Hemorrhage, postpartum

Ergonovine (100, R = NHCH(CH3)CH2 0H) was found to yield lysergic acid (100, R = OH) and (+)-2-aminopropanol on alkaline hydrolysis during the early analysis of its stmcture (66) and these two components can be recombined to regenerate the alkaloid. Salts of ergonovine with, for example, malic acid are apparently the dmgs of choice in the control and treatment of postpartum hemorrhage. 

Ergonovine and metiiylergonovine may be given orally during die postpartum period to reduce die possibility of postpartum hemorrhage and to prevent relaxation of die uterus. When die patient is to receive eitiier of tiiese drains after delivery, it is important to take die blood pressure, pulse, and respiratory rate before administration. 

Carboprost has been used successfully to control postpartum bleeding that was secondary to loss of uterine tone and where the myometrium was unresponsive to oxytocin, ergonovine, or methylergonovine. Given intramuscularly, carboprost causes an almost immediate and sustained uterine contraction. Clinical experience has shown that the use of this agent has saved many women from operative interventions (including hysterectomy) to control postpartum hemorrhage. 

Diddy GA 3rd. Postpartum hemorrhage New management options. Clin Obstet Gynecol 2002 45 330-344. 

Maughan KL, Heim SW, Galazka SS Preventing postpartum hemorrhage Managing the third stage of labor. Am Fam Physician 2006 73 1025. [PMID 16570736]... 

First- and second-trimester abortion Cervical reopening Induction of labor Augmentation of labor Postpartum hemorrhage Ectopic pregnancy Lactation suppression In gastrointestinal disease Peptic ulceration Liver transplantation Chemotherapy-induced mucosal lesions In cardiovascular disease Congenital cardiac malformations Raynaud s syndrome Chronic obstructive pulmonary disease Adult respiratory distress syndrome Pulmonary hypertension Arterial occlusive disease Extracorporeal circulation In urology Erectile dysfunction... 

Hayashi RH, Castillo MS, Noah ML. Management of severe postpartum hemorrhage due to uterine atony using an analogue of prostaglandin F2 alpha. Obstet Gynecol 1981 58(4) 426-9. 

Carboprost is a 15-methylated analogue of PGF2a- It is used in termination of pregnancy, in the management of labor, and to treat postpartum hemorrhage and uterine atony. 

A 38-year-old woman developed complete heart block, ventricular fibrillation, and subsequent asystole about 7 minutes after intravenous sulprostone 30 micrograms over 5 minutes, after she had previously been given a total dose of intramyometrial sulprostone 500 micrograms at seven different points for postpartum hemorrhage after cesarean section (5). 

Cardiac arrest occurred in a 39-year-old woman 3.5 hours after the administration of sulprostone 250 micrograms directly into the uterine wall for postpartum hemorrhage after manual removal of the placenta (6). She had specific contraindications to sulprostone, as formulated by the French authorities age over 35 years, heavy cigarette smoking, and cardiovascular risk factors. 

Oxytocin is a hypothalamic nonapeptide that selectively stimulates the smooth muscle of the uterus and mammary glands. It is used in the induction or augmentation of labor and to prevent postpartum hemorrhage, and is well tolerated and effective in a wide range of infusion rates and concentrations. Contraindications to its use... 

Golden seal is stated to be a stimulant to involuntary muscle, and possesses stomachic, oxytocic, antihemorrhagic, and laxative properties. Traditionally, it has been used for digestive disorders, gastritis, peptic ulceration, colitis, anorexia, upper respiratory catarrh, menorrhagia, postpartum hemorrhage, dysmenorrhea, topically for eczema, pruritus, otorrhea, catarrhal deafness and tinnitus, conjuctivitis, and specifically for atonic dyspepsia with hepatic symptoms. 

First- and second-trimester abortion Cervical reopening Induction of labor Augmentation of labor Postpartum hemorrhage Ectopic pregnancy Lactation suppression... 

Clinical use Induction of labor, to curtail bleeding postpartum, primarily responsible for dramatic decrease in maternal death secondary to postpartum hemorrhage. 

PH, the patient in the case above, has a postpartum hemorrhage after her delivery. Which of the following regimens can be used to stop the excessive bleeding ... 

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