safety of the mother and/or child. There are multiple techniques available to stimulate uterine contractions including mechanical, pharmacological, and alternative medicine methods to initiate contractions prior to spontaneous onset of labor. Postpartum hemorrhage, also known as PPH, is defined as a loss of 500 mL or greater of blood within 24 hours after giving birth. It is one of the le ...
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Uterine Atony
Uterine atony is the failure of the uterus to contract adequately following delivery. Contraction of the uterine muscles during labor compresses the blood vessels and slows flow, which helps prevent hemorrhage and facilitates coagulation. Therefore, a lack of uterine muscle contraction can lead to an acute hemorrhage, as the vasculature is not being sufficiently compressed. Text was copied from this source, which is available under Creative Commons Attribution 4.0 International License Uterine atony is the most common cause of postpartum hemorrhage, which is an emergency and potential cause of fatality. Across the globe, postpartum hemorrhage is among the top five causes of maternal death. Recognition of the warning signs of uterine atony in the setting of extensive postpartum bleeding should initiate interventions aimed at regaining stable uterine contraction. Risk factors There are many risk factors for uterine atony and several are due to the type of labor a mother experience ...
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Postpartum Bleeding
Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breathing rate. As more blood is lost, the patient may feel cold, blood pressure may drop, and they may become restless or unconscious. The condition can occur up to six weeks following delivery. The most common cause is poor contraction of the uterus following childbirth. Not all of the placenta being delivered, a tear of the uterus, or poor blood clotting are other possible causes. It occurs more commonly in those who: already have a low amount of red blood, are Asian, with bigger or more than one baby, are obese or are older than 40 years of age. It also occurs more commonly following caesarea ...
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Carbetocin
Carbetocin, sold under the brand names Pabal among others, is a medication used to prevent excessive bleeding after childbirth, particularly following Cesarean section. It appears to work as well as oxytocin. Due to it being less economical than other options, use is not recommended by NHS Scotland. It is given by injection into a vein or muscle. Side effects differ little from that of no treatment or placebo. Use is not recommended in people with epilepsy or eclampsia. Carbetocin is manufactured long acting form of oxytocin. It works by activating the oxytocin receptor which causes the uterus to contract. Carbetocin was first described in 1974. It was approved for medical use in Canada and the United Kingdom in 1997. It is on the World Health Organization's List of Essential Medicines. It is not available in the United States or Japan. Medical uses Carbetocin has been approved for use immediately following an elective Cesarean section when a local or spinal anesthesia ...
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Labor Induction
Labor induction is the process or treatment that stimulates childbirth and delivery. Inducing (starting) labor can be accomplished with pharmaceutical or non-pharmaceutical methods. In Western countries, it is estimated that one-quarter of pregnant women have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment. Medical uses Commonly accepted medical reasons for induction include: * Postterm pregnancy, i.e. if the pregnancy has gone past the end of the 42nd week. * Intrauterine fetal growth restriction (IUGR). * There are health risks to the woman in continuing the pregnancy (e.g. she has pre-eclampsia). * Premature rupture of the membranes (PROM); this is when the membranes have ruptured, but labor does not start within a specific amount of time. * Premature termination of the pregnancy (abortion). * Fetal death in utero a ...
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Carboprost
Carboprost (INN, trade names for the tromethamine salts Hemabate, Tham) is a synthetic prostaglandin analogue of PGF2α (specifically, it is 15-methyl-PGF2α) with oxytocic properties. Carboprost's main use is in the obstetrical emergency of postpartum hemorrhage which reduces postpartum bleeding Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume fo ... during these circumstances. Indication Used in postpartum hemorrhage caused by uterine atony not controlled by other methods. One study has shown that carboprost tromethamine is more effective than oxytocin in preventing postpartum hemorrhage in high-risk patients undergoing cesarean delivery. Carboprost is also used for the termination of pregnancy in the 2nd trimester.Hemabate ackage Insert New York, NY: Pharmacia and Upjohn Compan ...
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Misoprostol
Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. Misoprostol is taken by mouth when used to prevent gastric ulcers in persons taking NSAIDs. For abortions it is used by itself and with mifepristone or methotrexate. By itself, effectiveness for abortion is between 66% and 90%. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally. Common side effects include diarrhea and abdominal pain. It is pregnancy category X meaning that it is known to result in negative outcomes for the fetus if taken during pregnancy. In rare cases, uterine rupture may occur. It is a prostaglandin analogue—specifically, a synthetic prostaglandin E1 (PGE1). Misoprostol was developed in 1973. It is on the World Health Organization's List ...
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Sublingual Administration
Sublingual ( abbreviated SL), from the Latin for "under the tongue", refers to the pharmacological route of administration by which substances diffuse into the blood through tissues under the tongue. The sublingual glands receive their primary blood supply from the sublingual and submental arteries, which are branches of the lingual artery and facial artery, respectively. These arteries are both branches of the external carotid artery. The sublingual vein drains into the lingual vein, which then flows into the internal jugular system. The sublingual glands receive their parasympathetic input via the chorda tympani nerve, which is a branch of the facial nerve via the submandibular ganglion. The nerve functions in a secretomotor capacity. The chorda tympani branches from the motor branch of the facial nerve in the middle ear cavity, which then exits the middle ear through the petrotympanic fissure. The chorda tympani then travels with the lingual nerve to synapse at ...
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Uterine Hyperstimulation
Uterine hyperstimulation or hypertonic uterine dysfunction is a potential complication of labor induction. This is displayed as Uterine tachysystole- the contraction frequency numbering more than five in a 10-minute time frame or as contractions exceeding more than two minutes in duration. Uterine hyperstimulation may result in fetal heart rate abnormalities, uterine rupture, or placental abruption. It is usually treated by administering terbutaline. Causes * Mistoprostol is a drug treatment for peptic ulcers that can also cause abortion or induce labor. The use of this drug (inserted vaginally) to induce labor can cause uterine hyperstimulation. Treatment Treatments of uterine hyperstimulation are primarily experimental. Those that have shown to alleviate the conditions are: * Prostoglandin E2 is administered before labor to minimize risk of uterine hyperstimulation and to minimize the effects on Fetal Heart Rate. * Administration of tocolytic Tocolytics (also c ...
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Hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high blood pressure, however, is a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide. High blood pressure is classified as primary (essential) hypertension or secondary hypertension. About 90–95% of cases are primary, defined as high blood pressure due to nonspecific lifestyle and genetic factors. Lifestyle factors that increase the risk include excess salt in the diet, excess body weight, smoking, and alcohol use. The remaining 5–10% of cases are categorized as secondary high blood pressure, defined as high blood pressure due to an identifiable cause, such ...
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Pge1
Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In infants with congenital heart defects, it is delivered by slow injection into a vein to open the ductus arteriosus until surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction. Common side effects when given to babies include decreased breathing, fever, and low blood pressure. When used for erectile dysfunction side effects may include penile pain, bleeding at the site of injection, and prolonged erection (priapism). Prostaglandin E1 is in the vasodilator family of medications. It works by opening blood vessels and relaxing smooth muscle. Prostaglandin E1 was isolated in 1957 and approved for medical use in the United States in 1981. It is on the World Health Organization's List of Essential Medicines. Medical uses Patent ductus arteriosus Alprostadil is also used in mainta ...
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Vomiting
Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pregnancy, motion sickness, or hangover; or it can be an after effect of diseases such as brain tumors, elevated intracranial pressure, or overexposure to ionizing radiation. The feeling that one is about to vomit is called nausea; it often precedes, but does not always lead to vomiting. Impairment due to alcohol or anesthesia can cause inhalation of vomit, leading to suffocation. In severe cases, where dehydration develops, intravenous fluid may be required. Antiemetics are sometimes necessary to suppress nausea and vomiting. Self-induced vomiting can be a component of an eating disorder such as bulimia, and is itself now classified as an eating disorder on its own, purging disorder. Complications Aspiration Vomiting is dangerou ...
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