Uterine Stimulants & Relaxants

UTERINE STIMULANTS & RELAXANTS

Q. 1

Specific treatment of severe pre eclampsia is?

 A Magnesium sulfate
 B Termination of pregnancy
 C Anti convulsants
 D

Anti hypertensives

Q. 1

Specific treatment of severe pre eclampsia is?

 A Magnesium sulfate
 B Termination of pregnancy
 C Anti convulsants
 D

Anti hypertensives

Ans. A

Explanation:

Magnesium sulfate REF: Current Diagnosis & Treatment Obstetrics & Gynecology, 10th edition Chapter 19

In Severe Pre eclampsia During labor, magnesium sulfate is administered for seizure prophylaxis as an IV loading dose of 4-6 g over 20-60 minutes, followed by a maintenance dose of 1-2 g/h.


Q. 2

Drug that does not prevent preterm labor is:

 A Ritodrine
 B

Atosiban

 C Dexamethasone
 D Nitroglycerine patch
Q. 2

Drug that does not prevent preterm labor is:

 A Ritodrine
 B

Atosiban

 C Dexamethasone
 D Nitroglycerine patch
Ans. C

Explanation:

Dexamethasone REF: See APPENDIX-64 for list of “Tocolytic agents”

“Steroids are given in preterm labor for fetal lung maturity and not as tocolytic agent”

Nitroglycerine is also a tocolytic agent not listed in the APPENDIX-64 as it is not used routinely (not recommended)


Q. 3

Which of the following is an oxytocin antagonist?

 A Ritodrine
 B

Atosiban

 C Isoxsuprine
 D

Methergine

Q. 3

Which of the following is an oxytocin antagonist?

 A Ritodrine
 B

Atosiban

 C Isoxsuprine
 D

Methergine

Ans. B

Explanation:

AtosibanREF: Danforth’s Obstetrics and Gynecology 10th Edition page 175-178, http://en.wikipedia.org/ wiki/Tocolytic

See APPENDIX-64 for “TOCOLYTIC AGENTS”

Quiz In Between


Q. 4

Tocolytic of choice in heart disease

 A

Nifedepine

 B

Atosiban

 C

MgSo4

 D

Salbutamol

Q. 4

Tocolytic of choice in heart disease

 A

Nifedepine

 B

Atosiban

 C

MgSo4

 D

Salbutamol

Ans. B

Explanation:

Atosiban [Ref: Ian Donald practical problems in obstetrics 6h/e

  • Most tocolytics are contraindicated in women with cardiac disease because of their potential to precipitate cardiac failure.

– As there are no studies performed to look at the safety of tocolytic drugs in setting of existing heart failure the recommendations for their use can be best made on the basis of their side effect profile in normal women.

  • “Atobisan, an oxytocin antagonist seems to be the drug of choice at present”

In an animal study it was shown to have no central hemodynamic effect although some concern has been expressed over increased infant mortality rate.

  • Indomethacin has minimal effect on heart rate and mean arterial pressure and may be used as an alternative for short term tocolysis.
  • None of the other tocolytics are considered safe for cardiac disease.
  • Beta inimetics probably are the worst

They are contraindicated in 😕

– Cardiac arrhythinias

– Valvular disease

– Cardiac ischemia

  • Nifedipine

It is contraindicated in 😕

– Conduction defects

– Left ventricular failure

  • Magnesium sulfate

– Status of magnesium sulfate as regards it safety in cardiac disease in uncertain.


Q. 5

All of the following statements are true except :

 A

Oxytocin sensitivity is increased during delivery

 B

Prostaglandins may be given for inducing abor­tion during IIIrd trimester

 C

In lactating women genital stimulation enhances oxytocin release

 D

Oxytocin is used for inducing abortion in 1st tri­mester

Q. 5

All of the following statements are true except :

 A

Oxytocin sensitivity is increased during delivery

 B

Prostaglandins may be given for inducing abor­tion during IIIrd trimester

 C

In lactating women genital stimulation enhances oxytocin release

 D

Oxytocin is used for inducing abortion in 1st tri­mester

Ans. D

Explanation:

Ans. is d i.e. Oxytocin is used for inducing abortion in Ist trimester 

Lets see each option one by one.

  • Oxytocin causes contraction of smooth muscles of uterus. The sensitivity of uterine musculature to oxytocin is enhanced by estrogen and inhibited by progesterone. The sensitivity of uterus to oxytocin becomes very much increased in late pregnancy. Oxytocin levels reach maximum at the time of birth (i.e. option “a’ is correct).
  • In lactating women genital stimulation enhances oxytocin release (option “c” is correct).
  • Prostaglandins are used in I. and Ilna trimester for induction of abortion.

I can not understand what the examiner wants to say by “Ur trirnc,ctPr abortion” as beyond 28 weeks fetus is viable therefore, term abortion is never used. It may be a printing mistake.

As far as option “d” is concerned — It is absolutely incorrect as oxytocin is never used for Is‘ trimester abortions.

Friends don’t get upset, if you don’t remember “methods used of inducing abortion”right now, as we have dealt with it in detail in chapter Abortion & MTP”.



Q. 6

All of the following drugs have been used for medical abortion except :

 A

Mifepristone

 B

Misoprostol

 C

Methotrexate

 D

Atosiban

Q. 6

All of the following drugs have been used for medical abortion except :

 A

Mifepristone

 B

Misoprostol

 C

Methotrexate

 D

Atosiban

Ans. D

Explanation:

Ans. is d i.e. Atosiban

Drugs used for Medical abortion :

  • Prostaglandins : – Misoprostol – Gemeprost
  • Mifepristone
  • Methotrexate
  • Tamoxifen

Quiz In Between


Q. 7

Induction of abortion is best by :

 A

Oxytocin

 B

PGE2 gel

 C

Stripping of membrane

 D

Oestrogen

Q. 7

Induction of abortion is best by :

 A

Oxytocin

 B

PGE2 gel

 C

Stripping of membrane

 D

Oestrogen

Ans. B

Explanation:

PGE2 gel


Q. 8

Which of the following is NOT a tocolytic agent?

 A

Nifedipine

 B

MgSO4

 C

Dinoprostone

 D

Terbutaline

Q. 8

Which of the following is NOT a tocolytic agent?

 A

Nifedipine

 B

MgSO4

 C

Dinoprostone

 D

Terbutaline

Ans. C

Explanation:

The inhibition of uterine contractions, or tocolysis, has been the mainstay therapy for pre-term labour. 

Specific tocolytic agents are  adrenergic receptor agonists Terbutaline, Ritodrine), MgSO4, Ca2+ channel blockers (Nifedipine), COX inhibitors, oxytocin-receptor antagonists, and nitric oxide donors.

Two forms of prostaglandins are commonly used for cervical ripening prior to induction at term a) Misoprostol (PGE1) and Dinoprostone (PGE2)

Ref: Schimmer B.P., Parker K.L. (2011). Chapter 66. Contraception and Pharmacotherapy of Obstetrical and Gynecological Disorders. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e

Archie C.L. (2007). Chapter 10. The Course & Conduct of Normal Labor & Delivery. In A.H. DeCherney, L. Nathan (Eds), CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e


Q. 9

Oxytocin antagonists are used as tocolytics in preterm labor. Which among the following is an oxytocin antagonist?

 A

Ritodrine

 B

Atosiban

 C

Isoxsuprine

 D

Methergine

Q. 9

Oxytocin antagonists are used as tocolytics in preterm labor. Which among the following is an oxytocin antagonist?

 A

Ritodrine

 B

Atosiban

 C

Isoxsuprine

 D

Methergine

Ans. B

Explanation:

Atosiban is a selective oxytocin vasopressin receptor antagonist capable of inhibiting oxytocin induced myometrial contractions.

The mechanism appears to be competitive inhibition of oxytocin receptors in the myometrium and decidua.

Oxytocin antagonists result in a decrease in intracellular free calcium that results in decreased myometrial contractility.

Ref: Management of High-Risk Pregnancy: A Practical Approach By S. S. Trivedi, Manju Puri, M.D., 2011, Page 91; Danforth’s Obstetrics and Gynecology, 10th Edition, Page 175-178.

Quiz In Between


Q. 10

Which of the following best describes the mechanism of induction of labor with use of abortion stick?

 A

Stimulation of uterine contraction

 B

Oxytocin present in the stick

 C

Uterine necrosis

 D

Menstrual bleeding

Q. 10

Which of the following best describes the mechanism of induction of labor with use of abortion stick?

 A

Stimulation of uterine contraction

 B

Oxytocin present in the stick

 C

Uterine necrosis

 D

Menstrual bleeding

Ans. A

Explanation:

Abortion stick is a method of criminal abortion usually performed by professional abortionists (dhais)

It is introduced into the vagina or os of uterus and retained there till uterine contractions begin.

Ref: The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, 27th Edition, Chapter 14, Pages 373-76; Parikh’s Textbook of Medical Jurisprudence and Toxicology, 6th Edition, Page 5.62


Q. 11

Which of the following drugs is not useful in the management of Postpartum Hemorrhage(PPH)?

 A

Mifepristone

 B

Misoprostol

 C

Oxytocin

 D

Ergotamine

Q. 11

Which of the following drugs is not useful in the management of Postpartum Hemorrhage(PPH)?

 A

Mifepristone

 B

Misoprostol

 C

Oxytocin

 D

Ergotamine

Ans. A

Explanation:

Mifepristone is a progestin analogue and it blocks the effects of progesterone.

It is used as a medical termination of pregnancy in the first trimester and as a post-coital contraceptive.

While misoprostol, oxytocin and ergotamine are oxytocics and as uterine stimulants are used in the management of postpartum hemorrhage.

Ref: Dutta textbook of Obstetrics 6th edition, Pages 175, 550, 411-22


Q. 12

A 25 year old nulliparous woman at 35 weeks’ gestation comes to the labor and delivery ward complaining of contractions, a headache, and flashes of light in front of her eyes. Her pregnancy has been uncomplicated except for an episode of first trimester bleeding that completely resolved. She has no medical problems. Her temperature is 37 C (98.6 F), blood pressure is 160/110 mm Hg, pulse is 88/minute, and respirations are 12/minute. Examination shows that her cervix is 2 centimeters dilated and 75% effaced, and that she is contracting every 2 minutes. The fetal heart tracing is in the 140s and reactive. Urinalysis shows 3+ proteinuria. Laboratory values are as follows: leukocytes 9,400/mm3, hematocrit 35%, platelets 101,000/mm3. Aspartate aminotransferase (AST) is 200 U/L, and ALT 300 U/L. Which of the following is the most appropriate next step in management?

 A

Administer oxytocin

 B

Discharge the patient

 C

Encourage ambulation

 D

Start magnesium sulfate

Q. 12

A 25 year old nulliparous woman at 35 weeks’ gestation comes to the labor and delivery ward complaining of contractions, a headache, and flashes of light in front of her eyes. Her pregnancy has been uncomplicated except for an episode of first trimester bleeding that completely resolved. She has no medical problems. Her temperature is 37 C (98.6 F), blood pressure is 160/110 mm Hg, pulse is 88/minute, and respirations are 12/minute. Examination shows that her cervix is 2 centimeters dilated and 75% effaced, and that she is contracting every 2 minutes. The fetal heart tracing is in the 140s and reactive. Urinalysis shows 3+ proteinuria. Laboratory values are as follows: leukocytes 9,400/mm3, hematocrit 35%, platelets 101,000/mm3. Aspartate aminotransferase (AST) is 200 U/L, and ALT 300 U/L. Which of the following is the most appropriate next step in management?

 A

Administer oxytocin

 B

Discharge the patient

 C

Encourage ambulation

 D

Start magnesium sulfate

Ans. D

Explanation:

This patient has severe preeclampsia. Preeclampsia is diagnosed on the basis of hypertension, edema, and proteinuria.
Severe preeclampsia may be diagnosed when the patient has one of the following: a headache that does not respond to analgesics, visual changes, seizure, very elevated blood pressures, pulmonary edema, elevated liver function tests, severe proteinuria, oliguria, an elevated creatinine, thrombocytopenia, hemolysis, intrauterine growth restriction, or oligohydramnios.
The management of severe preeclampsia after 32 weeks is with delivery.
Prior to 32 weeks, consideration may be given to expectant management of the patient depending on the clinical circumstances. This patient is at 35 weeks’ with headache, visual changes, elevated blood pressures, thrombocytopenia, and elevated liver function tests. She, therefore, needs to be delivered.
She appears to already be in labor as she is contracting every two minutes and her cervix is dilated and effaced.
At this point, magnesium sulfate should be started.
Magnesium sulfate has consistently been demonstrated to be the most effective medication for seizure prophylaxis in women with preeclampsia.
 
To administer oxytocin would not be necessary for this patient. She appears to already be in labor with contractions every two minutes.
 
To discharge the patient would absolutely be incorrect. Severe preeclampsia need to be delivered or, at the very least, admitted to the hospital. There is no role for discharging a patient home in the management of severe preeclampsia.
 
To encourage ambulation would also be incorrect. Severe preeclampsia should be kept on bed rest.
 
Ref:  Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 34. Pregnancy Hypertension. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

Quiz In Between


Q. 13

All of the following drugs are used for management of post partum haemorrhage, EXCEPT:

 A

Oxytocin

 B

Misoprostol

 C

Prostaglandin

 D

Mifepristone

Q. 13

All of the following drugs are used for management of post partum haemorrhage, EXCEPT:

 A

Oxytocin

 B

Misoprostol

 C

Prostaglandin

 D

Mifepristone

Ans. D

Explanation:

Mifepristone is an analog of progestin acts as an antagonist blocking the effect of natural progesterone.

It is used as a medical method of first trimester abortion.

It is highly successful when used within It is not indicated in the treatment of post partum hemorrhage.

Bleeding and bleeding disorders are a contraindication for Mifepristol.

 
Ref: Textbook of Obstetrics By D.C.Dutta, 6th Edition, Pages 175, 416-418 ; Gomella L.G., Haist S.A. (2007). Chapter 22. Commonly Used Medications. In L.G. Gomella, S.A. Haist (Eds), Clinician’s Pocket Reference: The Scut Monkey, 11e.

Q. 14

A 32 weeks pregnant female with preterm contractions treated with tocolytic agents. She further developed pulmonary edema. Which of the following tocolytic must have caused pulmonary edema in this patient?

 A

Ritodrine

 B

Nifedipine

 C

Indomethacin

 D

Atosiban

Q. 14

A 32 weeks pregnant female with preterm contractions treated with tocolytic agents. She further developed pulmonary edema. Which of the following tocolytic must have caused pulmonary edema in this patient?

 A

Ritodrine

 B

Nifedipine

 C

Indomethacin

 D

Atosiban

Ans. A

Explanation:

The infusion of beta-agonists (Ritodrine) has resulted in frequent and at times, serious and fatal side effects. Pulmonary edema is a special concern. Because beta-agonists cause retention of sodium and water, with time—usually 24 to 48 hours, these can cause volume overload.

The cause of pulmonary edema is multifactorial, and risk factors include:

  • Tocolytic therapy with beta-agonists
  • Multifetal gestation
  • Concurrent corticosteroid therapy
  • Tocolysis for more than 24 hours
  • Large intravenous crystalloid volume infusion

Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 36. Preterm Birth. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.


Q. 15

Which of the drug is not comonly used in PPH ?

 A

Mifepristone

 B

Misoprostol

 C

Oxytocin

 D

Ergotamine

Q. 15

Which of the drug is not comonly used in PPH ?

 A

Mifepristone

 B

Misoprostol

 C

Oxytocin

 D

Ergotamine

Ans. A

Explanation:

Ans. is a i.e. Mifepristone

Medical management Atonicity is the most common cause of PPH. Any drug which increases the tone of uterus or the force of contraction is used to control PPH.

Uterine stimulants are:

  1. Oxytocin
  2. Ergometrine, Methyl ergometrine
  3. Syntometrine i.e. combination of ergometrine + oxytocin
  4. Prostaglandins
  5. PGE1                                                        
  6. PGF 2a. or
  7. 15 Methyl PGF-2a
  8. Misoprostol           
  9. Carboprost

Quiz In Between


Q. 16

A 30 year old woman pare 6 delivers vaginally following normal labour with spontaneous deliv­ery of an intact placenta. Excessive bleeding con­tinues, despite manual exploration, bimanual massage, intravenous oxytocin and adminis­tration of 0.2 mg methergin IV, which one of the following would be the next step in the manage­ment of this patient :

 A

Packing the uterus

 B

immediate hysterectomy

 C

Bilateral internal iliac ligation

 D

Injection of PGF 2a

Q. 16

A 30 year old woman pare 6 delivers vaginally following normal labour with spontaneous deliv­ery of an intact placenta. Excessive bleeding con­tinues, despite manual exploration, bimanual massage, intravenous oxytocin and adminis­tration of 0.2 mg methergin IV, which one of the following would be the next step in the manage­ment of this patient :

 A

Packing the uterus

 B

immediate hysterectomy

 C

Bilateral internal iliac ligation

 D

Injection of PGF 2a

Ans. D

Explanation:

Injection of PGF 2a


Q. 17

All are used in treatment for PPH except :

 A

Oxytocin

 B

Carboprost

 C

Ergometrine

 D

Ritodrine

Q. 17

All are used in treatment for PPH except :

 A

Oxytocin

 B

Carboprost

 C

Ergometrine

 D

Ritodrine

Ans. D

Explanation:

Ritodrine


Q. 18

The drug that inhibits uterine contractility and cause pulmonary edema is :

 A

Ritodrine

 B

Nifedipine

 C

lndomethacin

 D

Atosiban

Q. 18

The drug that inhibits uterine contractility and cause pulmonary edema is :

 A

Ritodrine

 B

Nifedipine

 C

lndomethacin

 D

Atosiban

Ans. A

Explanation:

Ans. is a i.e. Ritodrine                                  

  • Pulmonary edema is a serious complication of beta-adrenergic therapy (ritodrine) and MgSO4.
  • This complication occurs in patients receiving oral or (more common) intravenous treatment.
  • It occurs more frequently in patients who have excessive plasma volume expansion, such as those with twins or those who have received generous amounts of intravenous fluids and in patients with chorioamnionitis.
  • Patient presents with respiratory distress, bilateral rales on auscultation of the lungs, pink frothy sputum, and typical X-ray picture.
  • Patients receiving IV beta-adrenergic drugs should be monitored continuously with pulse oxymeter to anticipate the development of pulmonary edema.

Quiz In Between


Q. 19

Which one of the following methods for induction of labour should not be used in patient with previ­ous lower segment caesarean section?

 A

Prostaglandin Gel

 B

Prostaglandin tablet

 C

Stripping of the membrane

 D

Oxytocin drip

Q. 19

Which one of the following methods for induction of labour should not be used in patient with previ­ous lower segment caesarean section?

 A

Prostaglandin Gel

 B

Prostaglandin tablet

 C

Stripping of the membrane

 D

Oxytocin drip

Ans. B

Explanation:

Prostaglandin tablet


Q. 20

Oxytocin challenge test for assessing fetal well being is contraindicated in all except :

 A

Placenta previa

 B

Previous 2 LSCS

 C

Breech

 D

Premature labour

Q. 20

Oxytocin challenge test for assessing fetal well being is contraindicated in all except :

 A

Placenta previa

 B

Previous 2 LSCS

 C

Breech

 D

Premature labour

Ans. C

Explanation:

Breech


Q. 21

In a patient with heart disease, which of the following should not be used to control PPH :

 A

Methyergometrine

 B

Oxytocin

 C

Misoprostol

 D

Hysterectomy

Q. 21

In a patient with heart disease, which of the following should not be used to control PPH :

 A

Methyergometrine

 B

Oxytocin

 C

Misoprostol

 D

Hysterectomy

Ans. A

Explanation:

Ans. is a i.e. Methylergometrine

Antepartum Management

NYHA Class I and II :

  • Pregnancy and delivery are usually uneventful.
  • Patient can be managed on ambulatory treatment and need not be hospitalized early.
  • Time of hospitalisation in Class I patients is 36 weeks° and Class II patients is 28 weeks°.
  • Physical activity is limited to well within the patient’s cardiac reserve.
  • Adequate rest is prescribed.
    • If any surgical procedure like tooth extraction is required, bacterial endocarditis prophylaxis is indicated. NYHA Class III and IV :
    • They are at very high risk and ideally should become pregnant only after surgical correction.
    • If seen in the first trimester, such patients are candidates for MTP.
    • If pregnancy is continued, then the women are hospitalized for the remainder of the pregnancy.

Intrapartum Management :

  • This is the period of maximum risk as the cardiac output increases.

Patients should be allowed to go into spontaneous labour, if required induction with vaginal PGE2 may be done (Induction is safe in case of heart disease)

  • There is no place for trial of labour° in a patient with heart disease and in such cases, elective cesarean section should be done.
  • Vaginal delivery is preferred unless there are obstetric indications for cesarean section.
  • Only heart disease where vaginal delivery is contraindicated : Coarctation of aorta.
  • Patient is laid in semi recumbent position/propped up position and if required oxygen inhalation is given to the patient.
  • Pain should be adequately relieved (best done by epidural anaesthesia)
  • Meticulous fluid balance (not more than 75m1/hour).
  • Cut short the second stage with outlet forceps.
    • 40 mg of intravenous frusemide can be given immediately after the baby is born°. This will divert some of the excess blood volume that is added to the circulation by the contraction of uterus.

Management of Third stage :

  • Ergometrine and methergin are contraindicated.° Oxytocin should be used in the third stage by IV infusion to reduce the amount of bleeding. If PPH occurs in a cardiac patient—Oxytocin, and prostaglandins can be used.
  • Antibiotics are given as a prophylactic measure against infective endocarditis.

Management of Puerperium

  • Early ambulation (to pervent thrombosis) and lactation are encouraged.

Quiz In Between


Q. 22

In a case of intrauterine growth retardation, the most dependable method of determining fetal well being is :

 A

Ultrasonic fetal cephalometry

 B

Contraction stress test (oxytocin challenge test)

 C

Amniotic fluid triglyceride

 D

Uteroplacental blood flow

Q. 22

In a case of intrauterine growth retardation, the most dependable method of determining fetal well being is :

 A

Ultrasonic fetal cephalometry

 B

Contraction stress test (oxytocin challenge test)

 C

Amniotic fluid triglyceride

 D

Uteroplacental blood flow

Ans. B

Explanation:

Contraction stress test (oxytocin challenge test)


Q. 23

Prostaglandins (PGs) have effets on a variety of tissues. The different prostaglandins may have different effects. Which of the following statement is not correct –

 A

The human arteriolar smooth muscle is relaxed by PGE2 and PGI2, where asTXA2 and PGF2 Alpha cause vasoconstriction

 B

PGE l and PGI2 inhibit platelet aggregation, where asTXA2 facilitate aggregation.

 C

PGE2 has marked oxytocic action while PGF2 Alpha has tocolytic action

 D

PGE2 is bronchodilator whereas PGF2 alpha is a bronchoconstrictor

Q. 23

Prostaglandins (PGs) have effets on a variety of tissues. The different prostaglandins may have different effects. Which of the following statement is not correct –

 A

The human arteriolar smooth muscle is relaxed by PGE2 and PGI2, where asTXA2 and PGF2 Alpha cause vasoconstriction

 B

PGE l and PGI2 inhibit platelet aggregation, where asTXA2 facilitate aggregation.

 C

PGE2 has marked oxytocic action while PGF2 Alpha has tocolytic action

 D

PGE2 is bronchodilator whereas PGF2 alpha is a bronchoconstrictor

Ans. C

Explanation:

Ans. is ‘c’ i.e., PGE2 has marked oxytocic action while PGF2 a has tocolytic action

Both PGE2 & PGF2a have same action on the uterus i.e., they contract uterus, both of them are oxytocic


Q. 24

Oxytocin causes all except –

 A

Lactogenesis

 B

Milk ejection

 C

Contraction of uterine muscle

 D

Myoepithelial cell contraction

Q. 24

Oxytocin causes all except –

 A

Lactogenesis

 B

Milk ejection

 C

Contraction of uterine muscle

 D

Myoepithelial cell contraction

Ans. A

Explanation:

Ans. is ‘a’ i.e., Lactogenesis

Important actions of oxvtocin are :

  • Contraction of uterine smooth muscle (directly by acting on GPCR and indirectly by release of PG and LTs).
  • Milk ejection by contraction of myepithelial cells surrounding mammary alveoli.
  • At high concentration; anti-diuretic and vasopressor action can be seen.

Note : Lactogenesis is the action of prolactin (not oxytocin).

Quiz In Between


Q. 25

Which of the following is not an indication for oxytocin –

 A

Spontaneous premature labour

 B

Post partum hemorrhage

 C

Uterine inertia

 D

Breast engorgment due to inefficient milk ejection reflex

Q. 25

Which of the following is not an indication for oxytocin –

 A

Spontaneous premature labour

 B

Post partum hemorrhage

 C

Uterine inertia

 D

Breast engorgment due to inefficient milk ejection reflex

Ans. A

Explanation:

Ans. is ‘a’ i.e., Spontaneous premature labour

Uses of oxytocin

  1. Induction of labour       3. Post partum haemorrhage                 5. Oxytocin challenge test (for uteroplacental adequacy)
  2. Uterine intertia             4. Breast engorgment

Q. 26

Which tocolytic drug results in pulmonary oedema (adverse effect)-

 A

Ritodrine

 B

Indomethacin

 C

Nifedipine

 D

Atosiban

Q. 26

Which tocolytic drug results in pulmonary oedema (adverse effect)-

 A

Ritodrine

 B

Indomethacin

 C

Nifedipine

 D

Atosiban

Ans. A

Explanation:

Ans. is ‘a’ i.e., Ritodrine


Q. 27

Which of the following is an oxytocin antagonist?

 A

Ritodrine

 B

Atosiban

 C

Isoxsuprine

 D

Methergine

Q. 27

Which of the following is an oxytocin antagonist?

 A

Ritodrine

 B

Atosiban

 C

Isoxsuprine

 D

Methergine

Ans. B

Explanation:

Ans. is ‘b’ i.e., Atosiban

  • Atosiban is an oxytocin antagonist and is used as tocolytic agent (uterine relaxant).

Quiz In Between


Q. 28

The hormone which helps in milk secretion:

September 2008, September 2010

 A

Oxytocin

 B

Growth hormone

 C

FSH

 D

Prolactin

Q. 28

The hormone which helps in milk secretion:

September 2008, September 2010

 A

Oxytocin

 B

Growth hormone

 C

FSH

 D

Prolactin

Ans. D

Explanation:

Ans. D: Prolactin

Prolactin causes milk secretion from the breast after estrogen and progesterone priming. Its effect on the breast involves increased action of mRNA and increased production of casein and lactalbumin.

Prolactin also inhibits the effects of gonadotropins, possibly by an action at the level of the ovary.

The function of prolactin in normal males is unsettled, but excess prolactin secreted by tumors causes impotence. Remember oxytocin causes Ejection of milk.


Q. 29

Milk ejection is facilitated by:

March 2007, March 2013

 A

Oxytocin

 B

Growth hormone

 C

FSH

 D

LH

Q. 29

Milk ejection is facilitated by:

March 2007, March 2013

 A

Oxytocin

 B

Growth hormone

 C

FSH

 D

LH

Ans. A

Explanation:

Ans. A: Oxytocin

Hormonal control of Breast development and secretion and ejection of milk

  • Progesterone — influences the growth in size of alveoli and lobes.
  • Oestrogen — stimulates the milk duct system to grow and become specific.
  • Follicle stimulating hormone
  • Luteinizing hormone
  • Prolactin — contributes to the increased growth of the alveoli during pregnancy and formation of milk
  • Oxytocin — oxytocin contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the
    newly-produced milk into the duct system. Oxytocin is necessary for the milk ejection reflex, or let-down to occur.
  • Human placental lactogen (HPL) —This hormone appears to be associated with breast, nipple, and areola growth before birth.

Colostrum contains higher amounts of white blood cells and antibodies than mature milk, and is especially high in immunoglobulin A (IgA), which coats the lining of the baby’s immature intestines, and helps to prevent germs from invading the baby’s system.


Q. 30

Drug which is contraindicated before 2nd stage of labor is:     

March 2009

 A

Mifepristone

 B

Oxytocin

 C

Misoprostol

 D

Ergometrine

Q. 30

Drug which is contraindicated before 2nd stage of labor is:     

March 2009

 A

Mifepristone

 B

Oxytocin

 C

Misoprostol

 D

Ergometrine

Ans. D

Explanation:

Ans. D: Ergometrine

Drugs used for medical method of induction of labour are:

  • Mifepristone
  • Oxytocin
  • Misoprostol (Prostaglandins El)

Ergometrine is contraindicated in pregnancy, 1st stage of labour, 2nd stage of labour before crowning of the head and in breech delivery prior to crowning.


Q. 31

Oxytocin antagonist is –

 A

Nitrates

 B

Sultraban

 C

Atosiban

 D

Rimonabant

Q. 31

Oxytocin antagonist is –

 A

Nitrates

 B

Sultraban

 C

Atosiban

 D

Rimonabant

Ans. C

Explanation:

Ans. is ‘c’ i.e., Atosiban

  • Atosiban is a peptide analogue of oxytocin that acts as antagonist at oxytocin receptors.
  • It has been found to suppress premature uterine contractions and postpone preterm delivery with fewer cardiovascular and metabolic complications than beta 2 adrenergic agonists.

Quiz In Between



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