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Questions and Answers
What is the mechanism by which carboprost tromethamine primarily suppresses bleeding?
What is the mechanism by which carboprost tromethamine primarily suppresses bleeding?
- Causing intense uterine contractions (correct)
- Dilating blood vessels
- Inhibiting platelet aggregation
- Increasing blood volume
What is a common gastrointestinal side effect associated with carboprost tromethamine administration?
What is a common gastrointestinal side effect associated with carboprost tromethamine administration?
- Constipation
- Abdominal pain
- Ileus
- Vomiting (correct)
What differentiates fever caused by carboprost tromethamine from that caused by endometriosis?
What differentiates fever caused by carboprost tromethamine from that caused by endometriosis?
- Duration of the fever
- Response to antipyretics
- Presence of bronchoconstriction
- Associated gastrointestinal symptoms (correct)
What is the recommended route and dosage for administering oxytocin to control postpartum hemorrhage?
What is the recommended route and dosage for administering oxytocin to control postpartum hemorrhage?
Which potential risk is specifically associated with the use of carboprost tromethamine?
Which potential risk is specifically associated with the use of carboprost tromethamine?
What is the principal mechanism by which dinoprostone promotes cervical ripening?
What is the principal mechanism by which dinoprostone promotes cervical ripening?
Which of the following is NOT a benefit of using dinoprostone in labor?
Which of the following is NOT a benefit of using dinoprostone in labor?
In the context of postpartum hemorrhage, what volume of blood loss defines the condition after a vaginal delivery?
In the context of postpartum hemorrhage, what volume of blood loss defines the condition after a vaginal delivery?
Which formulation(s) of dinoprostone is available for the purpose of cervical ripening?
Which formulation(s) of dinoprostone is available for the purpose of cervical ripening?
What is the primary risk associated with the use of dinoprostone during labor?
What is the primary risk associated with the use of dinoprostone during labor?
What is one of the pharmacological effects of prostaglandins related to smooth muscles?
What is one of the pharmacological effects of prostaglandins related to smooth muscles?
During which trimester is the response of the uterus to prostaglandins maximized?
During which trimester is the response of the uterus to prostaglandins maximized?
Which clinical effect is NOT associated with the use of prostaglandins?
Which clinical effect is NOT associated with the use of prostaglandins?
Which of the following is a common use of prostaglandins in obstetrics?
Which of the following is a common use of prostaglandins in obstetrics?
What is a significant advantage of using prostaglandins during pregnancy?
What is a significant advantage of using prostaglandins during pregnancy?
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Study Notes
Carboprost Tromethamine
- Carboprost tromethamine (Hemabate) is effective for controlling postpartum hemorrhage, primarily through intense uterine contractions.
- Vasoconstriction also contributes to its ability to suppress bleeding.
- A single dose of 250 mcg injected deep intramuscularly is typically sufficient to stop bleeding.
- Used for both postpartum hemorrhage and inducing abortion.
Adverse Effects of Carboprost
- Gastrointestinal reactions are common, including vomiting and diarrhea in up to 60% of patients.
- Nausea often accompanies gastrointestinal issues; antiemetics and antidiarrheals may help mitigate these effects.
- Fever is frequent; differentiating between drug-induced fever and pyrexia from endometriosis is crucial.
- Vasoconstriction can lead to hypertension and impaired respiration.
Oxytocin and Misoprostol
- Oxytocin (Pitocin) and misoprostol (Cytotec) are potent uterotonic agents used for managing postpartum hemorrhage due to uterine atony.
- Misoprostol is administered rectally at a dosage of 600-1000 mcg.
- Oxytocin can be given intramuscularly (10 units after placental delivery) or intravenously (10-40 units in IV fluid, titrated to control uterine atony).
Dinoprostone
- Dinoprostone (Prepidil, Cervidil) is extensively used for cervical ripening, mimicking natural prostaglandin E2.
- It shortens labor duration and can reduce oxytocin usage and the need for cesarean delivery.
- Capable of inducing labor and used for abortion, it promotes strong uterine contractions.
- Available in gel and vaginal insert forms for cervical ripening.
Postpartum Hemorrhage
- Postpartum hemorrhage is a leading cause of maternal mortality, second only to preeclampsia/eclampsia.
- Defined as blood loss exceeding 500 mL during vaginal delivery or 1000 mL during cesarean delivery.
Prostaglandins (PGs)
- Prostaglandins induce contractions of smooth muscles in the uterus, blood vessels, gastrointestinal tract, and bronchioles.
- Clinical effects include myometrial contraction, cervix softening and dilation, and inhibition of progesterone secretion.
- Uterine response to prostaglandins is strongest in the middle trimester (13th to 20th weeks).
- Mifepristone pretreatment sensitizes the uterus to prostaglandin effects.
Use of Prostaglandins in Obstetrics
- Indications include abortion induction, termination of molar pregnancy, labor induction, cervical ripening, labor acceleration, management of atonic postpartum hemorrhage, and medical management of ectopic pregnancy.
Advantages of Prostaglandins
- Provides a potent oxytocic effect regardless of pregnancy stage, allowing for independent abortion induction.
- Useful for labor acceleration in later months.
- Lacks anti-diuretic effects.
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