Syntometrine


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Related to Syntometrine: Syntocinon

oxytocin

Pitocin, Syntocinon (CA) (UK), Syntometrine (UK)

Pharmacologic class: Posterior pituitary hormone

Therapeutic class: Uterine-active agent

Pregnancy risk category NR

FDA Box Warning

• Drug isn't indicated for elective induction of labor (defined as initiation of labor in pregnant woman with no medical indications for induction). Available data aren't adequate to evaluate benefits versus risk.

Action

Unknown. Thought to directly stimulate smooth muscle contractions in uterus and cervix.

Availability

Injection: 10 units/ml ampule or vial

Indications and dosages

To induce or stimulate labor

Adults: Initially, 1-ml ampule (10 units) in compatible I.V. solution infused at 1 to 2 milliunits/minute (0.001 to 0.002 units/minute). Increase rate in increments of 1 to 2 milliunits/minute q 15 to 30 minutes until acceptable contraction pattern is established.

To control postpartum bleeding

Adults: 10 to 40 units in compatible I.V. solution infused at rate adequate to control bleeding; or 10 units I.M. after placenta delivery

Incomplete abortion

Adults: 10 units in compatible I.V. solution infused at 10 to 20 milliunits/minute (0.01 to 0.02 units/minute)

Off-label uses

• Antepartal fetal heart rate testing
• Breast enlargement

Contraindications

• Hypersensitivity to drug
• Cephalopelvic disproportion
• Fetal distress when delivery is not imminent
• Prolonged use in uterine inertia or severe toxemia
• Hypertonic or hyperactive uterine pattern
• Unfavorable fetal position or presentation that's undeliverable without conversion
• Labor induction or augmentation when vaginal delivery is contraindi-cated (as in invasive cervical cancer, active genital herpes, or total placenta previa)

Precautions

Use cautiously in:
• previous cervical or uterine surgery, history of uterine sepsis
• breastfeeding patients.

Administration

• Reconstitute by adding 1 ml (10 units) to 1,000 ml of normal saline solution, lactated Ringer's solution, or dextrose 5% in water.

Don't give by I.V. bolus injection.
• Infuse I.V. using controlled-infusion device.
• Be aware that drug isn't routinely given I.M.
• Know that drug should be given only to inpatients at critical care facilities when prescriber is immediately available.

Adverse reactions

CNS: seizures, coma, neonatal brain damage, subarachnoid hemorrhage

CV: premature ventricular contractions, arrhythmias, neonatal bradycardia

GI: nausea, vomiting

GU: postpartal hemorrhage; pelvic hematoma; uterine hypertonicity, spasm, or tetanic contraction; abruptio placentae; uterine rupture (with excessive doses)

Hematologic: afibrinogenemia

Hepatic: neonatal jaundice

Other: hypersensitivity reactions including anaphylaxis, low 5-minute Apgar score (neonate)

Interactions

Drug-drug.Sympathomimetics: postpartal hypertension

Thiopental anesthetics: delayed anesthesia induction

Vasoconstrictors: severe hypertension (when given within 3 to 4 hours of oxytocin)

Drug-herbs.Ephedra (ma huang): increased hypertension

Patient monitoring

Continuously monitor contractions, fetal and maternal heart rate, and maternal blood pressure and ECG. Discontinue infusion if uterine hyper-activity occurs.

Monitor patient extremely closely during first and second stages of labor because of risk of cervical laceration, uterine rupture, and maternal and fetal death.
• When giving drug to control postpartal bleeding, monitor and record vaginal bleeding.
• Assess fluid intake and output. Watch for signs and symptoms of water intoxication.

Patient teaching

• Inform patient about risks and benefits of oxytocin-induced labor.

Teach patient to recognize and immediately report adverse drug effects.

Syntometrine

A brand name for ERGOMETRINE.
References in periodicals archive ?
A randomised trial of carbetocin versus syntometrine in the management of the third stage of labour.
And Mrs Hureh was later given Syntometrine, which is used to stimulate the womb and help deliver the placenta - but should not be given to women with pre-eclampsia.
She said: "All the opportunities that were not taken up to recognise her high blood pressure culminated in what has been described to me as a critical and unforgivable error of giving her Syntometrine.
A pilot-randomized comparison of sublingual misoprostol with syntometrine on the blood loss in third stage of labor.
Considering the high incidence of anaemia in our country and in an effort to minimise blood loss our unit policy from 1996 is IV syntometrine (10units syntocinon and0.
When simple massage of the uterus and uterotonics such as oxytocins, syntometrine and prostaglandins fail to manage the condition, surgical solutions including uterine artery ligation, devascularization of the uterus, internal iliac artery ligation and ultimately hysterectomy are employed.
Jasten Phiri, 49, should have administered a dose of diamorphine to the mother when he accidentally injected the drug syntometrine, it is claimed.
Had the blood pressure been acknowledged appropriately, Mrs Hureh would also not have been given Syntometrine to stimulate the womb to contract and help the delivery of the placenta.
Dr Long was quizzed by Mrs Hassell and admitted that had she knownabout the conditions, she would have diagnosed pre-eclampsia and a drug, Syntometrine, had been administered that was not appropriate for a patient suffering pre-eclampsia.
She stole Syntometrine from hospital and then accused her midwife of injecting the lethal dose.