DRUGS ACTING ON

UTERUS
 UTERINE RELAXANTS
(TOCOLYTICS)

Decrease uterine motility

Use:
• Delay/Postpone labour
• Arrest threatened abortion
• Dysmenorrhoea
 DRUGS
• Adrenergic drugs: Ritodrine
Isoxsuprine
• Calcium channel blockers: Nifedipine
• Magnesium sulfate
• Oxytocin antagonist: Atosiban
• Miscellaneous drugs: Ethyl alcohol
Nitrates
Progesterone
GA
PG synthesis inhibitors
 ADRENERGIC DRUGS

RITODRINE: β2 selective

MOA: β2 receptors on myometrium

Use: Suppress premature labour

Delay delivery
Dose: 50µg/min iv infusion
Rate increased every 10 min
Till uterine contractions cease
Or maternal HR above 120/min
Maintain : continue infusion
Or... 10 mg im 4-6 hrly, then orally

Delivery postponed in 70% cases....

By few hours to few weeks
Adverse effects:

CVS: Hypotension,Tachycardia,
Arryhthmia, Pulmonary edema
Metabolic: Hyperglycemia
Hyperinsulinemia
Hypokalemia
CNS: Anxiety, Restlessness, Headache
Fetal pulmonary edema
Avoid ..... if mother
• Is diabetic
• Has heart disease
• Receiving β blockers

Preparations:
• 10mg/ml (1 & 5 ml Amp)
• 10 mg tab
ISOXSUPRINE
• Long acting
• Poor efficacy

Preparations:
Duvadilan- 10 mg tab, 40 mg SR tab
10mg/2ml inj

Dose: 10mg oral/iv 4-6 hrly

CALCIUM CHANNEL BLOCKERS
NIFEDIPINE:
Reduce tone of myometrium & oppose
contractions

Use:
Prophylaxis of recurrent premature labour
Dose:
• Oral 10mg every 20-30 min
(till contractions stop)
• Then 10mg 6 hourly

Adverse effects:
• Tachycardia and hypotension
• Reduced fetal perfusion-Fetal hypoxia
 MAGNESIUM SULFATE
PIH: To control convulsions and reduce BP
• iv bolus (2-4g over 10-20 min)
• 1g/hr iv infusion regulated by response
WHO - Drug of choice

To delay preterm labour:

• Recent review (2002) – Ineffective
Problems:
• High infant mortality (especially if premature and
LBW)

• Maternal & neonatal

Cardiac arrhythmias
Muscular paralysis
CNS depression
Respiratory depression
Monitor :
• BP
• Resp rate
• Urine output
• Signs of overdosing
Loss of Knee jerk
Flushing
Drowsiness
Double vision
Slurred speech
 OXYTOCIN ANTAGONIST
ATOSIBAN: Peptide analog of oxytocin
Antagonist at oxytocin receptor

Suppresses preterm labour

• Fewer CVS & metabolic complications
• ? Higher infant mortality
 MISCELLANEOUS DRUGS
• Ethyl alcohol, Nitrates, Progesterone, General
anaesthetics, PG synthesis inhibitors
• Not dependable

Halothane anesthesia:
Used in external or internal version attempted
Prostaglandin synthesis inhibitor:
Indomethacin

Problems:
• Unpredictable efficacy
• Premature closure of fetal ductus arteriosus
• Oligihydramnios
• Intraventricular heamorrhages in newborn

Use: Dymenoehoea