Репродуктивная эндокринология (May 2020)
Modern uterotonics: vitally required and dangerous... Literature review
Abstract
Uterotonics are widely used in obstetrics for pre-induction and induction of labor, for prevention and treatment of postpartum hemorrhages. Oxytocin, carbetocin and misoprostol are used as uterotonic agents for prevention of postpartum hemorrhages. Oxytocin, ergometrine, syntomethrin and misoprostol are used for treatment of postpartum hemorrhages. Subject to the principle of active management of the third stage of labor, prophylactic use of uterotonics reduces the postpartum hypotonic bleeding risk by 60%. This review provides current data on the pharmacokinetics, doses, modes of use and possible complications of oxytocin drugs, prostaglandin E1 and E2 analogues, ergot alkaloids in obstetric practice. International consensus statement on the use of uterotonic agents during caesarean section (2019) are presented, taking into account the differences between their dose for planned and urgent Caesarean section. In addition to the uterotonic effect of oxytocin it has parasympathetic neuromodulation, vasodilation, negative inotropic and chronotropic effects, lowers blood pressure, and in large doses and fast administration can have a negative effect on the fetus. The author emphasizes that uterotonics of the second row should be considered as early as possible if the oxytocin/carbetocin does not give a good uterine tone, but remember that the combined use of oxytocin with ergometrine increases the risks of cardiac complications. Methylergometrine can lead to an increase in central venous pressure, as well as an increase in blood pressure, in some cases it can provoke ischemia and necrosis of the heart muscle. Misoprostol is used for labor pre-induction, induction and for prevention and off-label treatment of postpartum bleeding. Misoprostol increases the risk of uterine hyperstimulation and increased heart rate in fetus, and the mother's body temperature rises. Therefore the key to the effectiveness and safety of uterotonics is the correct use of the method, dose, route and administration speed, taking into account indications and contraindications, careful monitoring of the condition of pregnant woman, fetus, woman in childbirth, compliance with the recommended storage conditions for drugs.
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