Hello,
In the last confidential enquiry it was recommended that women should not
receive syntometrine as a first line drug for the active management of the
third stage of labour due to the side effects not being able to be
predicted. There were 3 women who died of cerebral haemorrhage, one of whom
had normal blood pressure. One was known to have hypertension and the third
had laboured too rapidly for blood pressure recording.
In my own unit, syntocinon only has been used for the active management of
the third stage for a number of years. As such there was a vast reduction in
the number of women who experienced vomiting and headache post birth which
interfered with the precious first moments of mother with baby.
I think the question that should be asked is why are other units still
using syntometrine as a first line?
Laura Muir
Labour Suite Co-ordinator/ Supervisor of Midwives
Ayrshire Maternity Unit
Scotland
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On Behalf Of Cecily Begley
Sent: 24 February 2013 06:17
To: [log in to unmask]
Subject: Re: MIDWIFERY-RESEARCH Digest - 22 Feb 2013 to 23 Feb 2013
(#2013-40)
Dear Martine,
There are references to this phenomenon occurring, but rarely, in the
literature in the 1960s and 1970s, usually following administration of
Ergometrine. Syntometrine is less likely to cause severe hypertension, with
resultant eclamptic seizures, as the syntocinon fraction has a hypotensive
effect, but it does still cause more hypertensive episodes than when no
oxytocic is given. In the Dublin trial of third stage management 1429 women
were randomly allocated to receive either "active" management using 0.5mg
Ergometrine IV or "physiological", with no routine oxytocic drug. One woman
in the "active" group who had no previous hypertension either antenatally or
in labour, had an eclamptic fit 4 hours after delivery and another woman in
the "active" group of the pilot study also had an eclamptic fit post
delivery. The paper is attached.
Regards,
Cecily
Prof. Cecily M. Begley,
Chair of Nursing and Midwifery,
School of Nursing and Midwifery,
Trinity College Dublin,
24, D'Olier St.
Dublin 2
Tel: 353 1 8962693
Fax: 353 1 896 3001
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On Behalf Of MIDWIFERY-RESEARCH
automatic digest system
Sent: 24 February 2013 00:02
To: [log in to unmask]
Subject: MIDWIFERY-RESEARCH Digest - 22 Feb 2013 to 23 Feb 2013 (#2013-40)
There is 1 message totaling 64 lines in this issue.
Topics of the day:
1. syntometrine induced eclamptic fits
----------------------------------------------------------------------
Date: Sat, 23 Feb 2013 15:25:37 -0000
From: Martine Storey <[log in to unmask]>
Subject: syntometrine induced eclamptic fits
Hi midwives,
We have recently had a case whereby a low risk woman had a grand mal fit
after being given syntometrine. She was treated with diazemuls and
phenytoin. All her PET associated blood films were normal, as was her blood
pressure. Her final diagnosis was eclamptic fit induced by syntometrine
administration. In her subsequent pregnancy she was not offered or given
this drug, getting syntocinon instead with no side effects.
My query is how frequent is this phenomena and is there an increase in its
occurence? What are the factors that predispose to this happening?
Martine Storey
Labour Coordinator/Supervisor of Midwives
------------------------------
End of MIDWIFERY-RESEARCH Digest - 22 Feb 2013 to 23 Feb 2013 (#2013-40)
************************************************************************
|