In obstetrics and gynecology, magnesium sulfate and mifepristone can definitely be called “old medicines” and “miracle drugs”. Of course, with the increasing level of research, aspirin, metformin and other “miracle drugs” in obstetrics and gynecology ” Its effects are constantly becoming known to the world. Today, I will talk to you about a “new” miracle drug – phloroglucinol’s miraculous effects in obstetrics and gynecology, which will open your eyes.
Where is phloroglucinol “sacred”
Phloroglucinol is a myotropic, non-atropine, non-papolline pure smooth muscle antispasmodic drug. It can directly act on the smooth muscles of the gastrointestinal tract and genitourinary tract. It is clinically used to treat acute symptoms caused by body dysfunction. Cramping pain. Compared with other smooth muscle antispasmodics, its biggest feature is that it does not have anticholinergic effects. While relieving smooth muscle spasm, it will not produce a series of anticholinergic adverse effects, nor will it cause hypotension, increased heart rate, or heart rhythm. Abnormalities and other symptoms have minimal impact on cardiovascular function. Because it only acts on spastic smooth muscle, it has little effect on normal smooth muscle. The half-life of phloroglucinol is about 15 minutes. The blood concentration decreases quickly within 4 hours after administration, and then decreases slowly, so it is safe for pregnant women and fetuses.
14 magical “magic uses”
Wonderful Use 1: Promote the progress of labor
During the maternal delivery process, the speed of cervical dilation depends to a certain extent on the conditions of the cervix itself. When the cervix is tough or edematous, it can only increase labor force, but the effect is not good. Only drugs that reduce cervical muscle tone and relieve cervical spasm and edema can promote the expansion of the cervix and accelerate the progress of labor.
Clinical use of such drugs such as diazepam and anisodamine is very common, but the main pharmacological effect of diazepam is sedation and hypnosis. Excessive use by pregnant women can cause ataxia, dizziness, drowsiness and even syncope. Its intravenous The injection may also cross the placental barrier, potentially affecting the fetus. Anisodamine is an M-choline receptor blocker. It is currently recognized as having the effect of relieving cervical spasm and edema, and promoting cervix dilation. However, the use of anisodamine can cause dry mouth, flushed complexion, and accelerated heart rate in postpartum women. and symptoms such as increased fetal heart rate. Pregnancy complicated by glaucoma, elevated intraocular pressure, heart rate ≥100 beats/min or irregular heartbeat is contraindicated.
Phloroglucinol mainly inhibits uncoordinated and ineffective muscle contractions and reduces the oxygen consumption of uterine smooth muscle. It has no effect on the rhythm and amplitude of normal uterine smooth muscle contraction, so it does not affect the intrauterine supply of the fetus. Oxygen and postpartum uterine recovery.
Compared with other smooth muscle antispasmodics, phloroglucinol is characterized by not having anticholinergic effects. It relieves smooth muscle spasm without producing a series of anticholinergic adverse reactions. Phloroglucinol has an excellent cervical dilation effect, which can shorten the cervical dilation time and allow the fetal head to move better into the cervical area, thus shortening the delivery time.
Wonderful Use 2 Late Threatened Abortion
Late threatened abortion refers to vaginal bleeding, lower abdominal distension and pain that occurs between 12 and 27 weeks, the cervix is not dilated and the fetus is alive. The main principle of treating threatened abortion is to use tocolytics to suppress uterine contractions, so that the fetal gestational age reaches 28 weeks and improve the fetal survival rate. At present, domestic tocolytics mainly include magnesium sulfate, phloroglucinol, ritodrine hydrochloride, atosiban and other drugs.
The FDA believes that using magnesium sulfate for more than 7 days can easily cause hypocalcemia and skeletal changes in newborns. Therefore, the pregnancy medication grade of magnesium sulfate injection has been changed from grade A to grade D, so its clinical application instructions are The timing of conquest and peace is subject to certain restrictions. The application of ritodrine hydrochloride in miscarriage also has certain requirements on cardiac function. Atosiban is not a long-term solution for the general population due to its high price.
Phloroglucinol can relieve uterine smooth muscle spasm without causing symptoms such as hypotension, accelerated heart rate, and arrhythmia. Therefore, it is superior to other models in terms of medication safety, convenience and adverse drug reactions.
Wonderful Use 3 Artificial Abortion
During abortion, most patients will experience significant pain, fear, and high mental stress, especially when the vagus nerve is highly excited, causing cardiac arrest and other complications.When an incident occurs, the body is in a state of sympathetic nervous excitement, a large amount of catecholamines are released, metabolism increases, and oxygen consumption increases, which causes certain harm and damage to the patient’s body and mind. Injecting phloroglucinol 40mg will produce muscle relaxant, antispasmodic and analgesic effects 15 minutes after administration. It is effective, fast, safe, has no adverse reactions, does no harm to the body, and the recipient is willing to accept it. No special equipment or full-time anesthesiologist is required. , the treatment method is simple.
The psychological disorders of unmarried women are much more serious than those of married women. They have insufficient understanding of the process of abortion leading to pregnancy termination, and often have an abnormal fear of pain. In clinical observation, it was found that when primiparous women take medication before surgery, the cervix becomes softer and more effective. The patient is always awake, quiet and relaxed. The operation time is short and the clinical effect is satisfactory.
Magical Use 4 Primary Dysmenorrhea
Primary dysmenorrhea usually occurs 2 to 3 years after menarche, and is relieved or disappears around the age of 25 or after the birth of the first child. Phloroglucinol has the characteristics of rapid onset and remarkable effect in treating dysmenorrhea. Primary dysmenorrhea is crampy lower abdominal pain associated with menstruation. Prostaglandins metabolized during menstruation stimulate uterine contractions, which can cause uncoordinated uterine contractions, increase intrauterine pressure, and induce spasmodic abdominal pain. Phloroglucinol is used to treat dysmenorrhea by acting on the uncoordinated, spasmodically contracted smooth muscles of the uterus, reducing their tension and reducing intrauterine pressure. It acts on the internal os and isthmus of the cervix to relieve spasm and relax it, allowing menstrual blood to pass through the internal os easily, removing obstructive factors and relieving spasmodic abdominal pain.
Fantastic Use 5: Postmenopausal IUD Removal
After menopause, due to uterine atrophy, the uterine cavity becomes smaller and the cervix becomes hard, which makes the ring removal operation difficult and may even lead to bleeding and uterine perforation. Phloroglucinol can significantly dilate the cervix and relieve pain caused by uterine smooth muscle spasm and contraction. Phloroglucinol will not cause adverse reactions such as hypotension, accelerated heart rate, arrhythmia, etc., and has minimal impact on cardiovascular function.
Phloroglucinol is used for ring removal surgery in postmenopausal women. It has satisfactory analgesic effect, good uterine relaxation, high safety, and few adverse reactions, which is helpful to improve the success rate of ring removal.
Wonderful Use 6: Hysteroscopy
Intravenous injection of phloroglucinol is a method of softening the cervix that works quickly and has few adverse reactions, and is suitable for hysteroscopy. This relaxing property is due in part to its inhibitory effect on catechol-O-methyltransferase.
Phloroglucinol can promote cervical dilation and relieve cervical smooth muscle spasm, relieve pain during hysteroscopy, reduce intrauterine pressure, make hysteroscopy images clearer, thereby shortening operation time, and application of phloroglucinol There was no lower abdominal distension, pain, nausea, vomiting or vaginal bleeding after hysteroscopy. Its analgesic effect is better than lidocaine hydrochloride, and its adverse reactions are lower than lidocaine hydrochloride. It is a safe and effective analgesic drug during hysteroscopy.
Magical Use 7 to assist in inducing labor during pregnancy
The drug commonly used clinically to induce labor in mid-trimester is ethacridine, and there are two methods of administration –
One method is intraamniotic injection, which is effective in inducing labor in the second trimester when the amount of amniotic fluid is normal. However, for induction of labor in the second trimester, the uterus is small and has limited capacity, so intracavitary injection is difficult, which can sometimes lead to failed induction of labor.
The other is the extra-amniotic injection method, which avoids the difficulty of intra-amniotic operation and is simple to operate and has a high success rate.
After extraamniotic injection of ethacridine, the drug can quickly enter the placenta. After absorption by the fetus, it will cause damage to the fetal heart, lungs, liver, kidneys and other important organs, eventually leading to fetal death in utero and delivery from the mother. However, the contractions of the uterine body caused by ethacridine-induced labor in the second trimester of pregnancy are too strong, and the cervix in the second trimester is long and hard, with poor maturity. When the two are out of sync, the contents of the official cavity will be squeezed out under the strong uterine contractions. The lower segment of the uterus, but the external cervical os fails to expand simultaneously, and the cervical tissue becomes thinner and squeezes toward the posterior vaginal fornix, making it easier for cervical and vaginal lacerations to occur.
Phloroglucinol works by selectively and directly relaxing the smooth muscle cells of some organs, inhibiting uncoordinated muscle contractions, reducing the oxygen consumption of uterine smooth muscle, and having no effect on normal uterine smooth muscle contraction and amplitude. . At the same time, it relieves cervical smooth muscle spasm, reduces cervical edema, and promotes cervical ripening, thereby reducing cervical resistance, facilitating cervical dilation, and shortening the time for induction of labor.
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