Estudio de la función endotelial de los fármacos oxitócicos en la prevención de la hemorragia pospartomecanismo de acción de la endotelina y oxido nítrico

Abstract

Postpartum hemorrhage (PPH) has been considered the main cause of maternal death worldwide. Excessive bleeding after delivery may occur as much as 19,8% of cases, resulting in an important morbidity and mortality. Uterine atony is the first cause of PPH. Therefore, in the management of the delivery; we must employ different obstetric strategies for hemorrhage prevention, one of them, prophylactic treatment with oxytocic agents for an effective constrictive action on the uterus. The mechanisms of action of oxytocin on the oxytocin receptor of the smooth muscle are well known. It is based on the increase of rhythmic contractions and uterine tone. However, oxytocin receptor is not only present in the smooth muscle, can also be located in many other different territories, some of them recently described such as tumoral cells of diverse tissues, bone cell, myoblast, cardiomyocites and endothelial cells. Among these different receptors, the one most interesting for us in the indication of oxytocin as uterotonic agent in the postpartum hemorrhage is the smooth muscle of blood vessels. This function could add to the classic action of the oxytocin a mechanism of vasoconstriction. The emerging of a new oxytocic agent, carbetocin, allow us to extend the prospect of this hypothesis and therefore of this study. In addition to verifying the endothelial action of oxytocic agents with an additional agent, it may permit us to evaluate the pharmacological potency through the comparison of this action between the two oxytocic agents available at the moment. Nitric oxide and endotelin represents biochemical markers that enable us the vascular function evaluation. The serum levels variation of these markers with regard to the administration of the oxytocic agents will allow us to define more accurately the vascular effect of oxytocin and carbetocin...