Uso de carbetocina frente al uso de oxitocina en pacientes intervenidas por cesárea con alto riesgo de atonía uterina / Use of Carbetocin versus Oxytocin in Cesareans with High Risk of Uterine Atony

Introducción: la utilización adecuada de medicamentos uterotónicos es fundamental en el manejo de la hemorragia obstétrica. Objetivo: describir los efectos de la carbetocina y su comparación con la oxitocina como primera elección para prevenir la hemorragia obstétrica en pacientes cesareadas con riesgo de atonía uterina. Métodos: se realizó un estudio prospectivo, comparativo y transversal, en el 2016, donde se incluyeron 165 pacientes embarazadas que ingresaron para interrupción del embarazo por cesárea, las cuales tenían factores de riesgo de atonía uterina. Se formaron dos grupos: el A, con 110 pacientes que recibieron oxitocina a dosis de 10 U por vía intravenosa, y el B, con 55 pacientes a las que se les administraron 100 mg de carbetocina después del nacimiento. Resultados: ambos grupos resultaron similares en la edad. En el grupo A, el promedio de edad fue de 27,5 años, y en el B, de 28,1 años. Se encontró una adecuada contractilidad en 83 pacientes del grupo A (75,45 por ciento) y en 53 del grupo B (96,36 por ciento). El grupo que recibió carbetocina requirió menor cantidad de maniobras o medicamentos adicionales. El sangrado transoperatorio fue, en promedio, de 845 ± 124,8 mL, para el grupo A, y de 709 ± 275,21 mL para el grupo B, en 21 pacientes del grupo A fue mayor de 1 000 mL y en 12 del grupo B. Conclusiones: las pacientes que recibieron carbetocina tuvieron resultados mejores en la contractilidad uterina. La necesidad de maniobras y medicamentos adicionales así como en la magnitud del sangrado y por tanto menor cantidad de transfusiones de hemoderivados(AU)

Introduction: the proper use of uterotonic drugs is fundamental in the management of obstetric hemorrhage. Objective: describe the effects of carbetocin and its comparison with oxytocin as the first choice to prevent obstetric hemorrhage in patients who are at risk for uterine atony. Methods: aprospective, comparative and cross-sectional study was conducted in 2016, which included 165 pregnant patients admitted for cesarean section, who had risk factors for uterine atony. Two groups were formed: A, with 110 patients receiving oxytocin at a dose of 10 U intravenously, and B, with 55 patients given 100 mcg of carbetocin after birth. Results: both groups were similar in age. In group A, the mean age was 27.5 years, and in B, 28.1 years. Adequate contractility was found in 83 patients in group A (75.45 percent) and 53 patients in group B (96.36 percent). The group receiving carbetocin required fewer maneuvers or additional medications. The intraoperative bleeding was, on average, 845 ± 124.8 mL in group A and 709 ± 275.21 mL in group B. It was more than 1,000 mL in 21 patients in group A and 12 patients in group B. Conclusions: patients who received carbetocin had better results in uterine contractility. The need for maneuvers and additional drugs was lesser as well as the magnitude of bleeding and therefore less transfusions of blood products(AU)

Prostaglandin F2 alpha: an effective alternate to surgical control of postpartum hemorrhage in uterine atony

To find out the use of Prostaglandin F2 alpha to avoid the surgical control of primary postpartum hemorrhage due to uterine atony and the adverse effects associated with prostaglandin F2 alpha. This was a Quasi-Experimental study carried out in obstetrics and gynecology unit 3 of Khyber Teaching Hospital Peshawar from 1st July 2003 - 30th June 2004. 50 patients having primary post partum hemorrhage due to uterine atony not responding to conventional oxytocics were given systemic and local prostaglandin F2 alpha. Vital signs, estimated blood loss and effect on uterine muscular tone were noted before and after prostaglandin F2 alpha. Surgical interventions were used in patients with continuous profuse vaginal bleeding despite maximum dose of prostaglandin F2 alpha and/ or hernodynamic instability of the patients. A semi-structured proforma was used to collect the data. A total of 44 [88%] patients responded well to the drug. Estimated blood loss before prostaglandin F2 alpha was 1000 - 4000ml with mean of 2250.00 + 686.98ml as compared to 416.00 + 294.41ml after prostaglandin F2 alpha was used. Side effects of the drug were mostly self limiting and required symptomatic treatment. No maternal death was recorded. Prostaglandin F2 alpha is an effective drug to control Primary post partum hemorrhage due to uterine atony and avoids surgical interventions in most of the patients. Side effects are minimum, most of which are self limiting

Efficacy of intramyometrial prostaglandin in the management of primary postpartum hemorrhage due to uterine atony in the multipara after failure on convential therapy

To determine the success rate of postgardin [PG] F[2] alpha in a primary post partum Hemorrhage [PPH] due to uterine along in multipara. Quasi-experimental study. Department of Obstetrics and Gynecology in PNS Shifa Karachi Pakistan, from 1st June 2004 to 30th May 2005. During this one year 126 cases of multipara had primary post partum hemorrhage. Inclusion criteria was multipara who developed PPH due to uterine atony and who did not respond to any other non surgical treatment modalities. Medical diseases were not considered in exclusion criteria. Primary gravida and those with secondary PPH were excluded. Out of these 26 patients had not responded by conventional methods. 250 micro g of PG F[2] alpha was administered intra-myonemetrially. Syntocinon drip was stopped before and ergometrine was not given along this. The patients without uterine atony were managed according to the cause. In this study 26[100%] received PGF[2] alpha out of which 22 [84.6%] patients responded successfully. Two patients required second dose. It was repeated at 15-90 minute interval maximum three doses were tried. The four patients [15.38%] who failed to response, two patients had chorioamionitis, one patient had placenta praevia. One patient had no uterine response possibly due to delayed use of drug and excessive blood loss. PGF[2] alpha is a safe drug which can reduce the rate of surgical procedures in cases uterine atony

Insulina intravenosa en la inercia uterina pos-parto / Intravenous insulin in post partum uterine inertia

Se presenta un caso de inercia uterina pos-parto en que el uso de insulina demostró tener un efecto retractor, después del fracaso de la Oxitocina. En esta forma fue evitada la histerectomía en una primípara. La terapia insulínica podría convertirse en alternativa de elección en esta patología antes de la solución quirúrgica