Uterotonics

FOR MBBS & OBG students

1. Uterotonics Dr Ravikanth G O

2. Ecbolics Induce uterine contractions What is the opp of uterotonics ? Oxytocin Ergot derivatives Prostaglandins

3. Oxytocin Nonapeptide Sir de vigneaud – Nobel prize Onset 3-4 min Duration 20 min

4. Mode of action

5. Preparations

6. Effectiveness of oxytocin

7. Indications Therapeutic Pregnancy Labor Puerperium Diagnostic Contraction stress test Contraction sensitivity test

8. During Pregnancy Early -- abortion Late -- induction of labor

9. During labor

10. During puerperium

11. Complications of oxytocin – Maternal.

12. Complications – Fetal. Fetal distress

13. What are the Routes of administration? Intravenous bolus Intravenous infusion (CII-controlled intravenous infusion) Intramuscular Buccal tablets Nasal spray

14. Controlled intravenous infusion Infusion pump For induction or augmentation of labor Physiological titration

15. Calculation of dose

16. Exercise Start 2miu/min 2iu is added to 500 ml of RL and running at the rate of 32 drop/min calculate the dose I,e . miu ./min What do you mean by strong uterine contrations ?

17. Oxytocin regime

18. How do you Monitor oxytocin CII ? Rate Uterine contraction Peak intrauterine pressure FHR PROGRES OF LABOR

19. What are the indications of stopping infusion? Abnormal uterine contration Fetal distress Maternal exhaustion

20. Diagnostic use Contraction stress test ( Oxytocin challenge test) Cardiotocograph is done

21. Interpretation of CST Positive Negative SUSPICIOUS Unsatisfactory Hyperstimulation

22. Ergot derrivatives Ergometrine Methyl ergometrine Alkaloid isolated by Dudley & Moir from fungus CLAVICEPS PURPURA Methergin - semisynthetic derived fro LSD. Mode of action Where is it can be sued ?

23. Mode of administration Ergometrine Iv 50 sec Im. 5 min Oral 10 min Methergine IV 1 ½ IM 7 min Oral 10 min

24. Complications

25. Contraindication - Prophylactic

26. Contraindication - Therapeutic

27. Prostaglandins

28. Mechanism of action

29. Indications

30. Contraindications

31. Match the fallowing drugs to its dose Name of drug Dose Response 1.oxytocin A.100 microgram 2. Methergine B.0.5mg+5IU 3. Misoprostol(PGE1) C.5IU 4. Dinoprost (PGE2) D.250 microgram 5.Prostodine(PG F2 Alpha) E.0.2mg 6.Synometrine F.25microgram Answer : 1-C,2-E,3-F,4-A,5-D,6-B.

32. Evaluation 1 What is oxytocin ? Why we can not use oxytocin by oral route ? What are the indications of Oxytocin ? What are the routes of administration of Oxytocin ? What are the contraindications of Oxytocin ? What are the side effects of Oxytocin ? What are the regime of oxytocin? How do you prepare 5miu/min solution?

33. Evaluation 2 What are the diagnostic use of oxytocin ? What is ergot ? What are the ergot derivatives used in clinical practice? What are the indication of ergot ? Why ergot can not be used in induction of labor ? What are the preparation of ergot available ? What are the side effects of ergot ?

34. Evaluatioin 3 What are prostaglandins ? What are the type PGs used in clinical practice ? A primigravida with full term pregnancy with h/o asthm.Indicate the method of induction of labor & what we should avoid? What are the side effects of prostaglandins?