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CARBETOCIN Postpartum Hemorrhage powder
Detailed Description
Introduction:
Carbetocin, a synthetic long-acting oxytocin analog, exhibits properties similar to naturally occurring oxytocin. It acts as an agonist, binding to uterine smooth muscle receptors and causing rhythmic contractions of the uterus. Carbetocin is primarily effective in pregnant and newly delivered uteruses, as the oxytocin receptor content is significantly higher during these periods. In this essay, we will explore the clinical and pharmacological properties of carbetocin, focusing on its use in controlling postpartum hemorrhage and preventing uterine contraction after cesarean section.
Postpartum Hemorrhage Control:
Carbetocin is a valuable drug used to manage postpartum hemorrhage, which refers to excessive bleeding after childbirth. By inducing uterine contractions, carbetocin helps restore uterine tone, reducing the risk of excessive bleeding. Its effectiveness lies in its ability to increase the frequency and tension of uterine contractions, preventing or minimizing postpartum hemorrhage.
Carbetocin is commonly administered after selective epidural or spinal anesthesia during cesarean section procedures to prevent uterine contraction and subsequent postpartum hemorrhage. This practice ensures that the uterine muscles remain contracted, reducing the likelihood of excessive bleeding. However, the use of carbetocin in emergency cesarean sections, classic cesarean sections, and under other types of anesthesia or in the presence of specific medical conditions has not been extensively studied. Therefore, caution should be exercised when considering carbetocin administration in these situations.
Mechanism of Action:
Carbetocin functions as an oxytocic, antihemorrhagic, and uterotonic drug, primarily targeting the peripheral nervous system. It acts as an agonist at peripheral oxytocin receptors, particularly in the myometrium (uterine muscle). These oxytocin receptors are G protein-coupled, and their activation involves second messengers and the production of inositol phosphates. Carbetocin mimics this mechanism, binding nonselectively at the extracellular N-terminus and loops E2 and E3 of the oxytocin receptor. Although carbetocin and oxytocin have similar affinity for the receptors, carbetocin's biological effect is approximately 50% that of endogenous or exogenous oxytocin. Notably, carbetocin has a longer-lasting effect than oxytocin, requiring only a single dose. It also inhibits the release of endogenous oxytocin, disrupting the uterine feedback loop with the hypothalamus and reducing both central and peripheral oxytocin release. Carbetocin can be considered a biased agonist of the oxytocin receptor.
During pregnancy, the synthesis of oxytocin receptors in the uterus significantly increases, reaching its peak during labor and delivery. Consequently, the administration of carbetocin or other oxytocin analogs during or immediately after birth enhances the uterotonic and contractile effects. However, carbetocin has no effect on non-pregnant uteruses with lower oxytocin receptor expression. Additionally, carbetocin contributes to blood thickening, further reducing the risk of postpartum hemorrhage.
Precautions and Limitations:
It is important to note that carbetocin should not be used for labor induction or augmentation, as it may lead to cardiac or respiratory distress in both the mother and infant.
Conclusion:
Carbetocin, a synthetic oxytocin analog, offers a valuable approach to managing postpartum hemorrhage and preventing excessive bleeding after cesarean section. By mimicking the mechanisms of naturally occurring oxytocin, carbetocin induces uterine contractions and promotes uterine tone. However, its use should be carefully considered in specific scenarios, and healthcare professionals must exercise caution when administering carbetocin.
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