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Andrea, in reply to your questions: “
ergot alkaloids act on dopamine receptors to suppress prolactin production and
lactation “. And “intravenous ergotamine 500mcgms for management of
the third stage gave a statistically significant increase in the number of
women supplementing and ceasing breastfeeding by one and four weeks postpartum,
mainly because lactation was inadequate for the infants needs.” And “Midwives
need to consider that syntometrine may adversely impact on breastfeeding.”
When she speaks of side effects of erometrine, we need to remember
that combining it with syntocinin doesn’t reduce the risk of side effects
of the ergometrine alone, just adds on the side effects of syntometrine. We
do know that syntocinin alone has a positive effect on lactation in some women.
And “hypersensitivity responses:
anaphylactic shock, weak & rapid pulse, pulmonary oedema, dysnoea, broncho
spasm in asthmatic women.” And Puerperal psychosis may be linked to
ergometrine administration”. Pge 71. I know that Syntometrine is
designed for IMI use, but I have seen it given IV in some hospitals as routine.
Pge 173 speaks of the positive effects of active management of the
third stage with oxytocics, but recommends syntocinin alone, because there are
less side effects eg: less nausea, vomiting, sweating, headache, shortness of
breath, chest pain, blood pressure elevation, and bradycardia” . Pge 169,
“mild or moderate diarrhoea” and “reflex bradycardia
and reduced cardiac output, hypertensive crisis and cerebral haemorrhage,
postpartum eclamptic fits, raised central venous pressure, coronary artery
spasm.” And “cerebral vasoconstriction may cause sudden severe
headache, dizziness, sweating, confusion, retinal detatchment, cerebrovascular
accisdent or seizures”. Vasoconstricion may affect peripheral
circulation (cold hands and feet), occasionally numbness, paraesthesae, pain,
weakness or even gangrene” This is not particularly talking
about IV administration, just the side effects of the action of the drug which
is complex. There are also a lot of side effects of oxytocin alone (syntocinon)
especially in relation to augmentation or induction. They are too long to
quote. There is a website (one of a million) http:/www.drugdigest.org which
gave a good, simple, coverage of the contraindications and side effects which
should be given to women before they give informed consent for the use of this
drug. (Do women give informed consent
? ) This information should not make anyone defensive about their practice, but
it is good to be aware of the full implications of drugs we use so often and of
the possible side effects we ignore, but for the woman are unpleasant. In
the past, women thought that vomiting after the baby was born was a normal part
of labour. No one told them it was because of the syntometrine they were
routinely given. Cheers, MM |
