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Venkataramu – OXYTOCICS (Oxytocin, Ergot, PGs)
Vijay Kumar - AntiHTN, Diuretics, Tocolytics, TERATOLOGY
Vishwanath – Anesthesia & Analgesia
OXYTOCICSOXYTOCICS
Venkataramu.B.S9term, MIMS
““OXYTOCICSOXYTOCICS
are the drugs of varying are the drugs of varying chemical nature that chemical nature that have the power to excite have the power to excite contraction of the contraction of the uterine musclesuterine muscles.”.”
OXYTOCICS
OXYTOCINERGOT
DERIVATIVESPROSTAGLANDINS
Ergometrine & Methergin E2&F2E2&F2άά
PGEPGE2 2 & &
PGFPGF22άά
Oxytocin: physiologyOxytocin: physiology
Human hypothalamusHuman hypothalamus
Diagram depicts a sagittal section through the Diagram depicts a sagittal section through the hypothalamus and pituitary gland.hypothalamus and pituitary gland.
The The posterior pituitary consists of axon posterior pituitary consists of axon terminals of magnocellular neurons terminals of magnocellular neurons arising in the supraoptic and arising in the supraoptic and paraventricular nuclei of the paraventricular nuclei of the hypothalamus. hypothalamus.
●
●●●
During lactationDuring lactation……
oxytocinoxytocin
mechanoreceptors mechanoreceptors in the in the nipple/ areolanipple/ areola
hypothalamic hypothalamic neuronal activityneuronal activityMILK EJECTIONMILK EJECTION
SucklingSuckling
Axon terminals
Axon terminals
myo
epith
elia
l
myo
epith
elia
l
cells
cells
con
trac
t
cont
ract
STIMULUS
RESPONSE
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 , uterine
smooth muscle shows an increase in the expression smooth muscle shows an increase in the expression of of oxytocin receptors(100-200fold) and becomes oxytocin receptors(100-200fold) and becomes increasingly sensitiveincreasingly sensitive to the stimulant action of to the stimulant action of endogenous oxytocin. endogenous oxytocin.
Stimulates PG synthesis. Stimulates PG synthesis. Physiological uterine contractionPhysiological uterine contraction - fundal - fundal
contraction; cervical relaxation. (law of polarity contraction; cervical relaxation. (law of polarity maintained)maintained)
Cervical and vaginal dilatation results in an acute Cervical and vaginal dilatation results in an acute release of oxytocin from the posterior pituitary in a release of oxytocin from the posterior pituitary in a process known as the process known as the Ferguson reflexFerguson reflex..
BSORPTION, METABOLISM, AND BSORPTION, METABOLISM, AND EXCRETIONEXCRETION
IntravenouslyAA (controlled infusion) for initiation for initiation and augmentation of labor. and 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 ampo Syntometrine (Sandoz - Syntocinon 5U+Ergometrine Syntometrine (Sandoz - Syntocinon 5U+Ergometrine
0.5mg)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 the kidneys and livereliminated by the kidneys and liver..
Circulating half-life of Circulating half-life of max. 5 minutesmax. 5 minutes. (avg 3-. (avg 3-4min)4min)
Duration of Duration of action-20minaction-20min Stored at 2-8 Stored at 2-8 00C C
PharmacodynamicsPharmacodynamicsUTERUSUTERUS Oxytocin acts through Oxytocin acts through G protein-coupled G protein-coupled
receptorsreceptors and the and the phosphoinositide -phosphoinositide -calcium calcium secondsecond-messenger system to contract uterine -messenger system to contract uterine smooth musclesmooth muscle. .
Oxytocin also stimulates the Oxytocin also stimulates the release of release of prostaglandinsprostaglandins and and leukotrienesleukotrienes that augment that augment uterine contractionuterine contraction. .
Oxytocin in Oxytocin in small dosessmall doses increases both the increases both the frequency and the force of uterine frequency and the force of uterine contractionscontractions. .
At At higher doseshigher doses, it produces , it produces sustained sustained contractioncontraction..
BREASTBREAST Oxytocin also causes contraction of Oxytocin also causes contraction of
myoepithelial cells surrounding myoepithelial cells surrounding mammary alveoli, which leads to mammary alveoli, which leads to milk milk ejectionejection..
Without oxytocin-induced contraction, Without oxytocin-induced contraction, normal lactation cannot occur. normal lactation cannot occur.
KIDNEYSKIDNEYS At high concentrations, oxytocin has At high concentrations, oxytocin has
weak antidiuretic and pressorweak antidiuretic and pressor activity due to activation of vasopressin activity due to activation of vasopressin receptors.receptors.
Toxicity Toxicity ““serious toxicity is rareserious toxicity is rare” when ” when
oxytocin is used judiciously. oxytocin is used judiciously.
excessive uterinestimulation
Hypertonia(↑duration)
uterine rupture..
Polysystole(>6 in 10min)
placental abruption
fetal distress
STIMULATION
HYPER
Grand multipara, MalpresentationContracted pelvisPrior 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. .
Pul. EdemaPul. EdemaHeart 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
To avoid hypotension, oxytocin isTo avoid hypotension, oxytocin is
administered intravenously as administered intravenously as
dilute solutions at a dilute solutions at a controlled rate.controlled rate.
OXYTOCIN BOLUS HYPOTENSION
Transient vasodilation
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 3rd stage
To minimise blood loss.
Control PPH
DIAGNOSTICContraction stress test (CST)
Oxytocin sensitivity test (OST)
CST/CST/oxytocinoxytocin challenge testchallenge test During the antepartum period, oxytocin induces During the antepartum period, oxytocin induces
uterine contractions that uterine contractions that transiently reduce transiently reduce placental blood flow to the placental blood flow to the fetusfetus. .
The The oxytocin challenge testoxytocin challenge test measures the measures the fetal heart fetal heart rate responserate response to a standardized to a standardized oxytocin infusionoxytocin infusion and provides information about and provides information about placental circulatory placental circulatory reservereserve. .
An abnormal response (+test) , seen as An abnormal response (+test) , seen as late late decelerationsdecelerations in the fetal heart rate, indicates in the fetal heart rate, indicates fetal fetal hypoxia and may warrant immediate cesarean hypoxia and may warrant immediate cesarean delivery.delivery.
Interpretation- Interpretation- PositivePositive Suspecious Suspecious Negative Negative
UnsatisfactoryUnsatisfactory HyperstimulationHyperstimulation
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 0.01U given IV at the end of
spontaneous contractionspontaneous contraction 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 failure of ut.contraction after 4 inj
signifies uterus is unlikely to be signifies uterus is unlikely to be responsive to induction.responsive to induction.
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
Methods of Methods of administrationadministration
Controlled Controlled intravenous intravenous InfusionInfusion
1-4mU/min (↑gradually)1-4mU/min (↑gradually). .
INTRAMUSCULAR
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 - Maintain normal pattern of uterine
activity till delivery and 30-60min beyond that.activity till delivery and 30-60min beyond that.
NOTE: NOTE:
Start with 4mU/min & ↑every 20minStart with 4mU/min & ↑every 20min
Semi-Fowlers position - avoid venecaval Semi-Fowlers position - avoid venecaval compression.compression.
Calculation of dose delivered in Calculation of dose delivered in milliunits(mU) & its correlation with milliunits(mU) & its correlation with drop rate per minutedrop rate per minuteUnits of oxytocin Units of oxytocin mixed in 500ml mixed in 500ml Ringer solutionRinger solution
1unit=1000 1unit=1000 miliunits(mU)miliunits(mU)
Drops per minuteDrops per minute
(15drops=1ml)(15drops=1ml)
15 30 15 30 60 60
In terms of mU/minIn terms of mU/min
11
22
88
2 4 2 4 8 8
4 8 4 8 16 16
16 32 16 32 64 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
CalculationCalculation
500ml contains 1I.U. i.e 1000mU of 500ml contains 1I.U. i.e 1000mU of oxytocinoxytocin
So 1ml containsSo 1ml contains
1000mU X 1ml1000mU X 1ml = = 2mU 500ml500ml1ml = 2mUAlso 1ml~15drops
Table showing Table showing convenient regimeconvenient regime
Dose of oxytocinDose of oxytocin Solution Solution used used
Escalating Escalating Drop rate at Drop rate at intervals of intervals of 20-30min 20-30min
To start with 1unitTo start with 1unit
If no response-If no response-2units2units
If still no response-If still no response-8units8units
500ml 500ml Ringer Ringer solutionsolution
-do--do-
-do--do-
15-30-6015-30-60
15-30-6015-30-60
15-30-6015-30-60
OBSERVATION DURING OBSERVATION DURING OXYTOCIN INFUSIONOXYTOCIN INFUSION
RATE of flow – calculating drops/min RATE of flow – calculating drops/min Uterine contraction - Finger tip Uterine contraction - Finger tip
palpation (hardening)palpation (hardening) Intra uterine pressure:-peak Intra uterine pressure:-peak
50to60mmHg resting 10to15mmHg50to60mmHg resting 10to15mmHg FHRFHR Assessment of progress of labour.Assessment of progress of labour.
Indications for stopping the Indications for stopping the oxytocin infusionoxytocin infusion
Nature of uterine contractions-Nature of uterine contractions- abnormal uterine contractions occurring abnormal uterine contractions occurring
frequently (every 2 min or less )frequently (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 ~•~•~•~~•~•~•~
Ergot Alkaloids Ergot Alkaloids
• Ergot is the Ergot is the natural alkaloid of of Claviceps purpureaClaviceps purpurea that grows on rye, wheat and other grains.that grows on rye, wheat and other grains.
ChemistryChemistry• The ergot alkaloids are derivatives of the The ergot alkaloids are derivatives of the tetracyclic tetracyclic
compound compound 6-methylergoline.6-methylergoline.
• The first pure ergot alkaloid ergotamine was obtained The first pure ergot alkaloid ergotamine was obtained in 1920, followed by the isolation of in 1920, followed by the isolation of ergometrine/ergonovine in 1932. 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)
PHARMACOKINETICS of PHARMACOKINETICS of
Ergometrine & metherginErgometrine & methergin
Absorption
ORAL
PARENTERAL(IM,IV)
rapidly absorbed peak concentrations (plasma) -60 to 90min
PREFERED ROUTE
PreparationPreparation ampoulesampoules tabletstablets
ErgometrErgometrineine
0.25mg/ 0.25mg/ 0.5mg0.5mg
0.5-0.5-1.0mg1.0mg
methermethergingin
0.2mg0.2mg 0.5-0.5-1.0mg1.0mg
SyntometriSyntometrine (sandoz)ne (sandoz)
0.5mg 0.5mg Ergometrine+ 5U-syntocinon
-:Composition of ergot preparations:-
METABOLISM, EXCRETIONMETABOLISM, EXCRETIONErgotamineErgotamine 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 Only traces of unmetabolized drug are found in urine
and feces.and feces.Ergometrine (Ergonovine) Ergometrine (Ergonovine) andand methergin methergin
((methylergonovine)-methylergonovine)-• ErgometrineErgometrine (Ergonovine) is metabolized and/or (Ergonovine) is metabolized and/or
eliminated more rapidly than is ergotamine. eliminated more 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 ErgometriErgometrinene
MetherginMethergin
IVIV 45-60sec45-60sec 95sec95sec
IMIM 6-7min6-7min 7min7min
OralOral 10min10min 10min10min
Onset of action
Pharmacodynamics:Pharmacodynamics:MECHANISM OF ACTION-MECHANISM OF ACTION-
Serotonin Receptor (5-HTSerotonin Receptor (5-HT22)+++ Mixed partial )+++ Mixed partial agonist Adrenoceptor++ agonist Adrenoceptor++ effectseffects
DIRECTLY ON MYOMETRIUM (Uterine Smooth DIRECTLY ON MYOMETRIUM (Uterine Smooth Muscle) Muscle)
• Sensitivity of the uterus to the stimulant effects of ergot Sensitivity of the uterus to the stimulant effects of ergot increases dramatically during pregnancy - increasing increases dramatically during pregnancy - increasing dominance of receptors as pregnancy progresses. dominance of receptors as pregnancy progresses.
• Non-physiological action Non-physiological action i.e uniform contraction of i.e uniform contraction of uterus (loss of polarity).uterus (loss of polarity).
• In very small doses, ergot preparations can evoke In very small doses, ergot preparations can evoke rhythmic contraction and relaxation of the uterus. rhythmic contraction and relaxation of the uterus.
• At higher concentrations, these drugs induce At higher concentrations, these drugs induce powerful powerful and prolonged contracture - STATE OF SPASMand prolonged contracture - STATE OF SPASM
• Ergonovine is more selectiveErgonovine is more selective than other ergot than other ergot alkaloids in affecting the uterus and is the agent of alkaloids in affecting the uterus and is the agent of choice in obstetric applications of these drugs. (Onset of choice in obstetric applications of these drugs. (Onset of action - 55sec by i.v.)action - 55sec by i.v.)
The uterine smooth muscle fibers when contracted compress traversing blood vessels –Principle for its clinical use.
INDICATION - INDICATION - THERAPEUTICTHERAPEUTIC
POSTPARTUM HEMORRHAGE-
• The uterus at term is The uterus at term is extremely sensitiveextremely sensitive to the to the stimulant action of ergot and even moderate stimulant action of ergot and even moderate doses produce a doses produce a prolonged and powerful spasm prolonged and powerful spasm of the muscle quite unlike natural laborof the muscle quite unlike natural labor. .
• Therefore, ergot derivatives should be used Therefore, ergot derivatives should be used only only forfor control of late uterine bleeding control of late uterine bleeding and should and should never be given before deliverynever be given before delivery. .
• Oxytocin is the preferred agent for control of Oxytocin is the preferred agent for control of postpartum hemorrhage but if this is ineffective, postpartum hemorrhage but if this is ineffective, ERGOMETRINEERGOMETRINE(0.2 mg ) is given (0.2 mg ) is given intramuscularly. intramuscularly.
• It is usually effective within 1–5 minutes and is It is usually effective within 1–5 minutes and is less toxic than other ergot derivatives for this less toxic than other ergot derivatives for this application.application.
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 delivery of the placenta.the placenta.
CAUTIONSCAUTIONS
ToxicityToxicity• Most common - Most common - gastrointestinal disturbances: gastrointestinal disturbances:
diarrhea, nausea, and vomitingdiarrhea, nausea, and vomiting. (Activation of . (Activation of the medullary vomiting center and of the the medullary vomiting center and of the gastrointestinal serotonin receptors )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 vasospasm → prolonged vasospasm → gangrenegangrene of toes of toes and requires amputation.and requires amputation.
• Bowel infarctionBowel infarction has also been reported and has also been reported and may require resection. may require resection.
• Interferes with LACTATION (↓prolactin)Interferes with LACTATION (↓prolactin)
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 Heart disease or severe hypertensive
disordersdisorders~•~•~•~•~•~•~~
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
PGE2PGF2ά
COOH
PGE1
SYNTHES
SYNTHES
IS
IS
& ACTIO
N
& ACTIO
N
Lungs & liver
Lungs & liver
PGF2ά- acts predominantly on myometrium
PGE2- on the cervix due to collagenolytic property
LOCAL HARMONES
The The amnionamnion synthesizes synthesizes PGE2 and and decidua – – PGF2ά 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”.
-vePGDH
-vephospholipase-A2phospholipase-A2
PGHS-2PGHS-2
+
PROSTAGLANDIN
USES IN OBSTETRICSUSES IN OBSTETRICSINDUCTION OF ABORTION – MTP / Missed abortion.INDUCTION OF ABORTION – MTP / Missed abortion.
11ststtrimester - 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)
PG analogues & Common ROAPG analogues & Common ROAPGE1 (methyl ester) – MISOPROSTOL (vaginal, oral, rectal)PGE2 – DINOPROSTONE (vaginal, extra amniotic) (NOTE: less toxic, more effective so widely used.)PGF 2ά- DINOPROSTONE TROMETHAMINE
PGF2ά (methyl analogue) – CARBOPROST (i.m., intra/extra-amniotic) -:Preparations:-Tablet-0.5mg dinoprostone (prostinE2)Vaginal suppository- 20mg PGE2 /50mg PGF2ά lipid baseVaginal pessary- 3mg PGE2
ProstinE2 gel- 500μg into cervical canal, below internal OS/1-2mg in the posterior fornix.
-:Parenteral:-PGE2 - ProstineE2 1mg/mlPGF2ά-ProstinF2 ά(Dinoprost tromethamine) 5mg/mlMethyl analogue of PGF2ά- Carboprost 2.5mg/10ml vial
Side effectsSide effectsSYSTEMICSYSTEMIC
NVD NVD BronchospasmBronchospasmFall in BP, tachycardia, chest painFall in BP, tachycardia, chest painShivering, fever, malaiseShivering, fever, malaise
LOCALLOCALUnduly forceful uterine contractionsUnduly forceful uterine contractionsUterine 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
CONTRAINDICATIONCONTRAINDICATION
Hypersensitivity to the drugHypersensitivity to the drug
Uterine scarUterine scar
Bronchial asthmaBronchial asthma
Heart diseasesHeart diseases
MisoprostolMisoprostol((PGEPGE11) - 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 PGE22- 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.
TTHHAANNKK YYOOUU☻