About the use of IUDs

Just "where there is labor, where there is the uterus"? No! Today, I accompany you to pick up the use of uterus ~

First, the uterus in obstetrics and gynecology

The uterus is mainly synthesized in the cells of the supraoptic nucleus of the hypothalamus, paraventricular nucleus and stored in the posterior pituitary, and released into the bloodstream. It is synthesized in the cells of the supraoptic nucleus and paraventricular nucleus of the hypothalamus, stored in the posterior lobe of the pituitary gland, and released into the bloodstream, and to a lesser extent in the adrenal medulla, the heart, the amnion, the corpus luteum, and other peripheral organs. The main role of hysteronin is to promote the contraction of uterine smooth muscle, is the current clinical induction of labor to induce labor, prevention and treatment of postpartum hemorrhage of the drug of choice.

1, the prevention and treatment of postpartum hemorrhage

This everyone knows, the contraction is the prevention and treatment of postpartum hemorrhage of the first choice of drugs, especially the lack of uterine contraction postpartum hemorrhage. "Where there is labor, where there is hysterotonin", this has been an indisputable fact. Almost all national and international guidelines list it as the first-line drug for postpartum hemorrhage. When used for the prevention and treatment of postpartum hemorrhage, IUDs can be administered intramuscularly or intravenously. Prophylactic use of oxytocin before delivery of the placenta can reduce postpartum hemorrhage by 60%. For vaginal deliveries, the dose and mode of administration are currently standardized to 10 U of oxytocin intramuscularly in the uterus or intravenously. For elective cesarean section, WHO (2013) recommends 20 U/h of continuous IV oxytocin, and the Royal College of Obstetricians and Gynecologists (2012) recommends 5 U/h of slow IV push. In cesarean section, smaller doses of oxytocin (<5U/h) can maintain adequate uterine contractility and significantly reduce hemodynamic changes, so it is proposed that the use of maternal oxytocin in cesarean section should follow the "rules of threes" (3U of oxytocin slowly pushed intravenously, 3min intervals for assessment, 3min intervals for evaluation, and 5U of oxytocin slowly pushed intravenously, 3min intervals for evaluation, and 3min intervals for evaluation, and 3min intervals for assessment, based on the results of the evaluation, and the results of the evaluation, and the results of the evaluation. A 3-min interval for assessment is used to decide whether to repeat the procedure a total of three times, ending with a 3U/h intravenous drip and three alternatives for replacement in the event of a lack of efficacy of the contraction therapy). In high-risk women undergoing cesarean delivery, cabazitocin (a long-acting contraction) has been shown to significantly reduce postpartum hemorrhage compared with contraction.

2. Induction of labor

The Society of Obstetricians and Gynecologists of Canada (SOGC, 2013) recommends that induction of labor at 41 to 42 weeks of gestation reduces the perinatal mortality rate and meconium aspiration syndrome without increasing the rate of cesarean delivery. An important marker of successful induction of labor is the cervical ripeness score (Bishop score). In the case of cervical immaturity (Bishop's score less than 4-6), it is best to promote cervical ripening before induction of labor. It is now generally accepted that contractions are best used to induce labor with a ripe cervix. The method of use is to add 2.5U of oxytocin into 500ml of 5% dextrose injection for 6-8h intravenously, once a day, usually for 3d consecutively, which shows that oxytocin is worthy of further in-depth exploration in promoting cervical ripening. For cervical ripening patients, if there is no contraindication, the use of contractions for induction of labor immediately after manual rupture of membranes can significantly shorten the duration of labor and reduce the rate of cesarean section. There are two different intravenous drip regimens for the use of contractions in induction of labor: low-dose and high-dose regimens. The low-dose regimen is defined as an initial dose of 1-2 mU/min, adjusted by 1-2 mU/min at 30-min intervals, which reduces the incidence of rapid uterine contractions and their associated fetal heart rate abnormalities. The high-dose regimen is defined as an initial dose of 4-6 mU/min, with adjustments of 4-6 mU/min at 15-30 min intervals. This regimen has a shorter duration of labor, with fewer chorioamnionitis and less cesarean section for obstructed labor, but with an increase in the incidence of tachycardia and its associated abnormalities of the fetal heart rate.

3, oxytocin

In the first stage of labor oxytocin used to induce labor is the key to timely detection and correct assessment of contraction weakness, in order to obtain timely oxytocin to enhance the timing of labor and adequate time frame; into the second stage of labor, oxytocin oxytocin still need to have a clear indication, avoiding the use of obstructed labor and rupture of uterus with premonitory signs. The results of the current study show that there is no difference between the aforementioned high-dose and low-dose intravenous drip oxytocin regimens, but there are many clinical cases of uterine rupture due to overdose of oxytocin in the second stage of labor. Therefore, when good contractions are obtained and labor progresses, the dose of contractions should be reduced or discontinued after entering the active phase to pursue a natural birth process. Induction of labor contractions should not be intramuscular, acupoint injection or submucosal administration, because these methods of administration vary from person to person on the sensitive dose of contractions is not good control, such as the emergence of strong contractions can lead to intrauterine fetal death or uterine rupture.

4, termination of pregnancy

Talking about the termination of pregnancy of the commonly used drugs (commonly known as "drug abortion"), we may think of the most is Mifepristone and Misoprostol. The actual sensitivity of the uterine muscle to the hysteronin is related to the gestational week, in the gestational week of 20~30 weeks, with the increase of the gestational week and gradually enhanced, to 34 weeks to reach the highest, and then maintain this level to the full term of the pregnancy. Therefore, oxytocin is not commonly used for termination of pregnancy during gestation. The Family Planning (SFP, 2011) guidelines for inducing labor in the second trimester of pregnancy state that high-dose contractions are available when prostaglandin analogs are lacking or contraindicated. Contractions for termination of pregnancy have fewer adverse effects than mifepristone and misoprostol, and can be used in pregnant women who are not candidates for mifepristone and mifepristone.

5, prenatal fetal monitoring

This is mainly applied to our prenatal monitoring of the hysteronin provocation test, which is still more commonly used in clinical practice. Anyone who suspects placental insufficiency, after excluding late hemorrhage in pregnancy, multiple pregnancy, too much or too little amniotic fluid, preterm labor, premature rupture of membranes, and scarred uterus, can carry out the Oxytocin challenge test (OCT). Oxytocin challenge test (OCT) can be performed after preterm premature rupture of membranes and scarred uterus. 2.5U of Oxytocin can be added into 500ml of 5% dextrose injection and injected intravenously, with the initial drip rate of 5 drops/min, and the drip rate is adjusted every 15min until the effective intensity of contraction is reached, i.e., 3 contractions occur every 10min and each contraction lasts for 40-60s, and fetal heartbeat and contraction curves are recorded in the monitor for 40min. The combined NST+OCT test can help reduce the rate of perinatal asphyxia and morbidity and mortality without increasing the incidence of fetal distress and neonatal asphyxia.

6, lactation

Peptide is a polypeptide, the main role is to strengthen the contraction of the uterus, but also to promote the smooth muscle cells around the breast follicle contraction, which is conducive to the discharge of milk. Peptide nasal spray can promote early lactation and increased lactation after delivery, the specific use of the maternal bilateral nostrils immediately after delivery, and then each time before breastfeeding 2~3min to use, each side of the nostrils of a spray, continuous use of 7d.

7, abortion (purging)

The use of this use in the clinic is also more common. For patients undergoing retrograde abortion/cleansing, we have nurses establish intravenous access for them before they enter the operating room. For patients with hyperemesis gravidarum, when a hysterectomy is proposed, due to the patient's large and soft uterus, there is often more bleeding and even possible shock during the hysterectomy. In order to reduce bleeding, can be fully dilated uterine orifice and after the start of suction in the infusion with the addition of hysteronin, per 500 ml of solution with the addition of hysteronin 5 ~ 10U to strengthen the uterine contraction to reduce bleeding, but also to prevent fetal tissue squeezed into the uterine blood sinus.

Peptide in the obstetrics and gynecology-related diseases in the application of roughly these, there are still for the clinical application of peptide in the treatment of endometriosis and uterine fibroids is still in the research stage, here will not be mentioned, here we look at peptide in the field of non-obstetrics and gynecology applications.

Two, the contraction of hemoptysis

Repeated bleeding and hemoptysis can cause shock and asphyxiation and make the patient's mortality rate increased significantly, the current tuberculosis hemoptysis of internal medicine treatment of choice for the treatment of posterior pituitary hormone combined with nitroglycerin, the former main component for the contraction of contraction of contraction of contraction of contraction of contraction of contraction of contraction and pressure of the main components of contraction of contraction of contraction of contraction, especially to the capillaries and small arteries, especially the Visceral blood vessels, thus playing a hemostatic role, the latter mainly through the promotion of nitric oxide release, activation of guanylate cyclase, so that the smooth muscle and other tissues within the increase in cyclic guanosine, regulating the contractile state of the smooth muscle, causing the expansion of the peripheral venous vascular beds, so that the blood is retained in the periphery, the return of blood to the heart to reduce the volume of blood, in addition, expansion of the arteries so that the reduction in the peripheral resistance, and then make the increase in the central venous pressure, pulmonary vascular resistance with the Vascular resistance of the body circulation is reduced to achieve the purpose of hemostasis. However, because the pituitary posterior lobe contains pressor, the latter can increase the reabsorption of water in the renal tubules and has an antidiuretic effect, so hyponatremia is prone to occur when using pituitary posterior lobe treatment. Purchasin is one of the components of posterior pituitary hormone, which can achieve hemostasis by dilating peripheral blood vessels, lowering pulmonary arterial pressure and reducing pulmonary blood flow. In contrast to posterior pituitary hormone, contractocin does not contain pressor, and therefore the incidence of adverse effects is also significantly lower than in the control group. In addition, contractions can increase coronary blood flow, so they should be safer to use in patients with hypertension, coronary artery disease, and heart failure.

Three, the contraction of uterine treatment of cirrhosis portal hypertension caused by upper gastrointestinal hemorrhage

For such patients, medical treatment is generally based on comprehensive treatment, plus the use of posterior pituitary hormone treatment, the success rate of about 60%, the mechanism of its action is mainly through the contraction of the visceral vasculature in order to reduce the portal blood flow, to reduce portal pressure, prompting the cessation of bleeding, side effects, large. Its mechanism of action is mainly to reduce portal blood flow and lower portal pressure by constricting visceral blood vessels, prompting the bleeding to stop, which has a large number of side effects and can cause serious cardiac and cerebral complications, thus restricting its wide application. Inspired by the successful cases of haemoptysis treated by contractin, related scholars have studied the treatment of upper gastrointestinal bleeding by contractin. The results showed that the success rate of haemostasis in the treatment of upper gastrointestinal haemorrhage complicated by portal hypertension in liver cirrhosis with contractin was up to 90%, and there was no significant difference between the statistically processed and pituitary posterior lobe hormone, while the side effects were significantly smaller than the latter.

Four, shrinkage control transurethral resection of the prostate (TURP) bleeding after surgery

TURP blood loss is mainly concentrated in the operation and the 24h after the operation, benign prostatic hyperplasia patients are elderly, often combined with the internal medicine of the underlying disease, bleeding is easy to induce or aggravate the underlying disease; TURP postoperative bedridden and the use of conventional hemostatic drugs, increasing the risk of thrombophilia. The target of the action of the prostate smooth muscle, does not interfere with the function of the blood system itself, does not cause hypercoagulable state of patients after TURP surgery; drug half-life is short, the use of intravenous homogeneous pumping, the blood concentration is maintained at a low level, to ensure the effectiveness of the drug and the continuity of the drug, but also to avoid the adverse effects of the drug. The principle of hemostasis after TURP may be: prostate blood vessels from the prostate peritoneum into the prostate tissue, the contraction of the prostate peritoneum induced by the contraction of the contraction of the prostate peritoneum, compression of blood vessels through the tissue, play a hemostatic role; and the combination of the contraction of blood vessels with the endothelial cells of the contraction of the receptor on the endothelial cells, contraction of the blood vessels in the prostate tissue and to play a role in the hemostasis.

Fifth, the effect of contraction on the development of neuropsychiatric system

Some studies have shown that excessive contraction in the process of delivery through the placental barrier and the blood-brain barrier and fetal brain contraction receptor binding, so that the contraction receptor desensitization, inactivation, down-regulation of the receptor biosynthesis, causing children behavioral abnormalities, such as autism. Plasma levels of oxytocin in normal children are positively correlated with age, and pre-pubertal levels of oxytocin follow the same trend of elevated levels of other hormones, but children with autism do not have this change. Furthermore, normal children's levels of oxytocin were positively correlated with social activity skills, whereas those of children with autism were negatively correlated with social activity skills. It has also been shown that early exposure to oxytocin-associated maternal behavior is associated with neuropsychiatric development in children and can influence their reproductive and social behavior in adulthood.

Six, peptide can regulate male sexual function

The male reproductive tract can secrete peptide, testicular Leydig cells produce peptide, involved in the contraction of spermatogonial tubules, regulating the production of testosterone and sperm development. During sexual stimulation, the concentration of peptide in the blood increases and reaches a peak during ejaculation. In addition, the D1/D2 dopamine receptor agonist apomorphine ( APO) induces penile erection by activating the peptide neurons in the paraventricular nucleus (PVN) of the hypothalamus, so it is believed that peptide is also involved in the process of penile erection in humans. The classical action of contractin is contraction of smooth muscle, so it is unlikely that contractin in the peripheral circulation induces penile erection. Blood oxytocin has been found to increase during male sexual activity, peaking at orgasm and at the onset of penile weakness, so oxytocin may be associated with muscle contractions of the genital tract and pelvic floor during orgasm. Blood oxytocin increases 5-fold during ejaculation and the onset of penile weakness, returning to normal levels in about 30 min, suggesting that oxytocin may mediate post-ejaculatory penile weakness and the prolonged period of incontinence thereafter. In conclusion, central oxytocin is a potent erectogenic factor, whereas peripheral oxytocin may be involved in penile weakness, especially orgasm and the post-ejaculatory period. The effect of contractions on ejaculatory function and semen excretion remains controversial and requires continued research.