Hi Annette,
Included in the RCOG guidance is a summary of evidence regarding the use of
both drugs.
http://www.rcog.org.uk/files/rcog-corp/GT52PostpartumHaemorrhage0411.pdf
It is interesting that there is a reluctance to use syntocinon only when
this is national guidance. I do not recall a sudden increase in PPH when we
changed our practice. We will still use syntometrine on occasion where
lochia is deemed to be moderate, however this is not a frequent occurrence.
Whenever I have administered syntometrine, invariably the woman experiences
nausea and/or vomiting which does not occur with syntocinon only. There is
also less occurrence of retained placenta with syntocinon only.
There is no doubt that ergometrine has a place in the management of actual
PPH but I definitely do not believe that there is any benefit to women to
use syntometrine prophylactically.
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On Behalf Of Sheila Brown
Sent: 24 February 2013 17:33
To: [log in to unmask]
Subject: Re: syntometrine induced eclamptic fits
Hi Annette,
There is a systematic review which may be of interest by McDonald et
al (2007). Here is the link. I just briefly looked at it. The authors
conluded that there was no statistically significant difference
between the two, with regards to blood loss, for blood loss over 1000
mls.
http://apps.who.int/rhl/reviews/langs/CD000201ru.pdf
Sheila
On 24 February 2013 17:24, Briley, Annette <[log in to unmask]>
wrote:
> Hi Laura
> With using Syntocinon as first line what is your PPH rate? Anecdotally
many
> feel the temporal rise in PPH is due to oxytocin for AMTSL. Have you got
> evidence this isn't the case?
>
> Annette
>
> Sent from my iPhone
>
> On 24 Feb 2013, at 16:56, "Laura Muir" <[log in to unmask]> wrote:
>
> 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
>
>
>
>
>
>
>
> ________________________________
>
> From: A forum for discussion on midwifery and reproductive health
research.
> [mailto:[log in to unmask]] On Behalf Of Martine Storey
> Sent: 23 February 2013 15:26
> To: [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
>
> QMC Campus, Nottingham
--
Sheila JS Brown
07840 296 731
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