Oxytocics

know their indications, contraindications, dosage, adverse effects and more!

1. Venkataramu – OXYTOCICS
(Oxytocin, Ergot, PGs)

Vijay Kumar - AntiHTN, Diuretics,
Tocolytics, TERATOLOGY
Vishwanath – Anesthesia & Analgesia

2. OXYTOCICSOXYTOCICS
Venkataramu.B.S
9term, MIMS

3. ““OXYTOCICSOXYTOCICS
are the drugs of varying chemical are the drugs of varying chemical
nature that have the power to nature that have the power to
excite contraction of the excite contraction of the
uterine musclesuterine muscles.”.”
OXYTOCICS
OXYTOCIN
ERGOT
DERIVATIVES
PROSTAGLANDINS
Ergometrine &
Methergin
E2&F2E2&F2άά
PGEPGE
2 2 & &
PGFPGF
22άά

4. Oxytocin: physiologyOxytocin: physiology
Human hypothalamusHuman hypothalamus

5. Diagram depicts a sagittal section through the hypothalamus and Diagram depicts a sagittal section through the hypothalamus and
pituitary gland.pituitary gland.
The The posterior pituitary consists of axon terminals of posterior pituitary consists of axon terminals of
magnocellular neurons arising in the supraoptic and magnocellular neurons arising in the supraoptic and
paraventricular nuclei of the hypothalamus. paraventricular nuclei of the hypothalamus.
●
●●
●

7. During lactationDuring lactation……
oxytocinoxytocin
mechanoreceptors mechanoreceptors
in the nipple/ areolain the nipple/ areola
hypothalamic hypothalamic
neuronal activityneuronal activity
MILK EJECTIONMILK EJECTION
SucklingSuckling
Axon terminals
Axon terminals
myoepithelial cells myoepithelial cells

contract contract
STIMULUS
RESPONSE

8. During parturition…During parturition…
oxytocin is the oxytocin is the primary mediatorprimary mediator of myometrial of myometrial
contractility during labor.contractility during labor.
During the During the second half of pregnancysecond half of pregnancy, uterine smooth , uterine smooth
muscle shows an increase in the expression of muscle shows an increase in the expression of oxytocin oxytocin
receptors(100-200fold) and becomes increasingly sensitivereceptors(100-200fold) and becomes increasingly sensitive to to
the stimulant action of endogenous oxytocin. the stimulant action of endogenous oxytocin.
Stimulates PG synthesis. Stimulates PG synthesis.
Physiological uterine contractionPhysiological uterine contraction - fundal contraction; cervical - fundal contraction; cervical
relaxation. (law of polarity maintained)relaxation. (law of polarity maintained)
Cervical and vaginal dilatation results in an acute release of Cervical and vaginal dilatation results in an acute release of
oxytocin from the posterior pituitary in a process known as oxytocin from the posterior pituitary in a process known as
the the Ferguson reflexFerguson reflex..

9. ABSORPTION, METABOLISM, AND ABSORPTION, METABOLISM, AND
EXCRETIONEXCRETION
Intravenously (controlled infusion) for initiation and for initiation and
augmentation of labor. augmentation of labor.
intramuscularlyintramuscularly -control of postpartum bleeding. -control of postpartum bleeding.
Buccal & nasal spray- Limited use.Buccal & nasal spray- Limited use.
Preparations: Preparations:
o Synthetic oxytocin (Syntocinon, Pitocin) 5IU/ml ampSynthetic oxytocin (Syntocinon, Pitocin) 5IU/ml amp
o Syntometrine (Sandoz - Syntocinon 5U+Ergometrine 0.5mg)Syntometrine (Sandoz - Syntocinon 5U+Ergometrine 0.5mg)
o Desamino oxytocin - Buccal tablet 50 I.U.Desamino oxytocin - Buccal tablet 50 I.U.
o Oxytocin nasal spray – 40U/mlOxytocin nasal spray – 40U/ml
Oxytocin is not bound to Oxytocin is not bound to plasma proteinsplasma proteins and is and is eliminated by eliminated by
the kidneys and liverthe kidneys and liver..
 Circulating half-life of Circulating half-life of max. 5 minutesmax. 5 minutes. (avg 3-4min). (avg 3-4min)
Duration of Duration of action-20minaction-20min
Stored at 2-8 Stored at 2-8
00
C C

10. PharmacodynamicsPharmacodynamics
UTERUSUTERUS
Oxytocin acts through Oxytocin acts through G protein-coupled receptorsG protein-coupled receptors and and
the the phosphoinositide -phosphoinositide -calcium secondcalcium second-messenger system -messenger system
to contract uterine smooth muscleto contract uterine smooth muscle. .
Oxytocin also stimulates the Oxytocin also stimulates the release of release of prostaglandinsprostaglandins and and
leukotrienesleukotrienes that augment uterine contractionthat augment uterine contraction. .
Oxytocin in Oxytocin in small dosessmall doses increases both the increases both the frequency and frequency and
the force of uterine contractionsthe force of uterine contractions. .
At At higher doseshigher doses, it produces , it produces sustained contractionsustained contraction..

12. BREASTBREAST
Oxytocin also causes contraction of myoepithelial Oxytocin also causes contraction of myoepithelial
cells surrounding mammary alveoli, which leads to cells surrounding mammary alveoli, which leads to
milk ejectionmilk ejection..
Without oxytocin-induced contraction, normal Without oxytocin-induced contraction, normal
lactation cannot occur. lactation cannot occur.
KIDNEYSKIDNEYS
At high concentrations, oxytocin has At high concentrations, oxytocin has weak weak
antidiuretic and pressorantidiuretic and pressor activity due to activation of activity due to activation of
vasopressin receptors.vasopressin receptors.

13. Toxicity Toxicity
““serious toxicity is rareserious toxicity is rare” when oxytocin is used ” when oxytocin is used
judiciously. judiciously.



excessive uterine
stimulation
Hypertonia
(↑duration)
uterine rupture..
Polysystole
(>6 in 10min)
placental
abruption
fetal distress
S
T
I
M
U
L
A
T
I
O
N
HYPER
Grand multipara,
Malpresentation
Contracted pelvis
Prior uterine scar
(hyterotomy)
NOTE: These complications can be detected NOTE: These complications can be detected
early by means ofearly by means of
standard standard fetal monitoring equipmentfetal monitoring equipment. .

14. Pul. EdemaPul. Edema
Heart FailureHeart Failure
water water
Intoxication-Intoxication-
hyponatremiahyponatremia
AntidiuresisAntidiuresis
excessive fluid excessive fluid
retentionretention
activation of activation of
vasopressinvasopressin
receptorsreceptors--
Seizures
& death
Inadvertent activation of Inadvertent activation of vasopressinvasopressin receptors receptors--
30-40mIU/min
40-50IU/min

15. To avoid hypotension, oxytocin isTo avoid hypotension, oxytocin is
administered intravenously as administered intravenously as
dilute solutions at a controlled rate.dilute solutions at a controlled rate.
OXYTOCIN
BOLUS
HYPOTENSION
Transient vasodilation

16. INDICATIONSINDICATIONS
THERAPEUTICTHERAPEUTIC
PREGNANCY LABOUR PUERPERIUM
EARLY LATE
-To accelerate
Abortion
(inevitable, Missed).
-Molar preg.
-To stop bleeding.
-Induction of
Abortion.
To induce labour.
For cervical
ripening.
Augmentation of
labour.
Uterine inertia.
Active management
of 3
rd
stage
To minimise
blood loss.
Control PPH
DIAGNOSTIC
Contraction stress test (CST)
Oxytocin sensitivity test (OST)

17. CST/CST/oxytocinoxytocin challenge testchallenge test
During the antepartum period, oxytocin induces uterine During the antepartum period, oxytocin induces uterine
contractions that contractions that transiently reduce placental blood flow transiently reduce placental blood flow
to the to the fetusfetus. .
The The oxytocin challenge testoxytocin challenge test measures the measures the fetal heart rate fetal heart rate
responseresponse to a standardized to a standardized oxytocin infusionoxytocin infusion and provides and provides
information about information about placental circulatory reserveplacental circulatory reserve. .
An abnormal response (+test) , seen as An abnormal response (+test) , seen as late decelerationslate decelerations in in
the fetal heart rate, indicates the fetal heart rate, indicates fetal hypoxia and may warrant fetal hypoxia and may warrant
immediate cesarean delivery.immediate cesarean delivery.
Interpretation- Interpretation- PositivePositive Suspecious Suspecious
Negative UnsatisfactoryNegative Unsatisfactory
HyperstimulationHyperstimulation

18. Contraction stress test (CST)
Assess Assess irritability of uterusirritability of uterus to oxytocin to oxytocin
Procedure – Procedure –
0.01U given IV at the end of spontaneous 0.01U given IV at the end of spontaneous
contractioncontraction
Repeated at 1min interval until induced Repeated at 1min interval until induced
contraction starts (hardening)contraction starts (hardening)
Inference- Inference-
failure of ut.contraction after 4 inj signifies failure of ut.contraction after 4 inj signifies
uterus is unlikely to be responsive to induction.uterus is unlikely to be responsive to induction.

19. ContraindicationsContraindications
PREGNANCY
Grand
multipara
malpresentation
contracted
pelvis
cephalopelvic
disproportion
prior uterine
scar
(hysterotomy)

LABOUR
All cont. in preg.
+
Obstructed
labour
Incoordinate
uterine
contraction
FETAL
DISTRESS
prematurity
ANY TIME
Hypovolemic
state
Cardiac disease

20. Methods of Methods of
administrationadministration
Controlled Controlled intravenous intravenous InfusionInfusion
1-4mU/min (↑gradually)1-4mU/min (↑gradually). .
INTRAMUSCULAR

21. For induction of labourFor induction of labour
Principle: Principle:
Start with LOW DOSE, escalate to achieve Start with LOW DOSE, escalate to achieve optimal responseoptimal response
(3contraction in 10min each lasting 45sec)(3contraction in 10min each lasting 45sec)
Maintain the dose- Maintain the dose- oxytocin titration technique.oxytocin titration technique.
OBJECTIVEOBJECTIVE- Maintain normal pattern of uterine activity till - Maintain normal pattern of uterine activity till
delivery and 30-60min beyond that.delivery and 30-60min beyond that.
NOTE: NOTE:
Start with 4mU/min & ↑every 20minStart with 4mU/min & ↑every 20min
Semi-Fowlers position - avoid venecaval compression.Semi-Fowlers position - avoid venecaval compression.

22. Calculation of dose delivered in milliunits(mU) & Calculation of dose delivered in milliunits(mU) &
its correlation with drop rate per minuteits correlation with drop rate per minute
Units of oxytocin mixed in Units of oxytocin mixed in
500ml Ringer solution500ml Ringer solution
1unit=1000 miliunits(mU)1unit=1000 miliunits(mU)
Drops per minuteDrops per minute
(15drops=1ml)(15drops=1ml)
15 30 6015 30 60
In terms of mU/minIn terms of mU/min
11
22
88
2 4 82 4 8
4 8 164 8 16
16 32 6416 32 64
NOTE: In majority of cases, max. response is seen with 16 mU/min
i.e 2U in 500ml RL at 60 drops per min

23. CalculationCalculation
500ml contains 1I.U. i.e 1000mU of oxytocin500ml contains 1I.U. i.e 1000mU of oxytocin
So 1ml containsSo 1ml contains1000mU X 1ml1000mU X 1ml = = 2mU
500ml500ml
1ml = 2mU
Also 1ml~15drops

24. Table showing convenient regimeTable showing convenient regime
Dose of oxytocinDose of oxytocin Solution used Solution used
Escalating Escalating
Drop rate at Drop rate at
intervals of intervals of
20-30min20-30min
To start with 1unitTo start with 1unit
If no response-2unitsIf no response-2units
If still no response-8unitsIf still no response-8units
500ml Ringer 500ml Ringer
solutionsolution
-do--do-
-do--do-
15-30-6015-30-60
15-30-6015-30-60
15-30-6015-30-60

25. OBSERVATION DURING OBSERVATION DURING
OXYTOCIN INFUSIONOXYTOCIN INFUSION
RATE of flow – calculating drops/min RATE of flow – calculating drops/min
Uterine contraction - Finger tip palpation (hardening)Uterine contraction - Finger tip palpation (hardening)
Intra uterine pressure:-peak 50to60mmHg resting Intra uterine pressure:-peak 50to60mmHg resting
10to15mmHg10to15mmHg
FHRFHR
Assessment of progress of labour.Assessment of progress of labour.

26. Indications for stopping the oxytocin Indications for stopping the oxytocin
infusioninfusion
Nature of uterine contractions-Nature of uterine contractions-
abnormal uterine contractions occurring frequently abnormal uterine contractions occurring frequently
(every 2 min or less )(every 2 min or less )
lasting more than 60sec(hyperstimulation)lasting more than 60sec(hyperstimulation)
↑↑tonus in between contractionstonus in between contractions
 Fetal distressFetal distress
 Maternal complicationsMaternal complications

~•~•~•~~•~•~•~

27. Ergot Alkaloids Ergot Alkaloids
•Ergot is the Ergot is the natural alkaloid of of Claviceps purpureaClaviceps purpurea that grows that grows
on rye, wheat and other grains.on rye, wheat and other grains.
ChemistryChemistry
•The ergot alkaloids are derivatives of the The ergot alkaloids are derivatives of the tetracyclic compound tetracyclic compound
6-methylergoline.6-methylergoline.
•The first pure ergot alkaloid ergotamine was obtained in 1920, The first pure ergot alkaloid ergotamine was obtained in 1920,
followed by the isolation of ergometrine/ergonovine in 1932. followed by the isolation of ergometrine/ergonovine in 1932.
•The The therapeutically usefultherapeutically useful natural alkaloids are natural alkaloids are
amide derivatives of amide derivatives of dd-lysergic acid. -lysergic acid.
•Semi-synthetic derivatives are obtained from
catalytic hydrogenation of the natural alkaloids.
e.g.- Methergin (methylergonovine)

28. PHARMACOKINETICS of PHARMACOKINETICS of
Ergometrine & metherginErgometrine & methergin
Absorption
ORAL
PARENTERAL(IM,IV)
rapidly absorbed
peak concentrations (plasma) -60 to 90min
PREFERED ROUTE
PreparationPreparationampoulesampoules tabletstablets
ErgometrineErgometrine
0.25mg/ 0.25mg/
0.5mg0.5mg
0.5-1.0m0.5-1.0m
gg
metherginmethergin
0.2mg0.2mg 0.5-1.0m0.5-1.0m
gg
Syntometrine Syntometrine
(sandoz)(sandoz)
0.5mg 0.5mg
Ergometrine
+ 5U-
syntocinon
-:Composition of ergot preparations:-

29. METABOLISM, EXCRETIONMETABOLISM, EXCRETION
ErgotamineErgotamine is is metabolized in the livermetabolized in the liver by largely by largely
undefined pathwaysundefined pathways..
• 90% of the metabolites are 90% of the metabolites are excreted in the bileexcreted in the bile. .
•Only traces of unmetabolized drug are found in urine and feces.Only traces of unmetabolized drug are found in urine and feces.
Ergometrine (Ergonovine) Ergometrine (Ergonovine) andand methergin methergin ( (methylergonovine)-methylergonovine)-
•ErgometrineErgometrine (Ergonovine) is metabolized and/or eliminated more (Ergonovine) is metabolized and/or eliminated more
rapidly than is ergotamine. rapidly than is ergotamine.
•The half-life (plasma) - 0.5 and 2 hours.The half-life (plasma) - 0.5 and 2 hours.
•Duration of action - 3hrsDuration of action - 3hrs
RouteRoute ErgometrineErgometrineMetherginMethergin
IVIV 45-60sec45-60sec95sec95sec
IMIM 6-7min6-7min 7min7min
OralOral 10min10min 10min10min
Onset of action

30. Pharmacodynamics:Pharmacodynamics:
MECHANISM OF ACTION-MECHANISM OF ACTION-
Serotonin Receptor (5-HTSerotonin Receptor (5-HT
22)+++ Mixed partial agonist )+++ Mixed partial agonist
Adrenoceptor++ effectsAdrenoceptor++ effects
DIRECTLY ON MYOMETRIUM (Uterine Smooth Muscle) DIRECTLY ON MYOMETRIUM (Uterine Smooth Muscle)
•Sensitivity of the uterus to the stimulant effects of ergot increases Sensitivity of the uterus to the stimulant effects of ergot increases
dramatically during pregnancy - increasing dominance of receptors dramatically during pregnancy - increasing dominance of receptors
as pregnancy progresses. as pregnancy progresses.
•Non-physiological action Non-physiological action i.e uniform contraction of uterus (loss of i.e uniform contraction of uterus (loss of
polarity).polarity).
•In very small doses, ergot preparations can evoke rhythmic In very small doses, ergot preparations can evoke rhythmic
contraction and relaxation of the uterus. contraction and relaxation of the uterus.
•At higher concentrations, these drugs induce At higher concentrations, these drugs induce powerful and powerful and
prolonged contracture - STATE OF SPASMprolonged contracture - STATE OF SPASM
•Ergonovine is more selectiveErgonovine is more selective than other ergot alkaloids in affecting than other ergot alkaloids in affecting
the uterus and is the agent of choice in obstetric applications of the uterus and is the agent of choice in obstetric applications of
these drugs. (Onset of action - 55sec by i.v.)these drugs. (Onset of action - 55sec by i.v.)

31. The uterine smooth muscle fibers when contracted
compress traversing blood vessels –Principle for its
clinical use.

32. INDICATION - INDICATION - THERAPEUTICTHERAPEUTIC
POSTPARTUM HEMORRHAGE-
•The uterus at term is The uterus at term is extremely sensitiveextremely sensitive to the stimulant action to the stimulant action
of ergot and even moderate doses produce a of ergot and even moderate doses produce a prolonged and prolonged and
powerful spasm of the muscle quite unlike natural laborpowerful spasm of the muscle quite unlike natural labor. .
•Therefore, ergot derivatives should be used Therefore, ergot derivatives should be used only foronly for control of control of
late uterine bleedinglate uterine bleeding and should and should never be given before never be given before
deliverydelivery. .
•Oxytocin is the preferred agent for control of postpartum Oxytocin is the preferred agent for control of postpartum
hemorrhage but if this is ineffective, hemorrhage but if this is ineffective,
ERGOMETRINEERGOMETRINE(0.2 mg ) is given intramuscularly. (0.2 mg ) is given intramuscularly.
•It is usually effective within 1–5 minutes and is less toxic than It is usually effective within 1–5 minutes and is less toxic than
other ergot derivatives for this application.other ergot derivatives for this application.

33. PROPHYLACTICPROPHYLACTIC::
AFTER DELIVERY OF ANT. AFTER DELIVERY OF ANT.
SHOULDERSHOULDER//
FOLLOWING DELIVERY OF FOLLOWING DELIVERY OF
BABYBABY
at the time ofat the time of delivery of the placenta.delivery of the placenta.

34. CAUTIONSCAUTIONS

35. ToxicityToxicity
•Most common - Most common - gastrointestinal disturbances: gastrointestinal disturbances: diarrhea, nausea, diarrhea, nausea,
and vomitingand vomiting. (Activation of the medullary vomiting center . (Activation of the medullary vomiting center
and of the gastrointestinal serotonin receptors )and of the gastrointestinal serotonin receptors )
•Precipitate MI, STROKE, BRONCHOSPASM & Precipitate MI, STROKE, BRONCHOSPASM &
raise in BP (Vasoconstrictive action)raise in BP (Vasoconstrictive action)
•More dangerous toxic effect of overdosage is More dangerous toxic effect of overdosage is prolonged prolonged
vasospasm → vasospasm → gangrenegangrene of toes and requires amputation. of toes and requires amputation.
•Bowel infarctionBowel infarction has also been reported and may require has also been reported and may require
resection. resection.
•Interferes with LACTATION (↓prolactin)Interferes with LACTATION (↓prolactin)

36. ContraindicationsContraindications
PROPHYLACTICPROPHYLACTIC
•Suspected multiple gestationSuspected multiple gestation
•Organic cardiac diseaseOrganic cardiac disease
•Severe pre-eclampsia, eclampsiaSevere pre-eclampsia, eclampsia
•Rh-negative motherRh-negative mother
THERAPEUTICTHERAPEUTIC
•Heart disease or severe hypertensive disordersHeart disease or severe hypertensive disorders
~•~•~•~~•~•~•~

37. 20-Carbon carboxylic acids with 20-Carbon carboxylic acids with
Cyclopentane ring Cyclopentane ring
Formed by PUFAFormed by PUFA
Prostaglandins
Prostanoic acidProstanoic acid
2468
10
12 14 16 18
20
PGE
2
PGF
2ά
COOH
PGE
1

38. SYNTHESIS SYNTHESIS
& ACTION& ACTION
Lungs & liverLungs & liver

39. PGF2ά- acts predominantly on myometrium
PGE2- on the cervix due to collagenolytic property
LOCAL HARMONES

40. The The amnionamnion synthesizes synthesizes PGE
2 and and decidua – – PGF
2ά
During pregnancy, the transport of prostaglandins from the During pregnancy, the transport of prostaglandins from the
amnion to maternal tissues is amnion to maternal tissues is limitedlimited by expression of the by expression of the
inactivating enzymes, inactivating enzymes, prostaglandin dehydrogenaseprostaglandin dehydrogenase (PGDH) in (PGDH) in
the chorion. the chorion.
Late in pregnancy synthesis is increased by increased Late in pregnancy synthesis is increased by increased
phospholipase-A2 and prostaglandin -H-synthase-type 2 phospholipase-A2 and prostaglandin -H-synthase-type 2
(PGHS-2) activity. (PGHS-2) activity.
During labor, PGDH levels decline and amnion-derived During labor, PGDH levels decline and amnion-derived
prostaglandins can influence membrane rupture and uterine prostaglandins can influence membrane rupture and uterine
contractility. contractility.
“ “PGs action is independend of the period of gestation”.PGs action is independend of the period of gestation”.
-ve
PGDH
-ve
phospholipase-A2phospholipase-A2
PGHS-2PGHS-2
+

42. PROSTAGLANDIN

43. USES IN OBSTETRICSUSES IN OBSTETRICS
INDUCTION OF ABORTION – MTP / Missed abortion.INDUCTION OF ABORTION – MTP / Missed abortion.
11
stst
trimester - misoprostol vaginally with the other drugs;trimester - misoprostol vaginally with the other drugs;
mid-trimesters:- all analogues are usefulmid-trimesters:- all analogues are useful
Terminate MOLAR PREGNANCY (vaginal misoprostol 400Terminate MOLAR PREGNANCY (vaginal misoprostol 400μμg, g,
3hr before evacuation)3hr before evacuation)
INDUCTION / ACCELERATIONINDUCTION / ACCELERATION OF LABOUR prefered in IUD, OF LABOUR prefered in IUD,
shorter period of gestation, elderly primigravidashorter period of gestation, elderly primigravida
Cervical ripening / dilatation – abortion, labour, diagnosticCervical ripening / dilatation – abortion, labour, diagnostic
Atonic PPH (refractory cases - step2)-Atonic PPH (refractory cases - step2)-
carboprost carboprost
250 250 μμg i.m/ Misoprostal 1000g i.m/ Misoprostal 1000μμg PRg PR
Tubal-ectopic pregnancy (carboprost for salpingocentesis)Tubal-ectopic pregnancy (carboprost for salpingocentesis)

44. PG analogues & Common ROAPG analogues & Common ROA
PGE
1
(methyl ester) – MISOPROSTOL (vaginal, oral, rectal)
PGE
2
– DINOPROSTONE (vaginal, extra amniotic)
(NOTE: less toxic, more effective so widely used.)
PGF
2

ά
- DINOPROSTONE TROMETHAMINE
PGF
2

ά


(methyl analogue) – CARBOPROST (i.m., intra/extra-amniotic)

-:Preparations:-
Tablet-0.5mg dinoprostone (prostinE
2)
Vaginal suppository- 20mg PGE
2 /50mg PGF
2ά lipid base
Vaginal pessary- 3mg PGE
2
ProstinE
2
gel- 500μg into cervical canal, below internal OS/1-2mg in the posterior fornix.
-:Parenteral:-
PGE
2
- ProstineE
2
1mg/ml
PGF
2ά
-ProstinF
2 ά
(Dinoprost tromethamine) 5mg/ml
Methyl analogue of PGF2ά- Carboprost 2.5mg/10ml vial

45. Side effectsSide effects
SYSTEMICSYSTEMIC
NVD NVD
BronchospasmBronchospasm
Fall in BP, tachycardia, chest painFall in BP, tachycardia, chest pain
Shivering, fever, malaiseShivering, fever, malaise
LOCALLOCAL
Unduly forceful uterine contractionsUnduly forceful uterine contractions
Uterine cramps Uterine cramps
Tachysystole (uterine hyperstimulation) Tachysystole (uterine hyperstimulation)
Uterine rupture (rare but use is avoided in previous LSCS)Uterine rupture (rare but use is avoided in previous LSCS)
Meconium passage.Meconium passage.
Cervical laceration (when used as an abortifacient)Cervical laceration (when used as an abortifacient)
Vaginal bleedingVaginal bleeding

46. CONTRAINDICATIONCONTRAINDICATION
Hypersensitivity to the drugHypersensitivity to the drug
Uterine scarUterine scar
Bronchial asthmaBronchial asthma
Heart diseasesHeart diseases

47. MisoprostolMisoprostol((PGEPGE
11) - Important points) - Important points
““Used for cervical ripening.”Used for cervical ripening.”
It is rapidly absorbed and more effective than oxytocin It is rapidly absorbed and more effective than oxytocin
or dinoprostone for induction of labour.or dinoprostone for induction of labour.
TransvaginalTransvaginal – induction of labour – induction of labour
5050μμg every 3hrs to a max. of 6 doses g every 3hrs to a max. of 6 doses
oror
2525μμg every 3hrs to a max of 8 doses.g every 3hrs to a max of 8 doses.
OrallyOrally - 50 - 50μμg every 4hrsg every 4hrs
No evidence of teratogenicity / carcinogenic effects.No evidence of teratogenicity / carcinogenic effects.
Advantages over PGEAdvantages over PGE
22- cheap, stable at room temp., - cheap, stable at room temp.,
long shelf life, easy to administer, less side effects. long shelf life, easy to administer, less side effects.
Induction delivery interval is short. Need of oxytocin Induction delivery interval is short. Need of oxytocin
augmentation is less. Failure of induction is less.augmentation is less. Failure of induction is less.

48. TTHHAANNKK YYOOUU
☻