Exam 2- Uterotonics (7.1)

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leading cause of maternal mortality
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Terms in this set (30)
leading cause of maternal mortality
postpartum hemorrhage (PPH)
•Excessive blood loss following delivery combined with hemodynamic instability
PPH
Most common cause of postpartum hemorrhage is
loss of muscle tone in uterus (atony)

Diminished myometrial contractility (uterine tissue)
Postpartum Hemorrhage (PPH)

•Primary/Early/Acute:
•Secondary/Late:
Within 24 hours of delivery

6-12 weeks postpartum
Pharmacotherapy is introduced either
with or after fundal massage
If it is not improved within 30 minutes of initiation of treatment, must consider
emergency surgery- ex historectomy
first line uterotonic medication
oxytocin (Pitocin)
name the med

•Hormone produced in hypothalamus and released from the posterior pituitary gland
•One of the few that does a positive feedback loop
oxytocin (Pitocin)

•Oxytocin stimulates contraction, contraction stimulates oxytocin, and so on (this is what causes the increase in intensity and frequency of contractions)
name the med

•Pharmacology: In uterus, results in increased Ca in uterine myofibrils and a subsequent increase in muscle contractions
oxytocin (Pitocin)
oxytocin (Pitocin)

•IV Onset:

•Side effects:

•If dose is too high, can cause....
<1 minute, Duration: 20 minutes (we will do this to initiate labor)

hypotension, tachyarrhythmia, myocardial ischemia

extreme water intoxication and death
oxytocin is contraindicated inthose taking fluids PO (might need to restrict fluids for a person who is on oxytocin)name the med •Pharmacology: analogue of Prostaglandin F 2alpha which stimulates myometrial contractionCarboprost (Hemabate) 2nd lineCarboprost (Hemabate) - how do you administer this med? - onset? - duration?•IM only (can be injected into myometrium/uterus) •Onset 3-5 minutes given every 15-90 minutes •Duration 60-120 minutesCarboprost (Hemabate) need to adminster how many doses•Need to administer 2mg total (8 doses) •If no response after 2 doses, move onto the next medication (we won't sit around and hope that it works)Carboprost (Hemabate) contraindicated in??asthma patients (can cause bronchospasm)name the med •Pharmacology: Serotonin agonists, weak dopamine antagonists, partial alpha-adrenergic agonists à increase in tone, rate, & amplitude of uterine contraction •Synthetic analog of ergometrineMethylergonovine (Methergine) and Ergometrine (ergonovine)2nd line medication used in moms with asthmaMethylergonovine (Methergine) and Ergometrine (ergonovine)Methylergonovine (Methergine) and Ergometrine (ergonovine) - how do you administer? - why is IV not suggested? - this med is only considered for- into myometrium or IM (if no good response after 1 dose, move onto next agent) - can cause sudden HTN and CVA - life threatening situationMethylergonovine (Methergine) and Ergometrine (ergonovine) contraindicated in what can happen with prolonged use?HTN or significant arterial disease (Regardless of preexisting HTN or preeclampsia/eclampsia) causes HTN and gangrenename the med •Prostaglandin E1 binding to smooth muscle cells in uterine liningMisoprostol (Cytotec)Misoprostol (Cytotec) - onset? - vaginal onset? - can also be given?- 8 minutes, Duration 120 minutes - 20 minutes, Duration 240 minutes - given SL and PR (often given rectally)Misoprostol (Cytotec) side effects? why is it not preferred? what big thing are we watching for with this med?•hyperthermia, hypotension, tachycardia •Not preferred due to uncomfortable, sepsis workup, unnecessary empiric therapy fever!! this will need a sepsis workupname the med •Pharmacology: Prostaglandin E2; stimulates uterine contraction •Can be used to relax cervix, allowing for dilation and passage through birth canalDinoprostone (Cervidil) cervical dialationDinoprostone (Cervidil) - route? - side effects?- vaginally (onset within 10 minutes) - hypotension, cardiac arrhythmianame the med •Indication: Use in addition to oxytocin in high-risk deliveries (refuse blood products or significant risk of PPH)Tranexamic Acid (Lysteda)name the med •Pharmacology: Reversibly displaces plasminogen from fibrin resulting in fibrinolytic inhibitionTranexamic Acid (Lysteda)Tranexamic Acid (Lysteda) - onset? - side effects?- <1 minute, Duration 45 minutes, can cause hypertension - pain and headahceTranexamic Acid (Lysteda) contraindicated inactive thrombosis (CVA, DVT, or PE) history of thrombus or thromboembolism intrinsic risk of thrombus/thromboembolismNursing implications for uterotonics•2 nurse verification of 5 rights (facility dependent) •On-going and frequent vital signs assessments •BP, HR, RR, SpO2, urine output •Like hypovolemic shock •Quantify additional blood loss •Prepare the mother to be moved to the Operating Room- if it doesn't get better may have to go back for surgery •Prepare for massive transfusion protocolIf the problem is not solved quickly, interdisciplinary team members will ramp up theinterventions and treatments to promote survival