Pharmacotherapy in obstetrics


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Pharmacotherapy in obstetrics

  1. 1. Pharmacotherapy in obstetrics<br />
  2. 2. Topics of the lecture<br />Introducton<br />Medications used during pregnancy – hormones and neuro-peptide analogues<br />Medications used in labor<br />Medications used for miscarriage treatment<br />Medications used for fetal hypoxia and gestosis treatment.<br />Medications used for treatment of extra-genital pathology.<br />Medications used for treatment of puerperium diseases.<br />
  3. 3. Introduction<br />Neuro-humoral system of woman is aimed for keeping uterus’ muscle relaxed during pregnancy. It’s possible because of increasing of blood levels of steroid hormone pregesterone which is “pregnancy pretector”<br />
  4. 4. Both estrogens and proges-terone are increased during pregnancy but proges-terone prevails<br />
  5. 5. Influence of steroid hormones<br />Progesterone performs its acton on uterus only in case estrogenes are synthesised enough by corpus luteumand placenta<br />In other case, progesterone looses its relaxing action on uterus’ muscle <br />
  6. 6. Progesterone<br />Increases level of adenosinmonophosphate (AMP) which ties Са2+ ions and blocks actine-myosine contractions<br />
  7. 7. Progesterone<br />Increases membrane potential of myocyte and particularly blocks impulses between myocytes<br />Myometrium becomes insensitive to irritatons<br />myometrium<br />
  8. 8. Progesterone<br />Since placenta is formed, progesterone is synthesized by it.<br />Consequently, placental site is more relaxed than the rest of myometrium<br />
  9. 9. Progesterone<br />Keeps its relaxing action even in case of retention of the part of the placenta inside of the uterus in puerperium.<br />It can provoke sub-involution of uterus and post-partum bleeding<br />
  10. 10. Influence of steroid hormones<br />Before labor level of progesterone decreases and estrogenes are rised<br />Estrogenes take out myometrium block<br />
  11. 11. Influence of steroid hormones<br />Membranes of myocytes become sensitive to:<br />oxitocine, <br />prostaglandines, <br />catheholamines, <br />serotonine.<br />
  12. 12. Mechanism of myometrium contractions<br />Depolarization of membtanes<br />Releasing of Ca2+<br />Interaction of calcium ions with contractive proteins.<br />
  13. 13. Mechanism of myometrium contractions<br />Myometrium has alpha and beta-adrenoreceptors.<br />Stimulation of alpha-receptors by catheholamines causes uterus contraction<br />Stimulation of beta-receptors by catheholamines causes uterus relaxation<br />
  14. 14. Mechanism of myometrium contractions<br />Uterus body contains alpha and beta catheholamines receptors<br />Lower segment contains choline and <br />serotonine receptors<br />Cervix contains chemo-, baro- and mechanoreceptors<br />
  15. 15. Uterotonics and tocolytics drugs<br />Uterotonics increase uterine contractions (oxytocine, prostaglandines, serotonine, kinines, cathecholamines). <br />Tocolytics decrease uterine contracions (spasmolytics, beta-receptor-stimulating medications, anti-oxytocin drugs).<br />
  16. 16. Oxitocine<br />It’s a hormone of supra-optic and para-ventricular nuclei of hypothalamus <br />Transported to pituitary by axons<br />Performs its influence on membranous level<br />
  17. 17. Prostaglandines<br />Play very big role in preparing to labor and delivery onset.<br />“Tissue hormones” are made from fatty (lipid) acides<br />
  18. 18. Prostaglandines<br />Nowadays synthetic analogues of E2 and F2-alpha prostaglantines are popular because of their high activity<br />E2 medications (dinoprostone, prepidil-gel, 1 mg) prepare cervix for labor (makes it “ripe”)<br />F2-alpha medications (dinoprost, enzaprost, i.v. 5 mg/ml) cause regular uterine contractions<br />
  19. 19. Prostaglandines<br />Their administration causes termination of pregnancy in any term<br />
  20. 20. Pharmacotherapy of miscarriage<br />Spasmolytics: drotaverine (No-spa) 2 ml i.m., papaverine in average doses<br />Homeopatic medication: Viburcol<br />
  21. 21. Magnesial treatment<br />MgSO4 25% - 40 ml i.v. soluted in 400 ml of 0.9% NaCl<br />MagneB6 1 pill 4-6 times daily (200-300 mg of Mg daily), <br />
  22. 22. Tocolysis (after 16 weeks of pregnancy)<br />Beta-adrenoreceptor agonist:<br />Gynipral (hexoprenalini<br />sulphatis)<br /> Pills 0.5 mg each 6-12 hrs<br />I.v. vials 5 mcg<br /> Side effects should be treated by calcium antagonists: verapamil (isoptin) 1 pill (40 mg) 3 times daily<br />
  23. 23. Tocolysis (after 16 weeks of pregnancy)<br />Calcium-chanel-blocking agents:<br />Corinfar (nifedipine) 10 mg every 20 min until symptoms of threatening of pre-term labor are resolved<br />
  24. 24. Key points of hormonal therapy of mascarriage<br />Hormonal medications should be strictly indicated;<br />Risk/benefit should be assessed thoroughly;<br />Individual dosage;<br />Prescription after 8 weeks of pregnancy should be preferred.<br />
  25. 25. Gestagens<br />Progesterone 10-25 mg daily; <br />Utrogestane 100 mg p.o. per vaginum 2 times per day (till 27 weeks); <br />Duphastone (didrogesterone) – 40 mg once, then 1 pill(10 mg) 2-3 times daily.<br />
  26. 26. Treatment of post-partum hemorrage<br />Oxitocine 5-20 IU<br />Methylergometrine— 1 ml i.m.<br />Prostaglandines<br />
  27. 27. Thank You!<br />