oxytocin and Signs-and-Symptoms

A study examined the pattern of stability of ergometrine, methylergometrine, and oxytocin, all used to treat and prevent excessive bleeding after vaginal delivery. It included observations of how longterm dark storage at both 25 and 30 degrees Celsius, short-term exposure to higher temperatures, and short-term exposure to light affect these drugs. Field surveys in Gambia, Malawi, Sudan, and Zimbabwe involved taking ergometrine injection samples from rural health facilities and medical reserves. The active ingredient in just 29% of the field samples met US and British Pharmacopoeia (USP/BP) limits of 90-100% of the stated content. 28% had less than 60% of the active ingredient. Field data on methylergometrine were available. The limited field data on oxytocin indicated that the quality was fine, since many samples had more active ingredient than stated. Overall, no differences in stability existed between ergometrine and methylergometrine. Sizable differences did exist between brands, however. Thus, programs should procure methylergometrine and ergometrine from a reliable supplier whose submitted documents comply with World Health Organization certification. The active ingredient in ergometrine and methylergometrine under refrigeration for 12 months fell an average of to 4 to 5%. At 30 degrees Celsius in the dark for 12 months, it fell on average 25%. At 40 degrees Celsius in the dark for 2 months, it fell about 5%. At 21-25 degrees Celsius in the light, the active ingredients fell 21-27% after 1 month and more than 90% after 12 months. On the other hand, refrigerated storage for 12 months did not reduce the potency of oxytocin. At 30 degrees Celsius in the dark for 12 months, the active ingredients of oxytocin samples fell on average 14%. Light did not destabilize oxytocin. Any noticeable difference between the color of (methyl)ergometrine and clear water means that the level of active ingredient is less than USP/BP standards (sensitivity 100%, specificity 85%). Thus, health workers should view every injection to ensure that it looks like clear water.

Topics: Africa; Africa South of the Sahara; Biology; Clinical Laboratory Techniques; Developing Countries; Diagnosis; Disease; Endocrine System; Hemorrhage; Hormones; Organization and Administration; Oxytocin; Pharmaceutical Preparations; Physiology; Pituitary Hormones; Postpartum Period; Quality Control; Reproduction; Signs and Symptoms; Therapeutics

The low postpartum levels of PGI2 interacting with oxytocin vis-a-vis myometrial contractility may prevent postpartum hemorrhage. Predisposing factors for atonic postpartum bleeding are uterine overdistension, grand multiparity, prolonged labor, anemia, toxemia, and heavy narcosis. Routine administration of oxytocic agents reduce uterine atony. In 1 group of 40 patients .2 mg methyl ergometrine given iv postplacentally produced less bleeding than in the other group of 40 getting placebo. 1 mg of iv PGE1, .2 mg ergometrine, 3 IU oxytocin or a combination of PGE1 and ergometrine was compared in 180 women. PGE1 did not reduce blood loss. PGF2alpha was used successfully to induce labor in 21 women reducing blood loss compared to oxytocin. Another 10 women received in syntometrine and 5 got im .25 mg sulprostone at the moment of crowning, and the latter reduced postpartum blood loss. 90 women in 3 groups of 30 each at high risk of hemorrhage were injected im .2 mg methyl ergometrine maleate, .25 mg 15-methyl-PGF2alpha, and .5 mg sulprostone, respectively, resulting in prevention of severe hemorrhage. Intramyometrial injection of .5-1 mg of PGF2alpha induced uterine contractions and controlled bleeding in atonic hemorrhage when oxytocin failed. 20 mg PGE2 vaginal suppositories controlled postpartum atony after cesarean section, although fever and hypotension did occur. Im 15-methyl-PGF2alpha proved superior in producing hemostasis to intramyometrial PGF2alpha injection. In 2 studies .25 mg of 15-methyl-PGF2alpha was injected at 1.5 hour intervals arresting hemorrhage in 15 out of 16 and 18 out of 20 cases, respectively. Intrauterine infection caused all 3 failures. Sulprostone by infusion of 1.7-30 mcg/min or by 500 mcg im injection also controls postpartum hemorrhage.

Topics: Biology; Birth Rate; Cesarean Section; Demography; Disease; Endocrine System; Fertility; General Surgery; Genitalia; Genitalia, Female; Hemorrhage; Hormones; Obstetric Surgical Procedures; Oxytocin; Parity; Physiology; Pituitary Hormones; Population; Population Dynamics; Postpartum Period; Prostaglandins; Reproduction; Signs and Symptoms; Therapeutics; Urogenital System; Uterus

A 20-year old female seeking legal abortion was pregnant with gestation in the 16th week as confirmed by ultrasound. Low hemoglobin count of 8.7 g/dl showed iron deficiency which was corrected by transfusion of 2 units of packed cells. Extraamniotic termination of pregnancy was commenced, and 5 mg of prostaglandin E2 (PGE2) in 50 ml of .9% saline was administered. Abortion started 9 hours later; the placenta was removed by curettage, however, severe hemorrhaging and shock ensued. Uterine perforation was ruled out by examination. Hartmann's solution and oxytocin 40 u/l were administered iv. A clotting defect with prolonged prothrombin time, thromboplastin time, and thrombin time was implicated in the excessive bleeding. 3 units of whole blood, 4 units of fresh frozen plasma, and 6 units of platelets were used to treat the coagulopathy. The patient recovered quickly, and clotting tests became normal after 2 days. Follow-up of 1 and 6 weeks showed normal hemoglobin values. PGE2 is routinely used in middle trimester abortions, however, a twentyfold increase in maternal mortality had been reported. Clotting screens are recommended for patients undergoing abortions because of coagulopathy associated with major hemorrhage.

Topics: Abortion, Induced; Abortion, Legal; Biology; Blood; Blood Coagulation; Curettage; Developed Countries; Disease; Endocrine System; England; Europe; Family Planning Services; General Surgery; Hemoglobins; Hemorrhage; Hormones; Iron; Obstetric Surgical Procedures; Oxytocin; Physiology; Pituitary Hormones; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Prostaglandins, Synthetic; Reproduction; Research; Signs and Symptoms; Therapeutics; United Kingdom

A prospective randomized survey of 113 abortions carried out by 1 operator using a single technique among women in the 7th-10th week of amenorrhea was undertaken to test the effectiveness of systemically administered oxytocins to reduce bleeding during therapeutic abortion by suction. General anesthesia was used in all cases. No oxytocin was used in 44 cases, an intravenous injection of .2 mg Methylergobasine was used in 36 cases, and a continuous perfusion of a solution of Syntocinan was used in 33 cases. There was no statistically significant difference in the gestational age, patient age, or parity of the 3 groups. The results indicated that bleeding is not significantly reduced as a result of the systemic use of oxytocins but blood loss is clearly associated with gestational age. There was no significant difference in the extent of digestive effects including nausea and vomiting in the 3 groups.

Topics: Abortifacient Agents; Abortion Applicants; Abortion, Induced; Anesthesia; Biology; Developed Countries; Disease; Endocrine System; Europe; Family Planning Services; France; Hemorrhage; Hormones; Oxytocin; Physiology; Pituitary Hormones; Pregnancy; Pregnancy Trimester, First; Reproduction; Signs and Symptoms

In an effort to study blood loss after Termination of pregnancy 190 1st trimester medical termination cases were divided into 3 groups: 1) a control group (70 patients) where no oxytocic agent was used; 2) a Syntocinon group (60 patients) where 10 units of Synotocin diluted in glucose was given; and 3) a Methergin group (60 patients) who received .2 mgm of Methyl Ergonovine. Results indicated that blood loss was twice as high in the control group as in the Methergin group. When oxytocics were used no patient had blood loss of more than 250 ml compared to 1.43% of patients in the control group who lost more than 250 ml. As gestation increased to 11-12 weeks blood loss also increased in the control group to 17 times more than at 4-6 weeks loss, 15 times more in the Syntocinon group and 11.5 times more in Ergometrine. No statistically signficant difference in amount of blood loss between the Oxytocin and Erogemetrine group could be found. However Ergometrine use increased blood pressure and vomiting.

Topics: Abortifacient Agents; Abortion, Induced; Asia; Biology; Developing Countries; Disease; Endocrine System; Family Planning Services; Hemorrhage; Hormones; India; Oxytocin; Physiology; Pituitary Hormones; Pregnancy; Pregnancy Trimester, First; Reproduction; Research; Signs and Symptoms