ergometrine


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Related to ergometrine: Carboprost, Syntometrine, Syntocinon

ergonovine

(er-goe-noe-veen) ,

ergometrine

(trade name),

Ergotrate

(trade name)

Classification

Therapeutic: none assigned
Pharmacologic: oxytocics
Pregnancy Category: UK

Indications

Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution.

Action

Directly stimulates uterine and vascular smooth muscle.

Therapeutic effects

Uterine contraction.

Pharmacokinetics

Absorption: Well absorbed after oral administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown. Probably metabolized by the liver.
Half-life: Unknown.

Time/action profile (uterine contractions)

ROUTEONSETPEAKDURATION
PO5–15 minunknown≥3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Avoid chronic use; Should not be used to induce labor.
Use Cautiously in: Hypertensive or eclamptic patients (increased susceptibility to hypertensive and arrhythmogenic side effects); Severe hepatic or renal disease; Sepsis; Third stage of labor.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Ear, Eye, Nose, Throat

  • tinnitus

Respiratory

  • dyspnea

Cardiovascular

  • arrhythmias
  • chest pain
  • hypertension
  • palpitations

Gastrointestinal

  • nausea (most frequent)
  • vomiting (most frequent)

Dermatologic

  • sweating

Miscellaneous

  • allergic reactions

Interactions

Drug-Drug interaction

Excessive vasoconstriction may result when used with other vasopressors, such as dopamine or nicotine.May ↑ the risk of adverse reactions with bromocriptine.

Route/Dosage

Oxytocic

Oral Sublingual (Adults) 0.2–0.4 mg q 6–12 hr (usual course is 48 hr).
Intramuscular Intravenous (Adults) 200 mcg (0.2 mg) q 2–4 hr for up to 5 doses.

Availability (generic available)

Tablets: 0.2 mg
Injection: 0.25 mg/mL

Nursing implications

Nursing assessment

  • Monitor BP, pulse, and respirations every 15–30 min until transfer to the postpartum unit, then every 1–2 hr. Report hypertension, chest pain, arrhythmias, headache, or change in neurologic status.
  • Monitor amount and type of vaginal discharge. Report symptoms of hemorrhage (increased bleeding, hypotension, pallor, tachycardia) immediately.
  • Palpate uterine fundus; note position and consistency. Notify health care professional if fundus fails to contract in response to ergonovine. Assess patient if cramping is severe; dose may be decreased.
  • Assess for signs of ergotism (cold, numb fingers and toes; nausea; vomiting; diarrhea; headache; muscle pain; weakness).
  • If patient fails to respond to ergonovine, check serum calcium level. Correction of hypocalcemia may restore responsiveness.
  • Lab Test Considerations: May cause ↓ serum prolactin level, which inhibits synthesis of breast milk.
  • Toxicity, initially manifested as ergotism, may cause seizures and gangrene. Seizures are treated with anticonvulsants. Vasodilators and heparin may be ordered to improve circulation to extremities.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)
Risk for injury (Side Effects)

Implementation

  • Do not administer solution that is discolored or contains a precipitate.
  • Oral: Administration is usually limited to 48 hr postpartum, by which time the danger of hemorrhage from uterine atony has passed.
    • Tablets may be administered SL.
  • Intramuscular: The preferred route is IM. Firm uterine contractions are produced within a few minutes. Dose may need to be repeated every 2–4 hr for full therapeutic effect.
  • Intravenous Administration
  • pH: 2.7–3.5.
  • The IV route is reserved for severe uterine bleeding. Diluent: Dilute with 5 mL of 0.9% NaCl.
  • Rate: Administer slow IV push over at least 1 min through Y-site injection of an IV of D5W or 0.9% NaCl.

Patient/Family Teaching

  • Review symptoms of toxicity with patient. Instruct the patient to report occurrence of these immediately.
  • Inform patient that uterine cramping demonstrates effectiveness of therapy.
  • Explain need for pad count to determine degree of bleeding. Instruct patient to report immediately an increase in degree of bleeding or passage of clots.
  • Instruct patient to report breastfeeding difficulties.
  • Caution patient not to smoke while receiving ergonovine; nicotine is also a vasoconstrictor.

Evaluation/Desired Outcomes

  • Uterine contraction and cramping in the prevention or cessation of uterine hemorrhage after delivery or abortion.

er·go·no·vine

(er'gō-nō'vēn),
An alkaloid from ergot; on hydrolysis it yields d-lysergic acid and l-2-aminopropanol; stimulates uterine contractions.

ergometrine

An ERGOT derivative drug used to promote contractions of the muscle of the womb (uterus). This can be valuable, after the baby is born, to close off the site of separation of the after-birth (placenta) and prevent POSTPARTUM HAEMORRHAGE. It is sometimes given when delivery of the baby is almost accomplished. The drug is on the WHO official list. A brand name is Syntometrine.
References in periodicals archive ?
Active pharmacologic management of the third stage of labour: A comparison of oxytocin and ergometrine. Obstet Gynecol.
In the study 79% of women received either oxytocin, ergometrine or both, as is routine in the NHS.
However, misoprostol is now gaining favor over dinoprostone for patients who fail both oxytocin and ergometrine. Given at a dose of 1,000 [micro]g (five tablets) rectally, it was 100% effective in 14 such patients (Obstet.
(340) Although ergometrine may cause bronchospasm particularly in association with general anaesthesia, (340) this is not a problem encountered when syntometrine (syntocinon/ergometrine) is used for postpartum haemorrhage prophylaxis.
Mrs Wildsmith was given ergometrine - a drug routinely given to mothers to ensure the placenta comes away from the uterine wall.
Currently, the import of ergotamine, ergometrine, pseudoephedrine, ephedrine, and lysergic acid is conditional with the recommendation from the Narcotics Division.
(47.) For data on RU 486/oral misoprostol abortion, see Thong & Baird, 1992 (4% of users: 1 woman needed emergency curettage for heavy bleeding due to incomplete abortion; 3 women were given intramuscular ergometrine for heavy bleeding at the time of expulsion of products); Peyron, et al., 1993 (0.4% of patients (2 women) in study 1 had hemorrhage requiring hemostatic curettage, with one patient needing a blood transfusion 9 days after misoprostol when hemoglobin fell from 13.0 g/dl to 6.1 g/dl); McKinley, et al., 1993 (5.5% had a drop in hemoglobin >2 g/dl, but no blood transfusions).
In addition, given the increased risk and danger of haemorrhage in the context of CS, addition of ergometrine for women without contraindications, and a second dose of oxytocin after 4 hours, have been recommended.
She continued to bleed on and off and after 10 minutes intravenous ergometrine 0.5mg was given but the bleeding continued.
AbstractObjective: To compare the safety and efficacy of 10 units of intravenous syntocinon alone with 10 units intravenous syntocinon and 0.25mg intramuscular ergometrine in the prevention of atonic uterine haemorrhage during caesarean section.Method: The quasi-experimental study was conducted at the Maternal and Child Health Centre Unit I Pakistan Institute of Medical Sciences Islamabad from November 1 2010 to February 28 2011.
Injection Oxytocin 20 IU and Inj Nexbolic (Methyl ergometrine maleate) 3 ml was administered by l/M route on 1S1 day only.