Uterine Protective Drugs in Cesarean section

Uterine Protective Drugs in Cesarean section
Kimia alavian,^1,*
Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. The use of oxytocic drugs during THE cesarean section is an important intervention in the treatment of PPH. Numerous studies have shown that these agents have a narrow therapeutic range. Therefore, accurate knowledge by anesthesiologists about optimal doses and side effects is necessary. Due to the insensitivity of the receptors, second-line agents, e.g. prostaglandins and ergot alkaloids, may be necessary. In this review article, we check the hemodynamics and side effects of these drugs and propose a suitable dose for the limitations of postpartum hemorrhage.
Methods: This review article conducted in February 2020. includes articles were from four well-known databases, Scopus, Pub med, Google Scholar, and Web of Science. The articles that did not include the purpose of the article were excluded from the study.
Results: Oxytocin has numerous physiological effects such as contraction, sexual and maternal behaviors, cardiovascular regulation, memory stability, and the regulation of food and drink intake. It is the ﬁrst choice of PPH. Major side effects of oxytocin on mothers are heart attack, arrhythmias, hypotension, nausea, vomiting, and headache. Because of the structural similarity with antidiuretic hormone (ADH), an overdose of oxytocin may cause water retention, hypertension, and coma. Due to the side effects of oxytocin, it is best to take the lowest effective dose possible in the most stable way. Oxytocin dose of 0.5 to 3 IU is believed to be appropriate in most cases. However, the dose and rate of intravenous oxytocin injection after and during delivery of the cesarean section is controversial. It was suggested that receptor desensitization may inﬂuence the effectiveness of oxytocin. Considering that repeated doses of oxytocin may become increasingly ineffective, second-line uterotonic factors are necessary. Carbetocin has a function similar to oxytocin that causes uterine contractions. It responds with a lower dose than oxytocin, but the side effects of carbetocin are similar to that of oxytocin. Ergot derived from the fungus, this alkaloid was the ﬁrst effective oxytocic drug used to prevent and treat postpartum hemorrhage or abortion. Ergot causes a fast and sustained contraction of the uterus. The high prevalence of nausea and vomiting has led to its being excluded as a first-line of cesarean section agent. Prostaglandins (PGs) increase uterine contraction (like oxytocin). Side effects of PGs after pharmacological administration include fever, nausea, and vomiting. PG E1 is a widely available oxytocic which is less effective than oxytocin and ergot alkaloids. Oral consumption of PG E1 may decrease the need for additional uterotonic agents at the cesarean section.
Conclusion: Uterotonic drugs are fundamental intervention in the inhibition of uterine postpartum hemorrhage. Oxytocin is the uterotonic of ﬁrst choice. Carbetocin and prostaglandins are second-line agents. Research into these drugs with their narrow therapeutic range will improve our ability to limit postpartum hemorrhage during a cesarean section, while decreasing perilous maternal side effects.
Keywords: Oxytocin, Cesarean, Carbetocin, Prostaglandins