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Uterotonic
A uterotonic, also known as an oxytocic or ecbolic, is a type of medication used to induce contraction or greater tonicity of the uterus. Uterotonics are used both to induce labor and to reduce postpartum hemorrhage.
Labor induction in the third trimester of pregnancy may be required due to medical necessity, or may be desired for social reasons. Generally, labor induction is indicated when the risk of carrying the pregnancy outweighs the risk of delivering. These reason include, but are not limited to, pregnancies that are prolonged, prelabor rupture of the fetal membranes, and concerns about the health and safety of the mother and/or child. There are multiple techniques available to stimulate uterine contractions including mechanical, pharmacological, and alternative medicine methods to initiate contractions prior to spontaneous onset of labor.
Postpartum hemorrhage, also known as PPH, is defined as a loss of 500 mL or greater of blood within 24 hours after giving birth. It is one of the leading causes of maternal mortality in women and adolescent girls worldwide, with mothers from low-resource countries being at a larger risk when compared to mothers of higher-resource countries. Occurring in 5% of all women giving birth, these situations are considered emergencies and require a quick, adequate response and the proper resources to prevent the death of the mother.
Labor and delivery is a sequential process that results in the birth of a fetus and placenta. It is dependent on maternal and fetal chemical signals to stimulate muscles in the uterus to contract and relax. Of such signals include prostaglandins and oxytocin. Uterotonics can be utilized in these chemical pathways in order to medically stimulate contractions in labor induction or to treat postpartum hemorrhage.
Oxytocin is a peptide hormone produced in the hypothalamus that plays an important role in many physiological functions. These functions include, enhancing mood and social relationships, promotion of maternal behaviors and stimulations of uterine contractions, among others roles. Uterine muscle contractions are induced via a G-protein pathway stemming from the oxytocin receptor (OXTR), the binding and activation site of oxytocin. When oxytocin binds to its associated receptors in the uterus, a cascade is initiated that results in an increase in calcium and subsequently an increase in muscle contractions. The release of oxytocin helps to facilitate stronger contractions during labor to aid in delivery of the fetus. Additionally, during pregnancy, the uterine muscles have an increased concentration of oxytocin receptors, leading to an increased response to oxytocin as well.
Oxytocin is the most commonly used agent for labor induction. It is given intravenously since it is easily degraded by the body if given orally. While giving oxytocin, it is important to monitor the mother and the fetus, specifically the mother's uterine activity and the fetal heart rate. The more common side effects of oxytocin include tachysystole, hyponatremia, and hypotension. Tachysystole is an increased rate of uterine contractions. If this occurs, it can be managed by lowering the dosage of oxytocin. Hyponatremia is a decreased concentration of sodium in the body as a result of increased fluids. This occurs due to oxytocin's similar structure to vasopressin (antidiuretic hormone), which acts to retain water in the body. Hypotension, or low blood pressure, is also a common side effect due to oxytocin's ability to relax smooth muscle of vessels. In comparison to women in spontaneous labor, women in induced labor on oxytocin experience a longer latent phase, however the duration of labor after reaching active labor (when the cervix has reached 6 cm), the duration of labor is considered equal.
The most common cause of postpartum hemorrhage is a loss of muscle tone in the uterus. Normally, the uterus will contract to constrict blood vessels and decrease the flow of blood to prevent bleeding out. However, if there is a loss of muscle tone, see uterine atony, there is an increased risk of bleeding. Oxytocin is the first-line pharmacological step to help prevent PPH and treat PPH.
Oxytocin plays an integral role in regulation of many of the body's biological processes- especially labor regulation. Since its structure was revealed in 1953, it has been the subject of intensive research. Some of the analogs produced from extensive modification of its chemical structure residues have produced drugs and therapies that are utilized as uterotonics. Similar to oxytocin, analogues bind to oxytocin receptors found along the muscles of the uterus and act as an agonist. During pregnancy, the number of oxytocin receptors increase until reaching their peak near completion of the pregnancy. An important note is that not all analogs of oxytocin work as an receptor agonist or as a uterotonic. Some may oppose uterine contractility such as atosiban.
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Uterotonic
A uterotonic, also known as an oxytocic or ecbolic, is a type of medication used to induce contraction or greater tonicity of the uterus. Uterotonics are used both to induce labor and to reduce postpartum hemorrhage.
Labor induction in the third trimester of pregnancy may be required due to medical necessity, or may be desired for social reasons. Generally, labor induction is indicated when the risk of carrying the pregnancy outweighs the risk of delivering. These reason include, but are not limited to, pregnancies that are prolonged, prelabor rupture of the fetal membranes, and concerns about the health and safety of the mother and/or child. There are multiple techniques available to stimulate uterine contractions including mechanical, pharmacological, and alternative medicine methods to initiate contractions prior to spontaneous onset of labor.
Postpartum hemorrhage, also known as PPH, is defined as a loss of 500 mL or greater of blood within 24 hours after giving birth. It is one of the leading causes of maternal mortality in women and adolescent girls worldwide, with mothers from low-resource countries being at a larger risk when compared to mothers of higher-resource countries. Occurring in 5% of all women giving birth, these situations are considered emergencies and require a quick, adequate response and the proper resources to prevent the death of the mother.
Labor and delivery is a sequential process that results in the birth of a fetus and placenta. It is dependent on maternal and fetal chemical signals to stimulate muscles in the uterus to contract and relax. Of such signals include prostaglandins and oxytocin. Uterotonics can be utilized in these chemical pathways in order to medically stimulate contractions in labor induction or to treat postpartum hemorrhage.
Oxytocin is a peptide hormone produced in the hypothalamus that plays an important role in many physiological functions. These functions include, enhancing mood and social relationships, promotion of maternal behaviors and stimulations of uterine contractions, among others roles. Uterine muscle contractions are induced via a G-protein pathway stemming from the oxytocin receptor (OXTR), the binding and activation site of oxytocin. When oxytocin binds to its associated receptors in the uterus, a cascade is initiated that results in an increase in calcium and subsequently an increase in muscle contractions. The release of oxytocin helps to facilitate stronger contractions during labor to aid in delivery of the fetus. Additionally, during pregnancy, the uterine muscles have an increased concentration of oxytocin receptors, leading to an increased response to oxytocin as well.
Oxytocin is the most commonly used agent for labor induction. It is given intravenously since it is easily degraded by the body if given orally. While giving oxytocin, it is important to monitor the mother and the fetus, specifically the mother's uterine activity and the fetal heart rate. The more common side effects of oxytocin include tachysystole, hyponatremia, and hypotension. Tachysystole is an increased rate of uterine contractions. If this occurs, it can be managed by lowering the dosage of oxytocin. Hyponatremia is a decreased concentration of sodium in the body as a result of increased fluids. This occurs due to oxytocin's similar structure to vasopressin (antidiuretic hormone), which acts to retain water in the body. Hypotension, or low blood pressure, is also a common side effect due to oxytocin's ability to relax smooth muscle of vessels. In comparison to women in spontaneous labor, women in induced labor on oxytocin experience a longer latent phase, however the duration of labor after reaching active labor (when the cervix has reached 6 cm), the duration of labor is considered equal.
The most common cause of postpartum hemorrhage is a loss of muscle tone in the uterus. Normally, the uterus will contract to constrict blood vessels and decrease the flow of blood to prevent bleeding out. However, if there is a loss of muscle tone, see uterine atony, there is an increased risk of bleeding. Oxytocin is the first-line pharmacological step to help prevent PPH and treat PPH.
Oxytocin plays an integral role in regulation of many of the body's biological processes- especially labor regulation. Since its structure was revealed in 1953, it has been the subject of intensive research. Some of the analogs produced from extensive modification of its chemical structure residues have produced drugs and therapies that are utilized as uterotonics. Similar to oxytocin, analogues bind to oxytocin receptors found along the muscles of the uterus and act as an agonist. During pregnancy, the number of oxytocin receptors increase until reaching their peak near completion of the pregnancy. An important note is that not all analogs of oxytocin work as an receptor agonist or as a uterotonic. Some may oppose uterine contractility such as atosiban.