Postpartum haemorrhage

IS-methyl-PGF is used to control postpartum haemorrhage when oxytocin and ergot alkaloids fail to control the bleeding. 

Oxytocin is used in induction of labour, in postpartum haemorrhage, abortion and in breast engorgement. It is used by IM/IV route (PITOCIN, 2-5 lU/ml inj). 

It increase force, frequency and duration of uterine contractions. It is used to control and prevent postpartum haemorrhage. It is also used to prevent uterine atony after cesarean or instrumental delivery. 

These are used in treatment of migraine and in obstetrics (to control late uterine bleeding - postpartum haemorrhage). Their predominant action involves vasoconstriction (partial agonist effects at alpha-adrenergic receptors and 5-HT receptor-mediated effects). They are metabolized mainly via CYP3A4. 

Ergometrine and oxytocin differ in their actions on the uterus. In moderate doses oxytocin produces slow generalised contractions with full relaxation in between ergometrine produces faster contractions superimposed on a tonic contraction. High doses of both substances produce sustained tonic contraction. It will be seen, therefore, that oxytocin is more suited to induction of labour and ergometrine to the prevention and treatment of postpartum haemorrhage, the incidence of which is reduced by its routine prophylactic use (generally i.m.). 

Carboprost (prostaglandin F a analogue) is used for postpartum haemorrhage (resistant to ergometiine and oxytocin) for its oxytocin action. It is highly effective. Adverse effects include hypertension, asthma and pulmonary oedema. 

Schuurmans N, MacKinnon K, Lane C, Etches D (2000) Prevention and management of postpartum haemorrhage. J Soc Obstet Gynaecol Can 22 271-281... 

Porcu G, Roger V, Jacquier A et al. (2005) Uterus and bladder necrosis after uterine artery embolisation for postpartum haemorrhage. BJOG 112 122-123... 

Death and surgical complications seem relatively unambiguous outcomes. However, some indicators of morbidity, such as wound infection, anastomotic leak and postpartum haemorrhage are difficult to define with precision (Lilford etal, 2004). Even death can pose difficulties of classification, in the sense that a death in hospital can simply mean the arrival of a terminally ill person who died shortly after admission. A death in those circumstances says nothing at all about the quality or safety of care in that hospital. 

Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, Hunt LP, Draycott T. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section the results of a double-blind randomised trial. BJOG 2010 117(8) 929-36. 

Blum J, Winikoff B, Raghavan S, Dabash R, Ramadan MC, Dilbaz B, Dao B, Durocher J, Yalvac S, Diop A, Dzuba IG, Ngoc NT. Treatment of postpartum haemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin a doubleblind, randomised, non-inferiority trial. Lancet 2010 375(9710) 217-23. 

Ergometrine, Me-Eigometrine Postpartum haemorrhage 5-HT, Partial agonism... 

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