carboprost and Uterine-Diseases

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

Six cases of acute puerperal inversion of the uterus are reported. In four of these, tocolytic agents were used to facilitate replacement of the inverted uterus; and in five, Prostin-15M was given after replacement. The use of tocolytics may obviate the need for general anesthesia for uterine replacement in some patients with uterine inversion. Prostin-15M serves to minimize bleeding and to maintain uterine position after replacement.

Topics: Adult; Carboprost; Combined Modality Therapy; Female; Humans; Magnesium Sulfate; Oxytocin; Pregnancy; Puerperal Disorders; Terbutaline; Uterine Contraction; Uterine Diseases

Sequential administration of a beta 2-mimetic and a prostaglandin, the latter preferably injected into the uterus, is a simple and highly effective method for managing acute puerperal uterine inversion.

Topics: Carboprost; Dinoprostone; Drug Therapy, Combination; Female; Fenoterol; Humans; Pregnancy; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F, Synthetic; Puerperal Disorders; Ritodrine; Uterine Diseases

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