Thursday, 8 November 2012
can give syntometrine in PIH?
Drug interactions
Prostaglandins increase the effect of oxytocin and vice-versa. The contractions should be carefully monitored if oxytocin is given after a prostaglandin dose.
Syntometrine may enhance the blood pressure raising effect of vasoconstrictors (medicines given to constrict the blood vessels).
Some inhaled anaesthetics used for general anaesthesia, such as cyclopropane and halothane, may reduce the effect of oxytocin and ergometrine. There may also be an increased risk of a drop in blood pressure and abnormal heart beats if oxytocin is given with these general anaesthetics.
Oxytocin/ergometrine (trade name Syntometrine) is an obstetric combination drug. The components are synthetically produced oxytocin, a human hormone produced in the hypothalamus, and ergometrine, an alpha-adrenergic, dopaminergic and serotonin (5-HT2) receptor agonist.
Both substances cause the uterus to contract. An injection of syntometrine is given in the third stage of labor, just after the birth of the child, to facilitate delivery of the placenta[1] and to prevent postpartum hemorrhage[1] by causing smooth muscle tissue in the blood vessel walls to narrow, thereby reducing blood flow.
Contraindications
Syntometrine should not be used in:
- Allergy to one or any of its ingredients.[1]
- First stage of labor[1]
- Second stage of labor before crowning of the baby's head[1]
- Uterine atony during labor[1]
- Severe kidney disorders[1]
- Severe liver disorders[1]
- Severe heart disorders[1]
- Vascular diseases[1]
- Severe hypertension[1]
- Pre-eclampsia or eclampsia[1]
- Sepsis[1]
It should be used with caution in:
- Decreased kidney function[1]
- Decreased liver function[1]
- Mild heart disease[1]
- Mild hypertension)[1]
- Porphyria[1]
Side effects
Possible side effects include:
- Nausea and vomiting[1][2]
- Abdominal pain,[1] feeling different than labor pains[2]
- Headache[1][2]
- Dizziness[1][2]
- Skin rashes[1], itching or hives[2]
- Swelling of face, lips, tongue or other body parts[2]
- Hypertension[1]
- Arrhythmias (abnormal heart beats)[1][2]
- Chest pain[1][2]
- Fall in blood pressure (causing dizziness and lightheadedness)[1]
- Difficulty in breathing[1][2]
- Circulatory shock[1]
Wednesday, 7 November 2012
obstructed labour
Defining obstructed labour
1. Obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier (obstruction) preventing its descent despite strong uterine contractions.
2. The obstruction usually occurs at the pelvic brim, but occasionally it may occur in the pelvic cavity or at the outlet of the pelvis.
3. When labour is prolonged because of failure to progress, there is a high risk that the descent of the fetus will become obstructed.
Box 9.1 When is labour classed as prolonged in the different stages of labour?
- Prolonged latent phase of labour: when true labour lasts for more than about 8 hours without entering into the active first stage.
- Prolonged active phase of labour: when true labour takes more than about 12 hours without entering into the second stage.
- Prolonged second stage of labour:
- Multigravida mother: when it lasts for more than 1 hour.
- Primigravida mother: when it lasts for more than 2 hours.
Saturday, 3 November 2012
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