Vaginal delivery

Oxytocic drag s are drug s that are used in antepartum (before birth of the neonate) to induce uterine contractions similar to those of normal labor. These dragp are desirable when early vaginal delivery is in the best interest of the woman and the fetus. 

Oxytocin is contraindicated in patients with known hypersensitivity to the drug, cephalopelvic disproportion, unfavorable fetal position or presentation, in obstetric emergencies, situations of fetal distress when delivery is not imminent, severe toxemia (preeclampsia, eclampsia), hypertonic uterus, during pregnancy (intranasal administration), when there is total placenta previa, or to induce labor when vaginal delivery is contraindicated. Oxytocin is not expected to be a risk to the fetus when administered as indicated. When oxytocin is administered with vasopressors, severe hypertension may occur. 

Herpes simplex virus may be transmitted to the neonate if active vaginal lesions or the prodrome is present at the time of birth. Consequently, cesarean section often is recommended for these women. Vaginal delivery is indicated if vaginal lesions or the prodrome are not present. 

Risk factors for venous thromboembolism in pregnancy include increasing age, history of thromboembolism, hypercoagulable conditions, operative vaginal delivery or cesarean section, obesity, and a family history of thrombosis. 

Conventional vaginal delivery systems include tablets, foams gels, suspensions, and pessaries. Mucoadhesive gel formulations based on polycarbophil have been reported to remain 3 to 4 days at the vaginal tissue, providing an excellent vehicle for the delivery of progesterone and nonoxynol-9 [66]. 

Richardson, J.L., and Armstrong, T.I., Vaginal Delivery of Calcitonin by Hyaluronic Acid Formulations. In Bioadhesive Drug Delivery Systems (E. Mathiowitz, D.E. Chickering, III, and C.-M. Lehr, eds.), Marcel Dekker, Inc., New York, 1999, pp. 563-599. 

Epidural analgesic - For epidural administration as an analgesic combined with low-dose bupivacaine, usually 12.5 mg per administration, during labor and vaginal delivery. 

Oxytocin is used to induce labor for conditions requiring early vaginal delivery such as Rh problems, maternal diabetes, preeclampsia, or ruptured membranes. It is also used to augment abnormal labor that is protracted or displays an arrest disorder. Oxytocin has several uses in the immediate postpartum period, including the control of uterine hemorrhage after vaginal or cesarean delivery. It is sometimes used during second-trimester abortions. 

However, uneventful vaginal deliveries have been reported in patients with two previous cesarean sections in whom labor was induced with vaginal PGE2 (121). 

Chattopadhyay SK, Sherbeeni MM, Anokute CC. Planned vaginal delivery after two previous caesarean sections. Br J Obstet Gynaecol 1994 101(6) 498-500. 

The authors commented that induction with prostaglandins in women with a previous lower segment cesarean scar is associated with a risk of symptomatic scar rupture no greater than 0.6%, and the vaginal delivery rate is about 75%, that is similar to rates quoted for spontaneous labor in women with a cesarean scar. At present, faced with the lack of... 

A 43-year-old woman, who had previously had a first trimester miscarriage that required evacuation of the uterus and a normal vaginal delivery at term 4 years before, was admitted for an abortion at 16 weeks. 

What cultural and patient acceptability factors may be important, for example, a tendency for the preparation to leak following initial application Vaginal delivery may not be universally acceptable in all cultures, and within cultures the preference for systems that can be self-inserted and removed, or considerations relating to leakage, will vary considerably. 

Hwang, S., et al. 1977. Systems approach to vaginal delivery of drugs IV Methodology for determination of membrane surface pH. J Pharm Sci 66 778. 

A vaginal suppository based on bromocriptine was employed for the therapy of hyperprolactinemia [32]. The rationale of the local vaginal delivery of bromocriptine lies in the noteworthy side effects consequent to oral therapy gastrointestinal disorders, extensive hepatic degradation, and hypotension. The pessary based on bromocriptine proved to be effective in lowering serum prolactin to normal levels after 20 days of local therapy the treatment was well tolerated by the majority of the patients and a minimal vaginal irritation was observed. 

Conventional systems do not offer sufficient flexibility in controlling drug-release rate and sustaining the release over time periods extending from days to months. Therefore specific modified release vaginal delivery systems are continuously under development and are based on mucoadhesive systems. Penetration enhancement may represent a necessary feature for certain delivery systems, particularly when the absorption regards a macromolecule (such as a peptide or a protein). 

Different drug delivery systems have been proposed for vaginal delivery of peptides and proteins. The first one was a mucoadhesive gel based on polyacrylic acid intended for vaginal administration of insulin [96]. More recently, microparticulate systems such as starch and hyaluronan ester (HYAFF) microspheres have been proposed for vaginal delivery of insulin... 

Mandal, T.K. 2000. Swelling-controlled release system for the vaginal delivery of miconazole. Eur... 

Rossi, S., et al. 2003. Development of films and matrices based on chitosan and polyacrylic acid for vaginal delivery of acyclovir. STP Pharma Sci 13 181. 

Karasulu, H.Y., et al. 2002. Sustained release bioadhesive effervescent ketoconazole microcapsules tabletted for vaginal delivery. J Microencap 19 357. 

Rochira, M., et al. 1996. Novel vaginal delivery systems for calcitonin. II. Preparation and characterization of HYAFF microspheres containing calcitonin. Int J Pharm 144 19. 

Oxytocin is used to induce labor and augment dysfunctional labor for (1) conditions requiring early vaginal delivery (eg, Rh problems, maternal diabetes, or preeclampsia), (2) uterine inertia, and (3) incomplete abortion. Oxytocin can also be used for control of postpartum uterine hemorrhage. 

Typical vaginal delivery systems such as foams, gels and tablets are removed in a relatively short period of time by the self-cleansing action of the vaginal tract. In the eye, materials are diluted by tears and removed via the lachrymal drainage system. 

The systemic absorption of these drugs had previously been considered only from the standpoint of toxicity. However, in addition to local delivery, there has recently been considerable interest in the possibility of vaginal delivery for the systemic delivery of drugs, via the mucous membranes of the vagina. 

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