29 - Afterpains

- Afterpains are vigorous uterine contractions that arise at intervals during puerperium. 

- These are mostly seen in multiparas when compared to primiparas. 

- This is because the puerperal uterus of primiparas remains tonically contracted.

- These afterpains increase in severity as parity increases.

- They tend to worsen when the infant feeds on the mother's breast because of release of oxytocin, which increases the uterine contraction.

- By the third postpartum day, these afterpains decrease in severity and become mild.

28 - Mifepristone (RU - 486)

*Mifepristone is a recently developed oral antiprogesterone agent.

*It also has antiandrogenic and antiglucocorticoid activity.

*It is used in the following conditions :
- Termination of pregnancy (MTP) - An abortificient.
      ~Termination is effective upto 9 weeks (63 days).
      ~Complete abortion occurs in 85% of cases with a single dose upto 6-7 weeks.
      ~A single oral dose of 600 mg is used.
- Post coital contraception :
      ~Mifepristone 600 mg given orally within 72 hours of intercourse.
      ~Interferes with implantation and is highly effective.


- Once a month contraception:
      ~Single 200 mg dose given 2 days after mid cycle each month prevents conception.
- Cervical ripening
- Induction of labour
- Cushing's syndrome : Mifepristone has glucocorticoid receptor blocking action. It is used for palliation in Cushing's syndrome with inoperable cases.
- Fibroids : Shrinking of uterine fibroids has been observed following mifepristone therapy.
- Ectopic pregnancy : Injection of mifepristone into the ectopic pregnancy (unruptured sac) causes its resolution.