What is prostodin?? Ans: It is chemically
Carboprost tromethamine and is synthetic
15-methyl analogue of prostaglandin F2α. It may be administered via
intramuscular injection at a dose of 0.25 mg, and may be repeated every 15 min
until a maximum total dose of 2 mg has been administered Carboprost has been
reported to be 84–96% effective in the treatment of persistent hemorrhage due
to uterine atony, and may avoid the need for surgical intervention However, few
studies have examined its use for the prevention of PPH in comparison to Oxytocin .
Researchers compared prophylactic sublingual
misoprostol, intramuscular methylergometrine and intramuscular carboprost for
the active management of the third stage of labor, and observed that
the three drugs were equally effective in the prevention of PPH, although vomiting
& diarrhea was more common in the patients who received carboprost. carboprost was more effective than oxytocin in preventing PPH in
high-risk patients undergoing cesarean delivery. The drug was
well-tolerated with minimal adverse effects. Carboprost may be considered to be
suitable drug for the active management of the third stage of labor in this
patient population.
In a similar study, compared
carboprost and methylergometrine in 150 females who were randomly assigned to receive one of the
two drugs, and observed that the duration of the third stage of labor and
mean blood loss were significantly less in the carboprost group. Overall efficacy in prevention of PPH by
carboprost is about 90%
Side effects of
prostodin ?? : Carboprost may cause
prostaglandin-like side-effects, including nausea, vomiting, diarrhea,
headaches, hypertension and bronchial asthma caused by the contraction of
smooth muscles. It may also act on the thermoregulatory center, increasing the
basal body temperature . Patients may experience hot flashes, sweating and
increased irritability. Despite the aforementioned potential side-effects,
serious side-effects are rare and self-limited Vomiting was relatively common
in the patients who received carboprost; however, it was readily managed.
.We
know that oxytocin reduce
the incidence of PPH but what is the limitations of oxytocin?? Oxytocin is the
most commonly used uterotonic agent for the prevention of PPH, and has been
demonstrated to reduce blood loss following delivery. However, oxytocin has
a half-life of <10 min and thus must be administered by continuous
intravenous infusion . Furthermore, saturation of uterine receptors
may occur, and excessive dosages are capable of producing water toxicity due to
its antidiuretic effect
. Inj Prostodin :- It is carboprost
tromethamine is the synthetic 15-methyl
analogue of prostaglandin F2α, and has been reported to be 84–96%
effective in the treatment of persistent hemorrhage due to uterine atony . Postpartum hemorrhage (PPH) refers to >500 ml blood loss within 24 h following
vaginal delivery, >1,000 ml following cesarean delivery, or the requirement
for a blood transfusion within 24 h of delivery PPH is reported to occur in ~5% of all deliveries, and the
risk is significantly greater with cesarean delivery than vaginal delivery .
In
China, PPH is the most common serious obstetric complication and the leading
cause of maternal mortality, accounting for 49.9% of maternal deaths The
leading cause of PPH is uterine atony, followed by retained placenta and injury
to the genital tract .
Risk factors for PPH include
fetal macrosomia, prolonged labor, multiple pregnancies, polyhydramnios,
uterine myoma, and placenta previa, grand multiparty and uterine infection
Other uterotonic agents have been studied, and have been shown to
reduce PPH, including carbetocin, a long-acting synthetic oxytocin analogue,
ergot alkaloids (such as ergonovine, syntometrine) and prostaglandins (such
as misoprostol and carboprost) .
However, since its introduction, there have been few studies of
its effectiveness for the prevention and treatment of PPH, and only one
specifically examining its use following cesarean delivery.
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