carboprost and Postpartum-Hemorrhage

Postpartum hemorrhage causes a quarter of global maternal deaths. The World Health Organization recommends oxytocin as the first line agent to prevent hemorrhage during cesarean delivery. However, some randomized controlled trials suggest that other uterotonics are superior.. We conducted a network meta-analysis comparing the ability of pharmacologic agents to reduce blood loss and minimize the need for additional uterotonics during cesarean delivery.. We searched the Cochrane Central Register of Controlled Trials, Embase, and MEDLINE databases from inception to May 2020.. We included randomized controlled trials that compared oxytocin, carbetocin, misoprostol, ergometrine, carboprost, or combinations of these in the prevention of postpartum hemorrhage during cesarean delivery.. We performed a systematic review followed by an NMA in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of the evidence was assessed with the Confidence in Network Meta-Analysis approach and Grading of Recommendations, Assessment, Development and Evaluations tool within the summary of findings table. Our primary outcomes were the estimated blood loss and need for additional uterotonics. Secondary outcomes included nausea and postpartum hemorrhage of >1000 mL. We performed sensitivity analyses to explore the influence of surgical context and oxytocin administration strategy.. A total of 46 studies with 7368 participants were included. Of those, 21 trials (6 agents and 3665 participants) formed the "estimated blood loss" network and, considering the treatment effects, certainty in the evidence, and surface under the cumulative ranking curve scores, carbetocin was assessed to probably be superior to oxytocin, but only in reducing the estimated blood loss by a clinically insignificant volume (54.83 mL; 95% confidence interval, 26.48-143.78). Misoprostol, ergometrine, and the combination of oxytocin and ergometrine were assessed to probably be inferior, whereas the combination of oxytocin and misoprostol was assessed to definitely be inferior to oxytocin. A total of 37 trials (8 agents and 6193 participants) formed the "additional uterotonic" network and, again, carbetocin was assessed to probably be superior to oxytocin, requiring additional uterotonics 185 (95% confidence interval, 130-218) fewer times per 1000 cases. Oxytocin plus misoprostol, oxytocin plus ergometrine, and misoprostol were assessed to probably be inferior, whereas carboprost, ergometrine, and the placebo were definitely inferior to oxytocin. For both primary outcomes, oxytocin administration strategies had a higher probability of being the best uterotonic, if initiated as a bolus.. Carbetocin is probably the most effective agent in reducing blood loss and the need for additional uterotonics. Oxytocin appears to be more effective when initiated as a bolus.

Topics: Carboprost; Ergonovine; Female; Humans; Misoprostol; Network Meta-Analysis; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy

Postpartum hemorrhage (PPH) remains a common cause of maternal mortality worldwide. Medical intervention plays an important role in the prevention and treatment of PPH. Prostaglandins (PGs) are currently recommended as second-line uterotonics, which are applied in cases of persistent bleeding despite oxytocin treatment.. PG agents that are constantly used in clinical practice include carboprost, sulprostone, and misoprostol, representing the analogs of PGF2α, PGE2, and PGE1, respectively. Injectable PGs, when used to treat PPH, are effective in reducing blood loss but probably induce cardiovascular or respiratory side effects. Misoprostol is characterized by oral administration, low cost, stability in storage, broad availability, and minimal side effects. It remains a treatment option for uterine atony in low-resource settings, but its effectiveness as a uterotonic for independent application may be limited. Key Messages: The present review article discusses the physiological roles of various natural PGs, evaluates the existing evidence of PG analogs in the prevention and treatment of PPH, and finally provides a reference to assist obstetricians in selecting appropriate uterotonics.

Topics: Carboprost; Dinoprostone; Drug Administration Routes; Drug Stability; Female; Humans; Misoprostol; Postpartum Hemorrhage; Prostaglandins; Receptors, Prostaglandin; Uterus

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, and uterine atony is the leading cause of postpartum hemorrhage. Risk factors for uterine atony include induced or augmented labor, preeclampsia, chorio-amnionitis, obesity, multiple gestation, polyhydramnios, and prolonged second stage of labor. Although a risk assessment is recommended for all parturients, many women with uterine atony do not have risk factors, making uterine atony difficult to predict. Oxytocin is the first-line drug for prevention and treatment of uterine atony. It is a routine component of the active management of the third stage of labor. An oxytocin bolus dose as low as 1 IU is sufficient to produce satisfactory uterine tone in almost all women undergoing elective cesarean delivery. However, a higher bolus dose (3 IU) or infusion rate is recommended for women undergoing intrapartum cesarean delivery. Carbetocin, available in many countries, is a synthetic oxytocin analog with a longer duration than oxytocin that allows bolus administration without an infusion. Second line uterotonic agents include ergot alkaloids (ergometrine and methylergonovine) and the prostaglandins, carboprost and misoprostol. These drugs work by a different mechanism to oxytocin and should be administered early for uterine atony refractory to oxytocin. Rigorous studies are lacking, but methylergonovine and carboprost are likely superior to misoprostol. Currently, the choice of second-line agent should be based on their adverse effect profile and patient comorbidities. Surgical and radiologic management of uterine atony includes uterine tamponade using balloon catheters and compression sutures, and percutaneous transcatheter arterial embolization.

Topics: Carboprost; Female; Humans; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Uterine Inertia

Motherwort (YiMuCao), a traditional Chinese herb, has been shown beneficial effects for women's diseases. This meta-analysis aimed to evaluate the efficacy and safety of motherwort injection add-on therapy to carboprost tromethamine for prevention of post-partum blood loss. A systematic literature search was conducted in PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang from their inception to December 2017. Randomized controlled trials that determined the add-on effects of motherwort injection to carboprost for prevention of post-partum blood loss were eligible. Pooled risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were used to summarize the effect sizes. Eight trials including 1276 pregnant women fulfilled the inclusion criteria. Prophylactic use of motherwort injection add-on therapy significantly reduced the post-partum 2 h (MD -127.5 mL; 95% CI -149.13 to -105.88) and 24 h (MD -146.85 mL; 95% CI -179.77 to -113.94) blood loss and incidence of post-partum hemorrhage (RR 0.28; 95% CI 0.17-0.45) than carboprost. Moreover, adjunctive treatment with motherwort injection significantly decreased the length of the third stage of labor (MD -3.41 min; 95% CI -4.33 to -2.49) and duration of lochia (MD -7.13 days; 95% CI -8.49 to -5.76). There was no statistical significant difference in the incidence of adverse events (RR 0.76; 95% CI 0.50-1.16). Prophylactic use of motherwort injection add-on therapy to carboprost tromethamine could reduce post-partum blood loss. However, more well-designed trials are necessary to confirm the findings of this study due to the methodological flaws of the included trials.

Topics: Carboprost; Drug Combinations; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Humans; Leonurus; Outcome Assessment, Health Care; Oxytocics; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic; Tromethamine

Uterine atony is a common cause of primary postpartum hemorrhage, which remains a major cause of pregnancy-related mortality for women worldwide. Oxytocin, methylergonovine, carboprost, and misoprostol are commonly used to restore uterine tone. Oxytocin is the first-line agent. Methylergonovine and carboprost are both highly effective second-line agents with severe potential side effects. Recent studies have called into question the effectiveness of misoprostol as an adjunct to other uterotonic agents, but it remains a useful therapeutic in resource-limited practice environments. We review the current role these medications play in the prevention and treatment of uterine atony.

Topics: Carboprost; Female; Humans; Methylergonovine; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy

Loss of more than 500 mL of blood following childbirth is usually caused by failure of the uterus to contract fully after delivery of the placenta, and occurs in over 10% of deliveries, with a 1% mortality rate worldwide. Other causes of postpartum haemorrhage include retained placental tissue, lacerations to the genital tract, and coagulation disorders. Uterine atony is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous labour, or who are of high parity.. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug interventions and of drug interventions to prevent primary postpartum haemorrhage? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: active management of the third stage of labour, carboprost injection, controlled cord traction, ergot compounds (ergometrine/methylergotamine), immediate breastfeeding, misoprostol (oral, rectal, sublingual, or vaginal), oxytocin, oxytocin plus ergometrine combinations, prostaglandin E2 compounds, and uterine massage.

Topics: Administration, Oral; Carboprost; Female; Humans; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Postpartum Period

Topics: Blood Transfusion; Blood Transfusion, Autologous; Carboprost; Dinoprostone; Drug Combinations; Embolization, Therapeutic; Emergency Treatment; Ergot Alkaloids; Female; Humans; Methylergonovine; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Pressure; Prostaglandins; Tromethamine; Ultrasonography, Prenatal

Carboprost tromethamine injection has a high safety factor in clinical application and has a good effect on uterine smooth muscle and vasoconstriction. Carboprost aminobutyriol combined with oxytocin may be beneficial to infant outcome and uterine involution after cesarean section.. To investigate the effects of carboprost tromethamine combined with oxytocin on infant outcome, postpartum hemorrhage, and uterine involution in parturients undergoing cesarean section.. A total of 120 parturients undergone cesarean section in our hospital from February 2019 to April 2021 were selected as the object of study. The parturients were randomly divided into control group (. The amount of bleeding in the research group was significantly lower than that in the control group (. Carboprost aminobutyriol combined with carbestatin can effectively prevent the occurrence of bleeding after cesarean section, improve uterine involution, and improve neonatal birth quality, which is worth popularizing.

Topics: Carboprost; Cesarean Section; Cohort Studies; Drug Combinations; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Oxytocin; Postpartum Hemorrhage; Pregnancy; Treatment Outcome; Tromethamine

The study was carried out to observe the effect of combination drug therapy during cesarean section in preventing postpartum hemorrhage for women with hypertensive disorder complicating pregnancy (HDCP). The 180 women who had been treated in our hospital for HDCP were enrolled and randomly divided into observation group (sublingual administration of carboprost combined with oxytocin treatment (20IU oxytocin and small pot drip of 10IU oxytocin after delivery) and control group (1mg of carboprost when the fetal head came out and then applied with intramuscular injection of 20IU oxytocin), each containing 90. The comparison of postpartum hemorrhage situation between two groups was carried out. Compared with control group, the observation group had significantly lower intraoperative blood loss and postoperative 1h blood loss, p<0.0, but similar postoperative 2-24h blood loss, p>0.05; in observation, there were 6 cases of postpartum hemorrhage, while the number in control group was 20 cases. The two groups had no difference in blood pressure after treatment, p>0.05.The combination drug therapy during cesarean section is effective and reliable in preventing postpartum hemorrhage for women with HDCP.

Topics: Carboprost; Cesarean Section; Drug Therapy, Combination; Female; Humans; Oxytocin; Postoperative Hemorrhage; Postpartum Hemorrhage; Pregnancy

To compare the efficacy and side effects of 0.2 mg methyl-ergometrine IM, 400 microg misoprostol sublingual and 125 microg 15 methyl PGF2alpha IM in active management of third stage of labor.. Two hundred low risk pregnant women with induced or spontaneous labor were randomized to receive either 400 microg misoprostol sublingually or 0.2 mg methyl-ergometrine intramuscularly or 125 microg 15-methyl PGF2alpha intramuscularly, after the delivery of anterior shoulder of baby. The main outcome measures were: blood loss more than 500 ml, need for additional oxytoxic drug, change in hemoglobin level and side effects due to drugs.. The median estimated blood loss, blood loss more than 500 ml, need for additional oxytocic drug and change in hemoglobin levels were similar in all three groups. The significant side effects in the misoprostol group were shivering, pyrexia (temperature > 38 degrees C) and vomiting, which were self-limiting. Diarrhea was significantly more in the 15 methyl PGF2alpha group. Three women in methyl-ergometrine group underwent manual removal of placenta. One woman in misoprostol group received blood transfusion.. Sublingual misoprostol appears to be as effective as intramuscular methyl-ergometrine and intramuscular 15-methyl PGF2alpha in the prevention of postpartum hemorrhage. It can be a good alternative in resource poor setting.

Topics: Administration, Sublingual; Adult; Birth Weight; Carboprost; Ergonovine; Female; Humans; Infant, Newborn; Injections, Intramuscular; Labor Stage, Third; Misoprostol; Oxytocics; Pilot Projects; Postpartum Hemorrhage; Pregnancy; Prospective Studies

To observe the effect and safety of hemabat (H) on prevention of postpartum hemorrhage in cesarean section and after cesarean section in high risk pregnant women.. Four hundred and sixty-nine pregnant women with high hemorrhagic risk factors including twin pregnancy, polyhydramnios, fetal macrosomia, placenta previa were planned cesarean section. A total of 457 pregnant women were divided into 3 groups by operation indications. There were 239 cases of fetal macrosomia, 145 cases of twin pregnancy and polyhydramnios, and 73 cases of placenta previa. Three kinds of hysterotonics were used randomly in each group. Group oxytocin (O): 20 U oxytocin injected into the uterine plus 20 U oxytocin intravascularly, 152 women; Group oxytocin + hemabate (O + H): 20 U oxytocin and 250 microg hemabat injected into the uterine, 192 women; group H: 250 microg hemabat, injected into the uterine, 125 women. The amount of bleeding during the operation and within 2-hour after delivery were measured. The side effect of each group was observed.. The amount of bleeding during cesarean section in group O was (445 +/- 262) ml, in group O + H (332 +/- 218) ml, and in group H (375 +/- 265) ml. There was an extremely significant difference between group O and group O + H (P < 0.01). The amount of bleeding within 2 hours after delivery in group O was (176 +/- 193) ml, in group O + H was (110 +/- 114) ml, and in group H was (124 +/- 103) ml. There was a significant difference between groups O, O + H and H. Among the 469 women, 31 had total amount of bleeding more than 1000 ml during operation and within 2 hours after delivery. 48% (15 women) were in group O, 23% in group O + H and 29% in group H. The total amount of bleeding in group O was much more than group O + H and group H in the group of fetal macrosomia (P < 0.01, P < 0.01). Similar results were found in the group of twin pregnancy and polyhydramnios (P < 0.01, P < 0.01). The total amount bleeding in group O + H was much less than group O in the group of placenta previa (P < 0.05). There were 5% (12) pregnant women whose total amount of bleeding was >/= 1000 ml in the group of fetal macrosomia, 8% (11) in the group of twin pregnancy, 11% (8) in the group of placenta previa. No hysterectomy was done among the women. The incidence of side effects in the three groups was 2.6%, 11.5% and 7.0% respectively. Vomiting was frequently seen in the latter two groups, but recovered soon without treatment.. Hemabat can significantly reduce the amount of bleeding during the cesarean section in pregnant women with high hemorrhagic risk factors and can be used with oxytocin as firstline medicine to prevent hemorrhage during and after delivery.

Topics: Adult; Carboprost; Cesarean Section; Female; Humans; Oxytocin; Postoperative Hemorrhage; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Risk Factors; Treatment Outcome; Uterus; Vomiting

Topics: Administration, Rectal; Carboprost; Female; Humans; Injections, Intramuscular; Labor Stage, Third; Misoprostol; Oxytocics; Postpartum Hemorrhage; Pregnancy

In a prospective, open-label, assessor-blind, randomised parallel group study the efficacy and safety of Hemabate (Pharmacia-Upjohn Pharmaceuticals, Milton Keynes, Buckinghamshire) an analogue of 15-methyl-prostaglandin (PGF2alpha) analogue was compared with Syntometrine (Alliance Pharmaceuticals, Chippenham, Wilts) the standard combination of ergometrine and syntocinon used for the active management of the third stage of labour and the prevention of primary postpartum haemorrhage (PPH). The study was set in a district general hospital with approximately 4,000 deliveries annually. The study was discontinued at the time of the interim analysis because of unacceptable gastrointestinal side effects. At the time of the interim analysis, a total of 529 women had completed the study with 263 randomised to receive PGF2alpha and 266 to receive ergometrine and syntocinon. In a pre-specified subgroup analysis, women delivered vaginally were further subdivided into those considered to be at high or low risk of primary PPH. The measured blood loss and incidence of PPH was similar in both treatment groups whether delivered by caesarean section or vaginally independent of whether women were considered to be at high or low risk. Adverse gastrointestinal events were recorded more often in the Hemabate group. The most common symptom was diarrhoea which occurred in 21% of women who received Hemabate compared to only 0.8% of Syntometrine users. PGF2alpha is as effective as Syntometrine in the prophylaxis of primary PPH in all groups studied but there was a statistically significantly increased risk of diarrhoea among users of PGF2alpha.

Topics: Adult; Blood Pressure; Body Height; Body Weight; Carboprost; Cesarean Section; Dinoprost; Disease Susceptibility; Drug Combinations; Ergonovine; Female; Gastrointestinal Diseases; Humans; Nausea; Oxytocin; Parity; Postpartum Hemorrhage; Pregnancy; Random Allocation; Single-Blind Method; Tromethamine

The authors examine the results of usage of Prostin 15M (Upjohn) in series of 19 women with hypotonic uterine bleeding after vaginal delivery. For the same period (1997) 1179 deliveries were performed in the Department of Obstetrics and Gynecology in HMS-Plovdiv. Positive effect was noted in 16 of the cases (84.22%). Unsatisfactory effect was marked in 3 of the cases--15.78%. Three of the women demonstrated adverse reactions after application of Prostin 15M.

Topics: Adult; Carboprost; Female; Humans; Oxytocics; Postpartum Hemorrhage; Pregnancy; Uterine Inertia

To observe the effects of methyl carprost suppository on postpartum bleeding in normal parturients.. Three hundred and sixty normal parturients were randomized into study group (n = 260) and the control group (n = 100). Parturients in study group were administered methyl carprost suppository tents either vaginally (n = 130) or via the rectum (n = 130). The controls were given 10IU oxytocin immediately after the delivery of anterior shoulder of the fetus either intramuscularly (n = 50) or intravenously (n = 50). The amount of bleeding with in 2 hours postpartum was measured.. The mean amount of bleeding for parturients who received vaginal or rectal methyl carprost was 146.4 ml and 134.2 ml, respectively. In contrast, the mean amount of bleeding for parturients who received oxytocin intramuscularly or intravenously was 267.9 ml and 210.6 ml, respectively. The differences in the amount of bleeding between the two groups were statistically significant (P < 0.01), whereas differences between the routes of drug administration within each group were not significant (P > 0.05).. Methyl carprost suppository is more effective than oxytocin in controlling postpartum bleeding. Drug administration through the rectum is easy to perform and, therefore, suitable for use in rural areas.

Topics: Administration, Rectal; Adult; Carboprost; Female; Humans; Oxytocics; Postpartum Hemorrhage; Pregnancy; Suppositories

A randomized controlled study of 112 women with singleton pregnancies at term, and no antenatal complications, admitted in spontaneous labour were randomized to receive either an intramuscular injection of 0.5 mg of Syntometrine or an intramuscular injection of 125 ug of prostaglandin 15-methyl F2 alpha at delivery of the anterior shoulder of the baby. Blood lost in the first 2 hours, and subsequent 22 hours postdelivery were collected separately and measured by colourimetric measurement of haemoglobin content. Other parameters in the third stage were measured, including need for transfusion of blood or blood products, length of the third stage, and change in haemoglobin concentration before and 24 hours after delivery. The incidence of side-effects with administration of either prostaglandin 15-methyl F2 alpha or Syntometrine were documented. The prophylactic use of intramuscular prostaglandin 15-methyl F2 alpha (Carboprost) in the active management of the third stage of labour gave similar results to prophylactic intramuscular Syntometrine in terms of length of the third stage of labour, incidence of postpartum haemorrhage and total blood loss in the first 2 hours and subsequent 22 hours after delivery. However it has the disadvantage of higher cost, as well as statistically significant increase in the incidence of profuse and frequent diarrhoea. Based on these results intramuscular injection of prostaglandin 15-methyl F2 alpha offers no advantage over intramuscular Syntometrine for routine prophylactic use to reduce blood loss in the third stage of labour.

Topics: Carboprost; Ergonovine; Female; Humans; Labor Stage, Third; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy

To compare carboprost trometamol with methylergometrine in managing the third stage of labor.. One hundred and fifty parturient women were randomly assigned to use carboprost trometamol or methylergometrine immediately after delivery.. Both the duration of the third stage and the mean blood loss were significantly less in the carboprost group than the methergine group (P < 0.001).. Carboprost trometamol is a more potent uterotonic drug than methylergometrine. Reducing blood loss in parturient women is very important especially in cases where there is the likelihood of anemia.

Topics: Adult; Carboprost; Drug Combinations; Female; Humans; Labor Stage, Third; Methylergonovine; Postpartum Hemorrhage; Pregnancy; Tromethamine; Uterine Contraction

The customary use of Hemabate sterile solution for postpartum hemorrhage was studied at 12 cooperating obstetrics units for a 12-month period. Outcomes of interest were the characteristics of patients chosen by the attending physicians to receive the drug, conditions of drug use, and patient status after drug use. Cessation of bleeding was considered a successful outcome and in 208 of 237 cases (87.8%) the hemorrhage was controlled directly after the administration of Hemabate sterile solution. An additional 17 successful outcomes were achieved with further administration of oxytocics for an overall success rate of 94.9%. Twelve cases of postpartum hemorrhage were considered pharmacologic treatment failures, requiring surgical intervention. Among the patients in whom pharmacologic treatment failed were factors that may have played a significant role in the cause of the hemorrhage including peripheral coagulopathy, retained products of conception, lacerations, chorioamnionitis, oxytocin-induced or augmented labor, increased fetal weight, magnesium-treated preeclampsia, and cesarean delivery. However, no combination of factors could be consistently associated with pharmacologic treatment failure.

Topics: Adult; Blood Pressure; Carboprost; Drug Combinations; Evaluation Studies as Topic; Female; Humans; Hysterectomy; Ligation; Multicenter Studies as Topic; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Prostaglandins F, Synthetic; Tromethamine

No well-designed and systematic evaluation of the efficacy and safety of leonurus japonicus injection (LJI) in combination with carboprost tromethamine has been found. Therefore, we undertook a meta-analysis to assess the efficacy and safety of carboprost tromethamine combined with LJI for the prevention of postpartum hemorrhage in high-risk pregnant women to provide new evidence-based medical evidence for clinical treatment.. This systematic review and meta-analysis would be performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The following databases including EMBASE, MEDICINE, Wanfang, China National Knowledge Infrastructure database, and Cochrane central controlled trial registries were searched by 2 reviewers from inception to July 2021. Mesh and keyword search terms were "motherwort," "Yimucao," "leonurus japonicas," "carboprost tromethamine," and "postpartum hemorrhage." Any cohort studies that assessed the efficacy and safety of carboprost tromethamine combined with LJI for the prevention of postpartum hemorrhage would be included. P < .05 was set as the level of significance.. The review would add to the existing literature by showing compelling evidence and improved guidance in clinic settings.. 10.17605/OSF.IO/2WC53.

Topics: Carboprost; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Humans; Leonurus; Meta-Analysis as Topic; Oxytocics; Phytotherapy; Postpartum Hemorrhage; Pregnancy; Systematic Reviews as Topic

Topics: Adolescent; Carboprost; Delivery, Obstetric; Factor VII Deficiency; Female; Heterozygote; Humans; Misoprostol; Oxytocics; Perineum; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Hematologic; Uterine Inertia

To assess whether mild thrombocytopenia (platelet count 100-149 k/microliter) is associated with an increased risk of postpartum hemorrhage.. Nulliparous women with term, singleton, vertex pregnancies undergoing labor at our institution between August 2016 and September 2017 were included. The primary exposure was mild thrombocytopenia, defined as platelet count 100-149 k/microliter, and the comparator was normal platelet count (150 k/microliter or greater). Those with severe thrombocytopenia (platelet count less than 100 k/microliter) were excluded from analysis. The primary outcome was postpartum hemorrhage, determined by International Classification of Diseases, Tenth Revision codes and the hospital discharge problem list. Secondary outcomes included use of uterotonic agents (methylergonovine maleate or carboprost tromethamine), total blood loss 1,000 mL or greater, and blood transfusion. Data were analyzed by t test, χ or Fisher exact test, and multivariable logistic regression, with significance at α <0.05.. We evaluated 2,845 eligible women, of whom 2,579 (90.2%) had normal platelet count 150 k/microliter or greater, 266 (9.3%) had platelet count 100-149 k/microliter (mild thrombocytopenia), and 13 (0.5%) had platelet count less than 100 k/microliter (severe thrombocytopenia). Compared with women with normal platelet count, those with mild thrombocytopenia had a higher rate of postpartum hemorrhage (16.9% vs 8.5%, P<.001) and were more likely to have total blood loss 1,000 mL or greater (4.5% vs 1.7%, P=.002) and receive methylergonovine maleate (10.5% vs 5.9%, P=.003) or carboprost tromethamine (6.0% vs 1.6%, P<.001) or both (3.8% vs 1.0%, P<.001), but rates of blood transfusion were no different (1.9% vs 1.5%, P=.59). The association between mild thrombocytopenia and postpartum hemorrhage persisted after multivariable adjustment for potential confounders (adjusted odds ratio 2.2, 95% CI 1.5-3.2, P<.001).. Among nulliparous women with term, singleton, vertex pregnancies undergoing labor, those with mild thrombocytopenia (platelet count 100-149 k/microliter) had a twofold greater likelihood of postpartum hemorrhage compared with those with normal platelet count.

Topics: Adult; Blood Transfusion; California; Carboprost; Cesarean Section; Drug Combinations; Female; Humans; Logistic Models; Multivariate Analysis; Parity; Platelet Count; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Risk; Thrombocytopenia; Tromethamine

To estimate whether the diagnosis of asthma is associated with the use of specific uterotonic and antihypertensive medications during delivery hospitalizations.. We used Perspective, an administrative database, to determine whether women hospitalized for delivery complicated by postpartum hemorrhage or preeclampsia received uterotonics and antihypertensive medications differentially based on the absence or presence of asthma from 2006 to 2015. Given that carboprost and intravenous (IV) labetalol may be associated with asthma exacerbation, adjusted models for receipt of these medications were created with adjusted risk ratios with 95% CIs as measures of effect. Risk for status asthmaticus based on receipt of carboprost and IV labetalol was analyzed.. Over the study period, a total of 5,691,178 women were analyzed, of whom 239,915 (4.2%) had preeclampsia and 139,841 postpartum hemorrhage (2.5%). Carboprost was used less frequently in patients with asthma compared with patients with no asthma (11.4% vs 18.0%) in comparison with IV labetalol, which was used more commonly when a diagnosis of asthma was present (18.5% vs 16.7%). In unadjusted analysis, the presence of asthma was associated with a 37% decrease in likelihood of carboprost use and an 11% increase in likelihood of labetalol use. In adjusted analysis, the presence of asthma was associated with a 32% decrease in likelihood of carboprost use (adjusted risk ratio 0.68, 95% CI 0.62-0.74) compared with a 7% decrease in labetalol use (adjusted risk ratio 0.93, 95% CI 0.90-0.97). Risk for status asthmaticus was significantly increased with use of IV labetalol compared with other antihypertensive medications (6.5 vs 1.7/1,000 delivery hospitalizations, P<.01).. There may be an opportunity to reduce use of β-blockers and carboprost among patients with asthma. Given their association with status asthmaticus, these drugs should be used cautiously in women with asthma.

Topics: Adult; Antihypertensive Agents; Asthma; Carboprost; Contraindications, Drug; Databases, Factual; Delivery, Obstetric; Drug Therapy, Combination; Female; Hospitalization; Humans; Labetalol; Odds Ratio; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Pregnancy Complications

Carboprost tromethamine is a synthetic prostaglandin derivative, which can effectively promote law contraction of the uterus and significantly reduce the amount of bleeding during and after delivery. In this study, we explored the effect of carboprost tromethamine on the prevention of postpartum hemorrhage after cesarean section and the effect on coagulation function and hemodynamics. At the same time, the effects of oxytocin and carboprost tromethamine were studied in different groups. The results showed that the amount of 2h bleeding (256.7±65.21) mL and the amount of 24h hemorrhage (308.3±78.3) after the operation were significantly decreased, and the difference was statistically significant (P<0.05). After the operation, the levels of APTT, TT and Fib in the two groups were significantly lower than those before the operation. The levels of SBP (119.4±8.24) mmHg and DBP (79.6±6.21) mmHg in the experimental group were significantly higher than those of the control group. In summary, carboprost tromethamine has a significant effect on the prevention of postpartum hemorrhage in cesarean section, and has a significant effect on improving the state of hypercoagulable blood and maintaining the stable hemodynamic state, which has clinical a value.

Topics: Adult; Carboprost; Cesarean Section; Drug Combinations; Female; Humans; Postpartum Hemorrhage; Pregnancy; Tromethamine; Young Adult

Uterine atony is a leading cause of postpartum hemorrhage. Although most cases of postpartum hemorrhage respond to first-line therapy with uterine massage and oxytocin administration, second-line uterotonics including methylergonovine and carboprost are integral for the management of refractory uterine atony. Despite their ubiquitous use, it is uncertain whether the risk of hemorrhage-related morbidity differs in women exposed to methylergonovine or carboprost at cesarean delivery.. We performed a secondary analysis using the Maternal-Fetal Medicine Units Network Cesarean Registry. We identified women who underwent cesarean delivery and received either methylergonovine or carboprost for refractory uterine atony. The primary outcome was hemorrhage-related morbidity defined as intraoperative or postoperative red blood cell transfusion or the need for additional surgical interventions including uterine artery ligation, hypogastric artery ligation, or peripartum hysterectomy for atony. We compared the risk of hemorrhage-related morbidity in those exposed to methylergonovine vs carboprost. Propensity-score matching was used to account for potential confounders.. The study cohort comprised 1335 women; 870 (65.2%) women received methylergonovine and 465 (34.8%) women received carboprost. After accounting for potential confounders, the risk of hemorrhage-related morbidity was higher in the carboprost group than the methylergonovine group (relative risk, 1.7; 95% confidence interval, 1.2-2.6).. In this propensity score-matched analysis, methylergonovine was associated with reduced risk of hemorrhage-related morbidity during cesarean delivery compared to carboprost. Based on these results, methylergonovine may be a more effective second-line uterotonic.

Topics: Adult; Carboprost; Cesarean Section; Cohort Studies; Erythrocyte Transfusion; Female; Humans; Hysterectomy; Ligation; Methylergonovine; Oxytocics; Postpartum Hemorrhage; Pregnancy; Propensity Score; Risk Factors; Uterine Artery; Uterine Inertia; Young Adult

Uterine atony (UA) is recognized as a leading cause of postpartum haemorrhage. However, knowledge of risk factors of haemorrhage-related morbidity among patients diagnosed with UA is uncertain. We investigated risk factors for haemorrhage-related morbidity among patients undergoing Caesarean delivery with UA.. We conducted a secondary analysis of data sourced from a 4-yr observational study at 19 US academic centres. Patients with UA were identified based on receiving methylergonovine or carboprost. Our primary outcome (haemorrhage-related morbidity) included a composite of intra- or postpartum transfusion; Caesarean hysterectomy; uterine or hypogastric artery ligation; intensive care admission for: pulmonary oedema, coagulopathy, adult respiratory distress syndrome, postoperative ventilation, or invasive line monitoring.. Among 57,182 patients who underwent Caesarean delivery, 2294 (4%) patients developed UA. Haemorrhage-related morbidity occurred in 450 (19.6%) patients with UA. The risk of haemorrhage-related morbidity was increased among African-Americans [adjusted odds ratio (aOR)=2.36; 95% confidence interval (CI)=1.73-3.23], Hispanics (aOR=1.4; 95% CI=1.04-1.9), women with multiple gestations (aOR=1.59; 95% CI=1.06-2.38), placenta praevia (aOR=4.89; 95% CI=3.04-7.87), patients with ASA class III (aOR=1.4; 95 CI=1.03-1.9), or ASA class IV (aOR=5.88; 95% CI=2.48-13.9), exposure to general anaesthesia (GA) (aOR=2.4; 95% CI=1.59-3.62) and combined general and regional anaesthesia (aOR=4.0; 95% CI=2.62-6.09), and ≥2 prior Caesarean deliveries (aOR=1.62; 95% CI=1.1-2.39).. Among patients with UA undergoing Caesarean delivery, the risk of haemorrhage-related morbidity is increased in African-Americans, Hispanics, patients with multiple gestations, placenta praevia, ASA class III or IV, ≥2 prior Caesarean deliveries and those undergoing GA.

Topics: Adolescent; Adult; Anesthesia, Obstetrical; Black or African American; Body Mass Index; Carboprost; Cesarean Section; Delivery, Obstetric; Female; Hispanic or Latino; Humans; Methylergonovine; Oxytocics; Placenta Previa; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Outcome; Reproducibility of Results; Risk Factors; Socioeconomic Factors; Uterine Inertia; Young Adult

Topics: Adolescent; Carboprost; Female; Humans; Infant, Newborn; Male; Oxytocics; Postpartum Hemorrhage; Pregnancy; Pulmonary Edema

All around the world as well as in Bulgaria postpartal haemorrhage is a main reason of maternal death. The treatment of postpartal haemorrhage of which approximately 70% is caused by hypotony of the uterus is still a challenge for physician-obstetrician. In the following study we have used prostaglandin-Carboprost tromethamole (Prostin 15M) for treatment of this important obstetric pathology. One year investigation which includes 82 patients with hypotony during vaginal delivery or cesarian section. Results showed that the use of Carboprost tromethamole (Prostin 15M) in treatment of hypotony leads to fast and extended contraction of the uterus as well as significantly decreases blood loss and the necessity of haemotrasfusion.

Topics: Bulgaria; Carboprost; Cesarean Section; Female; Humans; Oxytocin; Postpartum Hemorrhage; Pregnancy; Uterus

Topics: Carboprost; Female; Humans; Oxytocin; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Risk Factors; Tromethamine

Topics: Adult; Bronchial Spasm; Carboprost; Coagulants; Critical Illness; Female; Humans; Injections, Intramuscular; Postpartum Hemorrhage; Pregnancy

Topics: Carboprost; Female; Humans; Postpartum Hemorrhage; Pregnancy; Suppositories

Routine oxytocic prophylaxis is known to significantly reduce the risk of severe postpartum haemorrhage (> 1,000 ml) and need for blood transfusion after delivery. To what extent this evidence is implemented in clinical practice in Norway is not known.. A telephone questionnaire survey was carried out in September 2001 to evaluate the routine clinical practice for prevention and treatment of postpartum haemorrhage in Norwegian delivery units.. Data were available for 55 out of 57 institutions with a delivery unit. Routine third stage prophylaxis with 5-10 IU oxytocin was practiced in 47% of delivery units. Intravenous oxytocin infusion was used primarily in all the delivery units for the treatment of established primary postpartum haemorrhage. 74% of units used methylergometrine, 21% misoprostol as the second-line treatment.. Despite evidence for the use of oxytocics for the prevention of postpartum haemorrhage, less than half of delivery units in Norway practice routine prophylaxis in the third stage of labour. Norwegian women may benefit if all maternity care providers implement evidence-based practice.

Topics: Carboprost; Evidence-Based Medicine; Female; Health Care Surveys; Humans; Methylergonovine; Misoprostol; Norway; Oxytocics; Oxytocin; Postpartum Hemorrhage; Practice Patterns, Physicians'; Pregnancy; Surveys and Questionnaires

The authors aim is to find out the most common dosages, roads of administration and the effect of 15-Methyl PgF2a (Prostin 15 M) during the treatment of postpartal uterine hypotony 1 to 3 amp. Of Prostin 15 M-1 ml. (250 mg Carboprost) were used deeply muscular, intracervical or intramyometrial, by 51 patients with postpartal hypotony. The most common risk factors associated with the development of postpartal haemorrhage are PIH, prolonged labour, the general anaesthesis and higli multiparity. The adequate treatment with Prostin 15 M woned reduse the life threatening complication in the Labour room. The most efficient is the intracervical way of administration, a good effect could be achieved even with 1 amp. Prostin 15 M when it is applied after the conventional methods and manipulations. The lacu of effect grow Prostin 15 M (in 5.88% in this study) shows that there is another pathology responsible for postpartal hemorrhage and life threatening hemorrhage and this usually requires Laparotomy. We offer every Obstetric Clinic to have 3 amp. Prostin 15 M available and these would spare a lot of negative feelings or emotions and it wont supply a better obstetric outcomes.

Topics: Carboprost; Cervix Uteri; Female; Humans; Injections, Intramuscular; Muscle Hypotonia; Postpartum Hemorrhage; Pregnancy; Prostaglandins; Risk Factors

Topics: Abortifacient Agents, Nonsteroidal; Alprostadil; Carboprost; Catheterization; Female; Humans; Hysterectomy; Postpartum Hemorrhage; Pregnancy; Risk Factors

Available evidence shows that the benefits of routine oxytocic administration in the third stage of labor far outweigh the potential risks. In 1990, T.F. Baskett, MD, reviewed the routine use of oxytocic drugs by Canadian obstetricians in the management of the third stage of labor. With Dr Baskett's permission, we sent a similar questionnaire to 1500 obstetricians in Texas: 1000 practiced in urban areas and 500 practiced in rural areas of the state. Ninety-four percent of Texas obstetricians answering the survey used oxytocics routinely in managing the third stage of labor. However, only 14.9% administered the oxytocics before delivery of the placenta, in contrast to 92.1% who gave oxytocics after the delivery of the placenta. Oxytocin was the chosen oxytocic drug for routine third-stage management (95%) as well as for postpartum hemorrhage (73.3%). Of the physicians surveyed, 55.9% used 15-methyl prostaglandin F2a (Hemabate) to treat postpartum hemorrhage refractory to other drugs within the past year. Of the respondents, 14.3% had managed acute uterine inversion during the past year. Thus, Texas obstetricians use Oxytocin routinely in the management of the third stage of labor, but few are converted to active management.

Topics: Attitude of Health Personnel; Canada; Carboprost; Family Practice; Female; Humans; Labor Stage, Third; Obstetrics; Oxytocics; Oxytocin; Placenta; Postpartum Hemorrhage; Pregnancy; Rural Health; Texas; Urban Health; Uterine Diseases

Topics: Carboprost; Female; Humans; Injections, Intramuscular; Myometrium; Postpartum Hemorrhage; Pregnancy

Topics: Albuterol; Asthma; Bacterial Infections; Breast Diseases; Carboprost; Cefixime; Cefotaxime; Fatty Acids, Essential; Female; gamma-Linolenic Acid; Humans; Linoleic Acids; Oenothera biennis; Pain; Plant Oils; Postpartum Hemorrhage; Pregnancy; Salmeterol Xinafoate

Post-partum hemorrhage is a serious complication in obstetric practice. The aim of this study was to investigate, in vivo, the effects of 15 methyl-prostaglandin F2 alpha (Prostinfenem, Upjohn, Sweden) on uterine activity and hemorrhage. Twenty-seven women were included in the study and, in accordance with our clinical routine, all were given oxytocin (10 IE Syntocinon) intramuscularly immediately after delivery. In cases of heavy bleeding and signs of uterine atony, ethylergometrine (0.2 mg Methergin) and oxytocin (40 i.e. Syntocinon in 500 ml, 5.5% glucose) were administered intravenously. If this therapy failed, the woman was given an intravenous infusion of 15-methyl-prostaglandin F2 alpha (0.25 mg Prostinfenom, in 500 ml, 5.5% glucose). Myometrial activity was quantitated in 5 women by a micro-transducer introduced into the uterine cavity. The treatment resulted in a contracted uterus and cessation of bleeding within 12.5 min (mean). The intra-uterine pressure registered a prompt effect regarding both amplitude and frequency of uterine contractions.

Topics: Adult; Carboprost; Female; Humans; Infusions, Intravenous; Postpartum Hemorrhage; Pregnancy; Pressure; Prostaglandins F, Synthetic; Uterus

Over a six-month period, five women with severe uterine atony and postpartum hemorrhage developed marked maternal arterial oxygen desaturation within five to ten minutes of the administration of 15-methyl prostaglandin F2 alpha. The average fall from baseline was 10.4 +/- 5.4%, to a mean arterial oxygen saturation of 88.8 +/- 5.45%. The desaturation was accompanied by acute increases, averaging 20.7 +/- 5.9%, in the intrapulmonary shunt.

Topics: Blood Gas Analysis; Carboprost; Female; Humans; Oximetry; Oxygen; Postpartum Hemorrhage; Pregnancy; Prostaglandins F, Synthetic; Time Factors; Uterine Inertia

Postpartum hemorrhage is a potentially life-threatening obstetric complication. A 22-month experience treating postpartum hemorrhage with Prostin 15M patients who had not responded to conventional therapy is presented. A total of 26 patients were treated. There were 22 successes and 4 failures (84.6% success rate). Two failures were documented placenta accreta. Side effects occurred in 13 of the 26 patients and were generally mild. This group of patients is at risk for significant blood loss as well as blood replacement. The treatment of postpartum hemorrhage with intramuscular Prostin 15M was found to be safe and effective.

Topics: Adult; Carboprost; Drug Evaluation; Female; Humans; Injections, Intramuscular; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Prostaglandins F, Synthetic

The present report describes an unusual case of recurrent puerperal uterine inversion causing major postpartum hemorrhage. Blood replacement, oxytocin, and ergot therapy along with manual reduction failed to prevent immediate recurrence, but treatment with 15(S)-15-methyl prostaglandin F2 alpha (Prostin 15M) and uterine packing were successful. It is recommended that 15(S)-15-methyl prostaglandin F2 alpha be available in all obstetric suites for the management of similar emergencies.

Topics: Adult; Carboprost; Female; Humans; Methods; Postpartum Hemorrhage; Pregnancy; Prostaglandins F, Synthetic; Puerperal Disorders; Recurrence; Uterine Diseases; Uterine Hemorrhage

Presented is a three-year study using a 15-methyl analogue of prostaglandin F2 alpha, in the management of severe postpartum hemorrhage due to uterine atony in patients who were unresponsive to conventional therapies. Fifty-four patients were entered into the study, but 51 were analyzed for efficacy. Successful control of postpartum hemorrhage occurred in 86%. Of the seven in whom therapy failed and who subsequently required surgical therapy, four had chorioamnionitis. Six subjects had intramyometrial injection of the agent, with dramatic results in five. Mild transient side effects occurred in less than 10% of subjects.

Topics: Adult; Carboprost; Female; Humans; Postpartum Hemorrhage; Pregnancy; Prostaglandins F, Synthetic

The use of 15 (S)-15-methyl-prostaglandin F2 alpha for second-trimester termination of pregnancy, induction of labor in the presence of a dead or severely malformed fetus, and the management of molar pregnancy was investigated in 212 women. The dosage regime was 250 microgram of the prostaglandin analogue every 1 to 3 hours. Cumulative expulsion rates amounted to 94 and 97% after 24 to 36 hours, respectively. Gastrointestinal side effects occurred in 48% of the patients, and both the number and intensity of the episodes were significantly reduced by antiemetic and antidiarrheal drugs. No serious complications occurred.

Topics: Abortion, Induced; Adolescent; Adult; Carboprost; Female; Gastrointestinal Diseases; Humans; Labor Stage, Second; Middle Aged; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F, Synthetic; Time Factors