What medicine can shrink the uterus?

In clinical medicine, there are many kinds of drugs that promote uterine contractions, such as ergoflavonoids, vasopressin or prostacyclin. Among them, the most common one is oxytocin. In addition, there are also miso, carboprogesterone methyl suppositories, carboprogesterone amine tincture triol, ergonovine, etc.

Uterine contractions are a class of drugs that can selectively stimulate uterine smooth muscle and induce uterine contractions. Common drugs in clinical medicine are divided into three categories: vasopressin, prostaglandins, and ergoflavonoids.

introduce

Uterine contractions are a class of drugs that can selectively stimulate uterine smooth muscle and induce uterine contractions. Due to different drugs, different dosages and different physiological conditions of the uterus, the uterus may contract regularly or rigidly after taking the medicine. Drugs that cause regular contraction of the uterus can be used to induce labor or abortion before delivery; drugs that cause rigid contraction of the uterus are mostly used to promote blood circulation or restore the uterus after delivery. In addition, some drugs are also used in abortion surgery. [1]

Drug Classification

Common drugs in clinical medicine are divided into three categories: vasopressin, prostaglandins, and ergoflavonoids. [2]

Common drugs in clinical medicine:

1. Posterior pituitary hormones

(1) Oxytocin

This product is obtained from the neurohypophysis (posterior pituitary) of pigs, cattle and sheep, and can also be synthesized artificially. Their potency is expressed in units, with 1 unit equal to 2 µg of pure oxytocin.

Whole body process: Intramuscular injection is well digested and absorbed, with effects seen within 3-5 minutes and lasting for 20-30 minutes. Can be digested and absorbed through the nostrils. Most of it is destroyed by the liver, and a small portion is excreted unchanged in the urine.

Medicinal value: It has been confirmed that there is oxytocin kinase in the uterine smooth muscle and mammary gland. Oxytocin causes uterine contraction and promotes milk ejection by combining with kinase. The relative density of protein kinase in the non-pregnant uterus is low, while the total amount of protein kinase in the pregnant uterus increases gradually, reaching a peak value in the middle and late stages of pregnancy, and the total amount of protein kinase in the uterus is significantly higher than that in the cervix.

Blood pressure stimulates the uterus: Oxytocin can selectively stimulate uterine smooth muscle and increase uterine contractions. The efficacy and characteristics are as follows:

The effect is rapid and short-lived;

It has strong stimulating effect on the uterine body, but weak stimulating effect on the cervix;

The characteristics and strength of uterine contraction depend on the dosage. A certain dosage makes the uterus contract regularly, which is similar to normal labor and is beneficial to the delivery of the fetus. A large dosage causes the uterus to contract rigidly, which is not good for the fetus and pregnant mother during labor.

The effect is affected by the physiological state of the uterus: the body's estrogen level is high in the early stages of pregnancy, which can reduce the uterus's sensitivity to oxytocin, so the uterus is not sensitive to oxytocin in the early stages; the uterus's sensitivity to oxytocin gradually increases in the middle and late stages of pregnancy, reaching a peak during labor. This is because the body's estrogen level gradually increases with the progress of pregnancy, and estrogen can increase the uterus's sensitivity to oxytocin; after delivery, the uterus's sensitivity to oxytocin gradually decreases.

Blood promotes milk secretion: Oxytocin can cause the myosquamous epithelial cells around the mammary alveoli to contract, which can promote milk secretion, but does not increase the total milk output.

Other supplementary effects: Large doses of oxytocin can relax vascular smooth muscles and have a temporary blood pressure lowering effect; it also has a slight anti-diabetic effect.

Main uses in clinical medicine:

Blood pressure induction and labor induction surgery:

For pregnant women with dystocia due to uterine atony with normal fetal position and birth canal, a dose of oxytocin can be used to induce labor in order to increase the regularity of uterine contraction and promote delivery;

For those who need to terminate the pregnancy early due to fetal death, overdue pregnancy and pregnancy with serious diseases (such as heart disease, tuberculosis, etc.), dosed oxytocin can be used for induced abortion.

Blood circulation after childbirth: In case of postpartum hemorrhage, a large amount of oxytocin (5-10 mg) should be injected intramuscularly or subcutaneously immediately to cause the uterus to contract rigidly, compress the blood vessels in the muscle layer and activate blood circulation. However, due to its short-lived effect, it has been replaced in clinical medicine by ergonovine, which has a fast and long-lasting effect through intramuscular injection.

Supplementary lactation: 2-3 minutes before breastfeeding, use nasal drops to drip into the nose, 3 drops each time. After being absorbed by the mucosa, it can promote the secretion of milk. It can also be injected intramuscularly for 2-5 days to promote lactation.

side effect:

Blood pressure is slightly nausea, vomiting, and arrhythmia;

Excessive use of blood can cause persistent tonic contraction of the uterus, causing fetal intrauterine asphyxia and even uterine rupture.

Common problems with medication: When oxytocin is used to induce labor or abortion, please be sure to pay attention to the following:

Strictly control the dosage of blood pressure: timely adjust the intravenous drip rate according to the uterine contraction and fetal heartbeat status to avoid uterine tonic contraction.

Contraindications: Patients with abnormal birth canal, transverse fetal position, cephalopelvic disproportion, placenta previa, primiparas with more than three children, and cesarean section are prohibited from using it to avoid uterine rupture or fetal intrauterine asphyxia.

Supplementation with Chinese herbal preparations of oxytocin obtained from the pituitary glands of small animals may occasionally cause allergic symptoms, while synthetic ones do not.

(2) Pituitrin

This product is a crude Chinese medicine preparation obtained from the pituitary gland of small animals such as pigs, cattle, and sheep, containing equal amounts of oxytocin (oxytocin) and vasopressin (adrenal hormone).

The oxytocin in posterior pituitary hormone has the effect of inducing labor, inducing labor or activating blood circulation after giving birth. Due to its complex ingredients, including troponins, its selectivity for uterine smooth muscle is not high, and it has many side effects. Therefore, it has been replaced by oxytocin as a uterotonic drug. The vasopressin contained in posterior pituitary hormone has two functions: blood pressure increases the metabolism of water by combining with the corresponding protein kinase on the renal collecting duct, has a significant anti-diabetic effect, and can be used to treat diabetes insipidus; blood pressure acts on vascular smooth muscle, constricts blood vessels, especially capillaries and visceral arteries, and can be used to treat pulmonary hemorrhage (hemoptysis) and esophageal and gastric varicose vein rupture bleeding (hematemesis).

In addition, vasopressin also has the effect of transiently increasing blood pressure and stimulating gastrointestinal smooth muscles. After using posterior pituitary hormone, side effects such as nausea, vomiting, pale complexion, sweating, palpitations, chest tightness and shortness of breath, abdominal pain, constipation and allergic symptoms may occur. In such cases, the drug should be stopped immediately. It is forbidden to use if you have hypertension, coronary heart disease, cor pulmonale, heart failure, pregnancy-induced hypertension syndrome, etc. See oxytocin for other contraindications.

2. Ergot flavonoids

(1) Hydroxyergosides

Ergonovine, ergometrine

Medicinal value: It can selectively stimulate the smooth muscle of the uterus and cause uterine contraction. Its characteristics are:

The blood pressure effect is fast, strong and long-lasting;

Blood is more sensitive to the pregnant uterus than the non-pregnant uterus, especially during labor and after a newborn.

The supplement has no selective effect on the uterus and cervix, which is not conducive to the delivery of the fetus, so it is forbidden to use it in inducing labor and abortion.

A slightly larger amount of weight will cause the uterus to contract rigidly, compressing the blood vessels and activating the blood circulation.

Main uses in clinical medicine:

Blood pressure abnormal uterine bleeding: used for abnormal uterine bleeding caused by childbirth, curettage, menorrhagia, etc. Intramuscular injection is often used to cause the uterine smooth muscle to contract rigidly, mechanically compressing the blood vessels in the muscular layer to activate blood circulation.

Blood and uterine recovery after childbirth: Slow uterine recovery after childbirth can cause bleeding and infection. Therefore, after giving birth, the baby is used to promote uterine contractions to speed up its recovery.

Side effects: Some patients experience nausea, vomiting, dizziness, sweating, pale complexion and increased blood pressure; some patients experience allergic symptoms, and in severe cases, they may experience difficulty breathing and low blood pressure.

Contraindications: It is forbidden to use in patients with preeclampsia, hypertension, and coronary heart disease; it is forbidden to use before the fetus and embryo are delivered to prevent the risk of uterine rupture, intrauterine suffocation of the fetus, and retention of the placenta in the uterine cavity.

(2) Carbohydrate ergotamines

Dihydrorgotoxine (Hydroxyergotoxine)

Hydrogenated ergot is a dihydrogenated compound that is used to purify ergot, and its function is different from that of ergot.

By blocking α-protein kinase, it can cause peripheral vasodilation, reduced blood pressure, slower heart rate, and regulate adrenaline secretion, etc. It is used clinically to treat vascular spasm.

Hydroergoline also has a central nervous system sedative effect. It can form a hibernation mixture with promethazine and pethidine and is used in clinical medicine for artificial hibernation.

The main side effect of this product is postural hypotension, so the patient should stay in bed for 2 hours after injection. It is forbidden to use in patients with hypotension, severe arteriosclerosis, coronary heart disease, renal insufficiency, etc.

Ergotamine

Ergotamine can constrict the cardiovascular system, reduce the strength of cerebral arterial heartbeats, and relieve migraines with an efficiency of 90%, but it cannot prevent the onset of migraines. Because ergotamine is absorbed slowly and irregularly, it is combined with caffeine, which can not only enhance the absorption of ergotamine, but also constrict the cardiovascular system and exert a synergistic effect. Long-term use can damage vascular endothelial cells and cause branch necrosis, so oral administration is limited to 2-4 days.