A meta-analysis on the efficacy of carboprost versus methylergometrine maleate in the active management of third stage of labor for the prevention of postpartum haemorrhage / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: To determine the efficacy of Carboprost versus methylergometrine maleate in the active management of third stage of labor for the prevention of postpartum hemorrhage. METHODS: Entries in electronic databases with references cited in original studies and review articles were used to identify randomized clinical trials of carboprost versus methergin in the active management of third stage of labor. The quality of published clinical trials were evaluated and assessed based on the efficacy of Carboprost versus methylergometrine maleate for the prevention of postpartum hemorrhage. RESULTS: Six (6) clinical trials were analyzed comprising a total sample pool of 525 women randomized to carboprost group and another 525 women to methergin. The risk ratio for dichotomous outcomes were calculated using a random-effects model while continuous outcomes were pooled using the standard mean difference. Results showed that both carboprost and methergin are both effective in preventing postpartum hemorrhage. But carboprost was found to be more efficacious in reducing the duration and decreasing the amount of blood loss in the third stage of labor and there was less need for an additional drug dose. Risks of side effects were higher in carboprost. Vomiting is the most frequent adverse event followed by diarrhea but are usually self-limiting. CONCLUSION: Carboprost is well known for its therapeutic role in the management of postpartum hemorrhage, well-tolerated and with minimal adverse effects. It is therefore recommended to be used in hypertensive patients where methylergometrine maleate is contraindicated and in cases refractory to other uterotonic agents.

Diagnosis and management of postpartum hemorrhage

Postpartum hemorrhage (PPH) is an important cause of maternal mortality. There is currently no single, satisfactory definition of PPH. The various definitions of PPH may result in delayed diagnosis. Underestimated blood loss concerning PPH is considered one of the biggest problems. The diagnosis of PPH should include proper estimation of blood loss before vital signs and clinical symptoms change. Management of PPH involves early recognition, assessment and resuscitation. Careful monitoring of vital signs, laboratory tests, coagulation testing in particular, and timely diagnosis of the cause of PPH are important. The first priority in the management of PPH is the rapid correction of hypovolemia with fluid infusion and packed red blood cells transfusion, followed by blood component therapy as indicated by the hematocrit, coagulation tests, platelet count and clinical features. Pharmacological management of PPH is to contract uterus (e.g., oxytocin, methylergonovine, 15-methylprostaglandin F2alpha, misoprostol) and to aid hemostasis (e.g., tranexamic acid, recombinant factor VIIa). Surgical management (e.g., balloon tamponade, uterine compression suture, iliac artery ligation) should be considered if hemorrhage persists or vital signs is unstable.

Diagnosis and management of postpartum hemorrhage

Postpartum hemorrhage (PPH) is an important cause of maternal mortality. There is currently no single, satisfactory definition of PPH. The various definitions of PPH may result in delayed diagnosis. Underestimated blood loss concerning PPH is considered one of the biggest problems. The diagnosis of PPH should include proper estimation of blood loss before vital signs and clinical symptoms change. Management of PPH involves early recognition, assessment and resuscitation. Careful monitoring of vital signs, laboratory tests, coagulation testing in particular, and timely diagnosis of the cause of PPH are important. The first priority in the management of PPH is the rapid correction of hypovolemia with fluid infusion and packed red blood cells transfusion, followed by blood component therapy as indicated by the hematocrit, coagulation tests, platelet count and clinical features. Pharmacological management of PPH is to contract uterus (e.g., oxytocin, methylergonovine, 15-methylprostaglandin F2alpha, misoprostol) and to aid hemostasis (e.g., tranexamic acid, recombinant factor VIIa). Surgical management (e.g., balloon tamponade, uterine compression suture, iliac artery ligation) should be considered if hemorrhage persists or vital signs is unstable.

Palliative treatment of intractable hematuria in context of advanced bladder cancer a systematic review

In a patient with bladder urothelial cancer that is not suitable for or does not choose curative treatment, intractable hematuria is a disastrous condition. In this article, we tried to review the literature and extract a stepwise approach for palliative treatment of hematuria in these patients. The MEDLINE was searched with the help of the Medical Subject Headings system using different combinations of terms urinary bladder neoplasm, hematuria, carboprost, cyclophosphamide, cystitis, alum, and hyperbaric oxygenation. The articles were separately reviewed by the two authors and verified by each other. Eventually, a decision tree was developed for management of gross hematuria in patients with bladder cancer. Although, there was not any reported randomized controlled trial or prospectively designed study, the available case series were rather expressive to draw out a logical approach. Formalin has a grave adverse effect profile and is recommended only in special circumstances. For management of each case of gross hematuria in bladder cancer, the etiology of bleeding is the most important determinant. Hematuria in the context of advanced bladder neoplasms can now be effectively treated with fewer side effects using all available modalities in a logical holistic approach. We proposed a decision tree for management of hematuria in this context. However, regarding lack of well-designed trials, a treatment method should be based on individualized scenarios and clinical experience, bringing into account the patient's preferences

Control of Postpartum Bleeding by Rectal Misoprostols: A Report of 3 Cases / 대한산부인과학회잡지

Postpartum hemorrhage is an important cause of maternal mortality and morbidity. Especially uterine atony is the most common cause of postpartum hemorrhage. Conventional method to control postpartum uterine atonic bleeding is based on the use of oxytocin and ergot preparations. Prostaglandin F2alpha analogue such as carboprost can be used to promote contraction when these agents fail to produce uterine contraction. Prostaglandin E1 analogue, misoprostol has uterotonic effect by oral or vaginal administration. They are used to induce labor and first or mid trimester abortion. In postpartum uterine atonic bleeding, misoprostols cannot be used via oral or vaginal route. Recently we have experienced that postpartum uterine atonic bleedings unresponsive to conventional methods were controlled by rectal misoprostols. So we report these cases with a brief review of literatures.

Actividad Biológica de la Prostaglandina F2 Alfa y del Metil Carboprost en el Fundus Gástrico aislado de rata / Biological activity of prostaglandin Fs alpha and methyl carboprost in the gastric fundus isolated from rats

Se comparó la potencia contráctil de una muestra del éster metílico de 15 metil prostaglandina F2 alfa (metil carboprost) (1), producida por la Industria Farmacéutica Cubana, con una muestra comercial de prostaglandina F2 alfa (II), de la firma Chinoin, mediante el ensayo de los "tres puntos". También se comparó la duración de la contracción inducida por dichas muestras utilizando un análisis de regresión lineal de la relajación observada en función del tiempo, luego de suprimir el contacto entre la droga y el órgano efector. Se utilizó el fundus gástrico aislado de rata como órgano efectos. La actividad contráctil se registró mediante transductores fuerza-desplazamiento. La muestra I presentó una potencia relativa de 164,0 por ciento con respecto a la II, con límites de confianza de 111,2 y 247,8 por ciento (p =0,95; N=7), y mostró un efecto más prolongado en relación con la II. En las tiras contraídas por la muestra I debió transcurrir 6 min y 46 s, luego del lavado, para que la contracción se redujera a la mitad de la respuesta máxima observada (N=7), en tanto que en las tiras contraídas por la II fue de 1 min y 48 s (N=8)

Carboprost Metil. Parte I. Sus acciones farmacologicas / Carboprost methyl. Part I. Its pharmacological actions

Carboprost metil es una prostaglandina de actividad biologica de 10 a 20 veces superior a la PGR(2a). Es un potente estimulador de la actividad contractil del miometrio e induce dilatacion cervical. Su uso se ha sugerido desde los anos 70, a pesar de los efectos secundarios que produce. La presencia de un grupo metilo en el carbono 15 bloquea la accion de la enzima 15-hidroxi-prostaglandina dehidrogenasa, por lo cual se incrementa el tiempo de vida media: este hecho provoca que la duracion de la accion farmacologica sea de 2 a 3 veces mayor que el desarrollado por la PGF(2a)

Carboprost Metil. Parte II. Usos Clinicos Obstetricos / Carboprost methyl. Part II. Obstetric clinical user

Carboprost metil se ha evaluado clinicamente en la induccion del aborto por via intravaginal en el primer trimestre y en el pretratamiento de la induccion del aborto en el segundo mes de gestacion. Tambien durante el segundo trimestre es eficaz para terminar el embarazo cuando se administra por via intraamniotica. Por via intramuscular su administracion se hace impracticable dada su toxicidad gastrointestinal; sin embargo, muchos autores recomiendan esta via en los casos de aborto diferido, en la muerte fetal intrauterina y en otros tipos de embarazos anormales, y se ha utilizado en el control de la hemorragia postparto por via intravenosa. Por administracion intravesical se ha empleado en el tratamiento de la cistitis hemorragica inducida por ciclofosfamida, donde parece constituir una terapia efectiva segura

A comparative study of the efficacy and safety of synthetic prostaglandin E2 derivative and 15-methyl prostaglandin F2 alpha in the termination of midtrimester pregnancy.

A comparative study of a synthetic prostaglandin E2 (PGE2) derivative and 15-methyl prostaglandin F2 alpha (PGF2 alpha) in the termination of midtrimester pregnancy of 13-20 weeks of gestation by intramuscular route, showed 97.5% success rate in both the groups but in comparison to 15-methyl PGF2 alpha which produced severe side-effects eg. diarrhoea and vomiting, synthetic PGE2 derivative had minimal or no side-effects.

Management of the third stage of labour with carboprost trometamol in high risk patients for postpartum hemorrhage

This study aimed to compare carboprost treatment with methyl- ergometrine and oxytocin in managing the third stage of labor in parturient mothers had risk factor of PPH. One hundred and six parturient women were randomly assigned to use carboprost trometamol, methyl-ergometrine or oxytocin immediately after delivery of the baby. Both duration of the third stage and the mean blood loss were significantly low in the carboprost group than the other two groups. It was concluded that carboprost trometamol is more potent uterotonic drug than both methyl-ergometrine and oxytocin. It is effective in the presence of risk factor predisposing to PPH. To anticipate the risk of PPH and to use carboprost trometamol early is better than to treat PPH with the possible risks of hemorrhage and treatment. Reducing loss of blood in these women is very important especially in cases where there is the likelihood of anemia

Control of persistent vesical bleeding due to radiation cystitis by intravesical application of 15 (S) 15-methyl prostaglandin F2-alpha.

A 45 year old female who received radiotherapy for stage II-B uterine cervical cancer four and half years ago, presented with persistent hematuria due to radiation cystitis. 15 (S)-15-methyl prostaglandin F2-alpha (1 mg in 100 ml of normal saline) was instilled into the bladder daily for two days. The severity of bleeding decreased considerably. However, significant hematuria recurred 19 days later which continued despite bladder irrigation with normal saline. 1 mg of 15 (S) 15-Me PGF2 alpha mixed with hydroxyethyl cellulose gel to a volume of 10 ml was then instilled into the urinary bladder daily for three days and macroscopic hematuria ceased. Urinary frequency and urgency were the side effects which lasted for ten days. There has been no recurrence of macroscopic hematuria during the five months follow-up. In conclusion, 15 (S) 15-Me PGF2-alpha may be administered intravesically to control moderate hematuria due to radiation cystitis.