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Farmaci impiegati comunemente in corso di travaglio e di parto:
- Anestetici locali: il passaggio transplacentare degli anestetici locali (mepivacaina, lidocaina, prilocaina) dalle varie sedi di somministrazione (pudenda, paracervicale) può causare, nel feto, depressione del SNC e bradicardia.
- Ossitocina: la terapia ossitocica EV per aumentare o indurre il travaglio è sicura, ma la somministrazione non controllata può causare delle contrazioni uterine ipertoniche, che possono mettere in pericolo il feto.
- Anestetici: I narcotici, la scopolamina, i barbiturici, la ketamina e gli analgesici attraversano tutti la placenta. Il tiopentone si concentra nel fegato del feto.
- Benzodiazepine: Le dosi elevate di diazepam, somministrato EV alle madri prima del parto, può produrre nei neonati ipotonia, ipotermia, un basso punteggio di Apgar alla nascita, un’insufficiente risposta metabolica allo stress da freddo e depressione neurologica.
- Antispastici:
5a) Floroglucina (Spasmex) è caratterizzato da un’emivita plasmatica molto breve (15 minuti), una volta assorbito tende a concentrarsi prevalentemente a livello del tratto gastro-intestinale, uro-genitale e biliare, dove espleterà la propria azione terapeutica. Il meccanismo biologico alla base della proprietà spasmilitica sulle cellule muscolari lisce prevede l’inibizione dell’enzima catecol-o-metil-transferasi, importante nel normale metabolismo delle catecolamine, responsabili dello spasmo.
5b) Atropina solfato: antagonista competitivo per il legame con i recettori muscarinici dell’acetilcolina e di altre molecole dotate di attività muscarinica. Dopo iniezione endovena si raggiungono concentrazioni massime che decadono entro 10 minuti: l’attività terapeutica compare rapidamente e dura circa 5 ore. Il legame con le proteine plasmatiche è del 50%. Viene metabolizzata a livello epatico ed escreta a livello renale (80-90% della dose); emivita 2-4 ore. Limitare l’uso in gravidanza perché i suoi effetti si ripercuotono sul cuore del feto, per quanto riguarda la teratogenicità si colloca nella categoria C delle “pregnancy risk categories” della FDA.
5c) Mebeverina (Duspatal): agisce direttamente sulle fibrocellule muscolari lisce riducendo la permeabilità al sodio e indirettamente l’entrata del calcio e quindi la contrazione muscolare. La mebeverina può inoltre indirettamente ridurre la fuoriuscita di potassio dalla cellula prevenendo l’ipotonia muscolare.
5d) Propantelina: Farmaco anticolinergico antimuscarinico derivato dell’ammonio quaternario. Brevettato nel 1050. Possiede azione simile a quella dell’atropina differenza della quale non supera la barriera placentare e la barriera emato-encefalica e non esercita quindi effetti sul sistema nervoso centrale.
5e) Ioscina-n-butilbromido (Buscopan): Antagonista competitivo dei recettori muscarinici.
Tab. 26 – Farmaci del parto |
management |
|||
|
anestetici locali |
mepivacaina, lidocaina, prilocaina |
ctg C della FDA; cuminate del SNC fetale e bradicardia fetale |
||
|
Ossitocina |
Syntocinon |
ctg C della FDA; in caso di sovradosaggio, contrazioni uterine ipertoniche, sofferenza fetale, morte fetale improvvisa |
||
| ketamina | ketalar |
ctg C della FDA |
||
| tiopentone | pentotal |
ctg C della FDA; si concentra nel fegato del feto |
||
|
Solfato di Mg |
ctg C della FDA; letargia e ipotonia fetale, cuminate respiratoria temporanea nei neonati. |
|||
| Ossitocina | Syntocinon |
Ctg A1 Dosi eccessive possono provocare rottura d’utero; Sofferenza fetale, morte fetale |
||
| Gemeprost | Cervidil candelette |
B3 rottura d’utero; Sofferenza fetale, morte fetale |
||
|
Prostaglandina F |
Prostyn F2a |
Ctg C rottura d’utero; Sofferenza fetale, morte fetale |
||
|
Antispastici |
dl-iosciamina | |||
anticolinergico, antimuscarinico
alcaloide estratto dalle
solanacee
Atropina solfato
ctg C per gravidanza
ctg B2 per allattamento
Floroglucina
Spasmex
ctg B2; non ci sono dati sull’uso
nel 1° trimestre
Mebeverina
Duspatal
ctg B2;
non ci sono dati clinici sull’uso in gravidanza
Propantelina
Propantelina bromuro ctg B2
Lexil: (associazione con psicolettici) ctg C della FDA
Controindicato soprattutto nel 1° trim e in allattamento
Ioscina-n-butilbromido: Buscopan ctg B2 della FDA
Trimebutina: Debridat indicato nell’atonia intestinale post-operatoria (agisce sui plessi nervosi autonomi di Meissner ed Auerbach) ctg B3 Sconsigliato nel 1° trim e durante l’allattamento
Neostigmina, Prostigmina, Intrastigmina: Atonia intestinale post-operatoria e ritenzione urinaria post-chirurgica farmaco parasimpaticomimetico che possiede la capacità di inibire reversibilmente l’acetilcolinesterasi.
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