Uterotonics are the mainstay of management for postpartum haemorrhage and an understanding of their use is essential for the obstetric anaesthetist. First-line uterotonics comprise oxytocin and carbetocin, which act on the oxytocin receptor, and recent research has shown that lower doses of first-line uterotonics can be used to adequate effect. The oxytocin receptor is known to undergo desensitisation with exposure to the agonist over time and with increasing concentrations. Therefore, second-line uterotonics, such as ergometrine, carboprost, sulprostone or misoprostol, need to be considered earlier than they have been in past clinical practice. Choice of second-line uterotonic will vary depending on the comorbidities of the patient. This article will outline each of the available first- and second-line uterotonics, their mechanisms of action, pharmacokinetics, side effects and contraindications. Comparisons between them will also be discussed, as well as differences in superiority and guidance on dosing, based on recent evidence.
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Uterotonics update.
Best Pract Res Clin Anaesthesiol
September 2024
Center for Reproductive Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, USA. Electronic address:
Uterotonics are the mainstay of management for postpartum haemorrhage and an understanding of their use is essential for the obstetric anaesthetist. First-line uterotonics comprise oxytocin and carbetocin, which act on the oxytocin receptor, and recent research has shown that lower doses of first-line uterotonics can be used to adequate effect. The oxytocin receptor is known to undergo desensitisation with exposure to the agonist over time and with increasing concentrations.
View Article and Find Full Text PDFVacuum-induced tamponade for managing postpartum hemorrhage: a systematic review.
J Matern Fetal Neonatal Med
December 2024
Master of Physician Assistant Studies, Sacred Heart University, Fairfield, Connecticut, USA.
Article Synopsis
- - Postpartum hemorrhage is a significant cause of maternal health issues globally, and a new low-suction vacuum hemorrhage device (VHD) may offer an alternative treatment when standard medications fail.
- - A systematic review analyzed data from six studies, involving a total of 1,018 participants, where VHDs showed around 90% effectiveness in controlling bleeding within 5 minutes and had a total deployment time of 3 hours.
- - Although some minor adverse events were reported, the conclusion suggests that VHDs could provide a fast and effective mechanical solution for postpartum hemorrhage, but further rigorous studies are needed to evaluate their safety and efficacy.
A narrative review of the literature relevant to obstetric anesthesiologists: the 2023 Gerard W. Ostheimer lecture.
Int J Obstet Anesth
May 2024
Stanford University School of Medicine, Stanford, CA, USA. Electronic address:
Unlabelled: This narrative review of the 2023 Gerard W. Ostheimer lecture presented at the Society for Obstetric Anesthesia and Perinatology 2023 annual meeting summarizes 2022 literature relevant to obstetric anesthesiologists.
Antenatal Studies: Neonatal morbidity is reduced with antenatal maternal buprenorphine compared with methadone for treatment of opioid use disorder.
Introduction: Uterine compressive sutures are conservative measures applied in cases of severe postpartum hemorrhage unresponsive to uterotonics. Pereira's suture was introduced in 2005 and consists of two longitudinal and three transverse non-transfixes sutures. Previous studies reported favorable results, highlighting its benefits and value.
View Article and Find Full Text PDFA survey evaluating practice pattern in management of obstetric hemorrhage.
J Neonatal Perinatal Med
January 2023
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, George Washington University, Washington, DC, USA.
Background: Hemorrhage anticipation and management has shifted significantly over the past decade due to evolution of data surrounding management of obstetric hemorrhage. Limited data exists which describe the practical use and clinical application of hemorrhage management. Our goal was to identify obstetric hemorrhage management patterns in a cohort of practicing Maternal Fetal Medicine physicians.
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