Uterotonic Agents Used in Cesarean Delivery
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Published:
Jul 19, 2019
Keywords:
cesarean delivery, uterotonic agents, uterine atony
Main Article Content
Abstract
Uterotonic agents are used to prevent and treat
postpartum hemorrhage after vaginal or cesarean delivery.
In order to achieve the maximum standard of care,
anesthesiologists must know the actions, dosages,
contraindications and side effects of uterotonic agents.
Although oxytocin is the first-line medication, the fact that
oxytocin receptor desensitization can occur makes the
availability and understanding of second and third-line
medications essential. These alternative uterotonics
include ergot alkaloid and prostaglandins. The aim of this
article was to provide a review of what is currently known
about the guideline-based use of uterotonics relative to
their use to prevent or treat postpartum hemorrhage. This
information may improve care team treatment decisions
and patient outcomes among patients with postpartum
hemorrhage.
Article Details
Section
Review articles
References
References
1. Committee on Practice Bulletins-Obstetrics. Practice Bulletin
No. 183: Postpartum Hemorrhage. Obstet Gynecol
2017;130(4):e168-e186.
2. Frolich M, Bucklin BA. Obstetric emergencies. In: Bucklin
BA, Gambling DR, Wlody DJ, editors. A practical approach
to obstetric anesthesia. Philadelphia: Lippincott William &
Wilkins; 2009. p.239-66.
3. Scavone BM. Antepartum and postpartum hemorrhage. In:
Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y,
Mhyre JM, editors. Chestnut’s obstetric anesthesia: principles
and practice. 5th ed. Philadelphia:Elsevier; 2014.p.881-914.
4. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF.
WHO analysis of causes of maternal death: a systematic
review. Lancet 2006;367(9516):1066-74.
5. Bucklin BA, Piehl E. Drugs commonly used in obstetric
anesthesia. In: Santos AC, Ebstein JN, Chaudhuri K, editors.
Clinical anesthesiology guide obstetric anesthesia. New
York: McGraw-Hill; 2015.p.60-77.
6. Arais F. Pharmacology of oxytocin and prostaglandins. Clin
Obstet Gynecol 2000;43:455-68.
7. Dyer RA, van Dyk D, Dresner A. The use of uterotonic drugs
during caesarean section. Int J Obstet Anesth 2010;19(3):
313-9.
8. Vallera C, Choi LO, Cha CM, Hong RW. Uterotonic Medications:
Oxytocin, Methylergonovine, Carboprost, Misoprostol.
Anesthesiol Clin 2017;35(2):207-19.
9. Oladapo OT, Okusanya BO, Abalos E. Intramuscular versus
intravenous prophylactic oxytocin for the third sate of labour.
Cochrane Database Syst Rev 2012;(2):CD009332.
10. Carvalho JC, Balki M, Kingdom J, Windrim R. Oxytocin
requirements at elective cesarean delivery: a dose-finding
study. Obstet Gynecol 2004;104(5):10005-10.
11. Butwick AJ, Coleman L, Cohen SE, Riley ET, Carvalho B.
Minimum effective bolus dose of oxytocin during cesarean
delivery. Br J Anaesth 2010;104(3):338-43
12. Kovacheva FP, Soens MA, Tsen LC. A randomized,
double-blinded trial of a “rule of threes” algorithm versus
continuous infusion of oxytocin during elective cesarean
delivery. Anesthesiology 2015;123(1):92-9.
13. George RB, McKeen D, Chaplin AC, McLeod L. Up-down
determination of the ED(90) of oxytocin infusions for the
prevention of postpartum uterine atony in parturients
undergoing Cesarean delivery. Can J Anesth 2010;57(6):
578-82.
14. Balki M, Ronayne M, Davies S, et.al. Minimum oxytocin dose
requirement after cesarean delivery for labor arrest. Obstet
Gynecol 2006;107(1):45-50.
15. Phaneuf S, Rodriguez LB, TambyRaja RL, MacKenzie IZ,
Lopez BA. Loss of myometrial oxytocin receptors during
oxytocin-induced and oxytocin-augmented labour. J Reprod
Fertil 2000;120:91-7.
16. Magalhaes JK, Carvalho JC, Parkes RK, Kingdom J, Li Y,
Balki M. Oxytocin pretreatment decreases oxytocin-induced
myometrial contractions in pregnant rats in a concentrationdependent
but not time-dependent manner. Reprod Sci
2009;16:501-8.
17. Nivatpumin P. Cardiopulmonary resuscitation in maternal
cardiac arrest and perimortem cesarean delivery. Thai J
Anesthesiology 2017;43(3):257-70.
18. Bergum D, Lonnee H, Hakli TF. Oxytocin infusion: acute
hyponatraemia, seizures and coma. Acta Anaesthesiol
Scand 2009;53:826-7.
19. Abdul-Karim R, Assali NS. Renal function in human pregnancy.
V.Effects of oxytocin on renal hemodynamics and water and
electrolyte excretion. J Lab Clin Med 1961;57:522-32.
20. Rath W. Prevention of postpartum haemorrhage with the
oxytocin analogue carbetocin. Eur J Obstet Gynecol Reprod
Biol 2009;147:15-20.
21. Meshykhi LS, Nel MR, Lucas DN. The role of carbetocin in
the prevention and management of postpartum haemorrhage.
Int J Obstet Anesth 2016;28:61-6
22. Anandakrishnan S, Balki M, Farine D, Seaward G, Carvalho
JC. Carbetocin at elective Cesarean delivery: a randomized
controlled trial to determine the effective dose, part 2. Can
J Anaesth 2013;60(11):1054-60.
23. Khan M, Balki M, Ahmed I, Farine D, Seaward G, Carvalho
JC. Carbetocin at elective cesarean delivery: a sequential
allocation trial to determine the minimum effective dose. Can
J Anaesth 2014;61(3):242-8.
24. Nguyen-Lu N, Carvalho JC, Farine D, Seaward G, Ye XY,
Balki M. Carbetocin at Cesarean delivery for labour arrest:
a sequential allocation trial to determine the effective dose.
Can J Anaesth 2015;62(8):866-74.
25. Su LL, Chong YS, Samuel M. Oxytocin agonists for preventing
postpartum haemorrhage. Cochrane Database Syst Rev
2007;18(3):CD005457.
26. Jin B, Du Y, Zhang F, Zhang K, Wang L, Cui L. Carbetocin
for the prevention of postpartum hemorrhage: a systematic
review and meta-analysis of randomized controlled trials. J
Matern Fetal Neonatal Med 2016;29(3):400-7.
27. van Dongen PW, Verbruggen MM, de Groot AN, van
Roosmalen J, Sporken JM, Schulz M. Ascending dose tolerance
study of intramuscular carbetocin administered after
normal vaginal birth. Eur J Obstet Gynecol Reprod Biol
1998;77(2):181-7.
28. Moertl MG, Friedrich S, Kraschl J, Wadsack C, Lang U,
Schlembach D. Haemodynamic effects of carbetocin and
oxytocin given as intravenous bolus on women undergoing
caesarean delivery: a randomised trial. BJOG 2011;118:
1349-56.
29. de Groot AN, van Dongen PW, Vree TB, Hekster YA, van
Roosmalen J. Ergot alkaloids. Current status and review of
clinical pharmacology and therapeutic use compared with
other oxytocics in obstetrics and gynaecology. Drugs
1998;56(4):523-35.
30. Kuczkowski KM. Myocardial ischemia induced by intramyometrial
injection of methylergonovine maleate. Anesthesiology
2004;100(4):1043.
31. Crawford JS. Bronchospasm following ergometrine.
Anaesthesia 1980;35(4):397-8.
32. Johnston D, Hughes D. Bronchospasm following ergometrine
in a non-asthmatic patient. Int J Obstet Anesth 2013;22(3):
261-2.
33. McDonald S, Abbott JM, Higgins SP. Prophylactic
ergometrine-oxytocin versus oxytocin for the third stage of
labour. Cochrane Database Syst Rev 2004;(1):CD000201.
34. Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic
Z. Treatment for primary postpartum haemorrhage. Cochrane
Database Syst Rev 2014,13;(2):CD003249.
35. Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage:
Prevention and Treatment. Am Fam Physician 2017;95(7):
442-9.
36. Bateman BT, Tsen LC, Liu J, Butwick AJ, Huybrechts KF.
Patterns of second-line uterotonic use in a large sample of
hospitalizations for childbirth in the United States: 2007-2011.
Anesth Analg 2014;119(6):1344-9.
1. Committee on Practice Bulletins-Obstetrics. Practice Bulletin
No. 183: Postpartum Hemorrhage. Obstet Gynecol
2017;130(4):e168-e186.
2. Frolich M, Bucklin BA. Obstetric emergencies. In: Bucklin
BA, Gambling DR, Wlody DJ, editors. A practical approach
to obstetric anesthesia. Philadelphia: Lippincott William &
Wilkins; 2009. p.239-66.
3. Scavone BM. Antepartum and postpartum hemorrhage. In:
Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y,
Mhyre JM, editors. Chestnut’s obstetric anesthesia: principles
and practice. 5th ed. Philadelphia:Elsevier; 2014.p.881-914.
4. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF.
WHO analysis of causes of maternal death: a systematic
review. Lancet 2006;367(9516):1066-74.
5. Bucklin BA, Piehl E. Drugs commonly used in obstetric
anesthesia. In: Santos AC, Ebstein JN, Chaudhuri K, editors.
Clinical anesthesiology guide obstetric anesthesia. New
York: McGraw-Hill; 2015.p.60-77.
6. Arais F. Pharmacology of oxytocin and prostaglandins. Clin
Obstet Gynecol 2000;43:455-68.
7. Dyer RA, van Dyk D, Dresner A. The use of uterotonic drugs
during caesarean section. Int J Obstet Anesth 2010;19(3):
313-9.
8. Vallera C, Choi LO, Cha CM, Hong RW. Uterotonic Medications:
Oxytocin, Methylergonovine, Carboprost, Misoprostol.
Anesthesiol Clin 2017;35(2):207-19.
9. Oladapo OT, Okusanya BO, Abalos E. Intramuscular versus
intravenous prophylactic oxytocin for the third sate of labour.
Cochrane Database Syst Rev 2012;(2):CD009332.
10. Carvalho JC, Balki M, Kingdom J, Windrim R. Oxytocin
requirements at elective cesarean delivery: a dose-finding
study. Obstet Gynecol 2004;104(5):10005-10.
11. Butwick AJ, Coleman L, Cohen SE, Riley ET, Carvalho B.
Minimum effective bolus dose of oxytocin during cesarean
delivery. Br J Anaesth 2010;104(3):338-43
12. Kovacheva FP, Soens MA, Tsen LC. A randomized,
double-blinded trial of a “rule of threes” algorithm versus
continuous infusion of oxytocin during elective cesarean
delivery. Anesthesiology 2015;123(1):92-9.
13. George RB, McKeen D, Chaplin AC, McLeod L. Up-down
determination of the ED(90) of oxytocin infusions for the
prevention of postpartum uterine atony in parturients
undergoing Cesarean delivery. Can J Anesth 2010;57(6):
578-82.
14. Balki M, Ronayne M, Davies S, et.al. Minimum oxytocin dose
requirement after cesarean delivery for labor arrest. Obstet
Gynecol 2006;107(1):45-50.
15. Phaneuf S, Rodriguez LB, TambyRaja RL, MacKenzie IZ,
Lopez BA. Loss of myometrial oxytocin receptors during
oxytocin-induced and oxytocin-augmented labour. J Reprod
Fertil 2000;120:91-7.
16. Magalhaes JK, Carvalho JC, Parkes RK, Kingdom J, Li Y,
Balki M. Oxytocin pretreatment decreases oxytocin-induced
myometrial contractions in pregnant rats in a concentrationdependent
but not time-dependent manner. Reprod Sci
2009;16:501-8.
17. Nivatpumin P. Cardiopulmonary resuscitation in maternal
cardiac arrest and perimortem cesarean delivery. Thai J
Anesthesiology 2017;43(3):257-70.
18. Bergum D, Lonnee H, Hakli TF. Oxytocin infusion: acute
hyponatraemia, seizures and coma. Acta Anaesthesiol
Scand 2009;53:826-7.
19. Abdul-Karim R, Assali NS. Renal function in human pregnancy.
V.Effects of oxytocin on renal hemodynamics and water and
electrolyte excretion. J Lab Clin Med 1961;57:522-32.
20. Rath W. Prevention of postpartum haemorrhage with the
oxytocin analogue carbetocin. Eur J Obstet Gynecol Reprod
Biol 2009;147:15-20.
21. Meshykhi LS, Nel MR, Lucas DN. The role of carbetocin in
the prevention and management of postpartum haemorrhage.
Int J Obstet Anesth 2016;28:61-6
22. Anandakrishnan S, Balki M, Farine D, Seaward G, Carvalho
JC. Carbetocin at elective Cesarean delivery: a randomized
controlled trial to determine the effective dose, part 2. Can
J Anaesth 2013;60(11):1054-60.
23. Khan M, Balki M, Ahmed I, Farine D, Seaward G, Carvalho
JC. Carbetocin at elective cesarean delivery: a sequential
allocation trial to determine the minimum effective dose. Can
J Anaesth 2014;61(3):242-8.
24. Nguyen-Lu N, Carvalho JC, Farine D, Seaward G, Ye XY,
Balki M. Carbetocin at Cesarean delivery for labour arrest:
a sequential allocation trial to determine the effective dose.
Can J Anaesth 2015;62(8):866-74.
25. Su LL, Chong YS, Samuel M. Oxytocin agonists for preventing
postpartum haemorrhage. Cochrane Database Syst Rev
2007;18(3):CD005457.
26. Jin B, Du Y, Zhang F, Zhang K, Wang L, Cui L. Carbetocin
for the prevention of postpartum hemorrhage: a systematic
review and meta-analysis of randomized controlled trials. J
Matern Fetal Neonatal Med 2016;29(3):400-7.
27. van Dongen PW, Verbruggen MM, de Groot AN, van
Roosmalen J, Sporken JM, Schulz M. Ascending dose tolerance
study of intramuscular carbetocin administered after
normal vaginal birth. Eur J Obstet Gynecol Reprod Biol
1998;77(2):181-7.
28. Moertl MG, Friedrich S, Kraschl J, Wadsack C, Lang U,
Schlembach D. Haemodynamic effects of carbetocin and
oxytocin given as intravenous bolus on women undergoing
caesarean delivery: a randomised trial. BJOG 2011;118:
1349-56.
29. de Groot AN, van Dongen PW, Vree TB, Hekster YA, van
Roosmalen J. Ergot alkaloids. Current status and review of
clinical pharmacology and therapeutic use compared with
other oxytocics in obstetrics and gynaecology. Drugs
1998;56(4):523-35.
30. Kuczkowski KM. Myocardial ischemia induced by intramyometrial
injection of methylergonovine maleate. Anesthesiology
2004;100(4):1043.
31. Crawford JS. Bronchospasm following ergometrine.
Anaesthesia 1980;35(4):397-8.
32. Johnston D, Hughes D. Bronchospasm following ergometrine
in a non-asthmatic patient. Int J Obstet Anesth 2013;22(3):
261-2.
33. McDonald S, Abbott JM, Higgins SP. Prophylactic
ergometrine-oxytocin versus oxytocin for the third stage of
labour. Cochrane Database Syst Rev 2004;(1):CD000201.
34. Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic
Z. Treatment for primary postpartum haemorrhage. Cochrane
Database Syst Rev 2014,13;(2):CD003249.
35. Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage:
Prevention and Treatment. Am Fam Physician 2017;95(7):
442-9.
36. Bateman BT, Tsen LC, Liu J, Butwick AJ, Huybrechts KF.
Patterns of second-line uterotonic use in a large sample of
hospitalizations for childbirth in the United States: 2007-2011.
Anesth Analg 2014;119(6):1344-9.