Uterotonic

A uterotonic, also known as an oxytocic or ecbolic, is a type of medication used to induce contraction or greater tonicity of the uterus. Uterotonics are used both to induce labor and to reduce postpartum hemorrhage.[1]

Labor induction in the third trimester of pregnancy may be required due to medical necessity, or may be desired for social reasons. Generally, labor induction is indicated when the risk of carrying the pregnancy outweighs the risk of delivering. These reason include, but are not limited to, pregnancies that are prolonged, prelabor rupture of the fetal membranes, and concerns about the health and safety of the mother and/or child. There are multiple techniques available to stimulate uterine contractions including mechanical, pharmacological, and alternative medicine methods to initiate contractions prior to spontaneous onset of labor.[2]

Postpartum hemorrhage, also known as PPH, is defined as a loss of 500 mL or greater of blood within 24 hours after giving birth. It is one of the leading causes of maternal mortality in women and adolescent girls worldwide, with mothers from low-resource countries being at a larger risk when compared to mothers of higher-resource countries. Occurring in 5% of all women giving birth, these situations are considered emergencies and require a quick, adequate response and the proper resources to prevent the death of the mother.[3]

Labor and delivery is a sequential process that results in the birth of a fetus and placenta. It is dependent on maternal and fetal chemical signals to stimulate muscles in the uterus to contract and relax. Of such signals include prostaglandins[4] and oxytocin.[5] Uterotonics can be utilized in these chemical pathways in order to medically stimulate contractions in labor induction or to treat postpartum hemorrhage.

  1. ^ Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z, et al. (Cochrane Pregnancy and Childbirth Group) (February 2014). "Treatment for primary postpartum haemorrhage". The Cochrane Database of Systematic Reviews. 2017 (2): CD003249. doi:10.1002/14651858.CD003249.pub3. PMC 6483801. PMID 24523225.
  2. ^ Mozurkewich EL, Chilimigras JL, Berman DR, Perni UC, Romero VC, King VJ, Keeton KL (October 2011). "Methods of induction of labour: a systematic review". BMC Pregnancy and Childbirth. 11: 84. doi:10.1186/1471-2393-11-84. PMC 3224350. PMID 22032440.
  3. ^ Uterotonics for the prevention of postpartum haemorrhage. WHO recommendations. Geneva: World Health Organization. 7 November 2018. ISBN 9789241550420. OCLC 1143281597.
  4. ^ Thomas J, Fairclough A, Kavanagh J, Kelly AJ (June 2014). "Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term". The Cochrane Database of Systematic Reviews. 2014 (6): CD003101. doi:10.1002/14651858.CD003101.pub3. PMC 7138281. PMID 24941907.
  5. ^ Uvnäs-Moberg K, Ekström-Bergström A, Berg M, Buckley S, Pajalic Z, Hadjigeorgiou E, et al. (August 2019). "Maternal plasma levels of oxytocin during physiological childbirth - a systematic review with implications for uterine contractions and central actions of oxytocin". BMC Pregnancy and Childbirth. 19 (1): 285. doi:10.1186/s12884-019-2365-9. PMC 6688382. PMID 31399062.