Avacopan was approved for medical use in the European Union in January 2022. Names
Avacopan is the international nonproprietary name (INN). References
Further reading
Jayne DR, Bruchfeld AN, Harper L, Schaier M, Venning MC, Hamilton P,  et al. (September 2017). "Randomized Trial of C5a Receptor Inhibitor Avacopan in ANCA-Associated Vasculitis". J Am Soc Nephrol. 28 (9): 2756–2767. doi:10.1681/ASN.2016111179. PMC 5576933. PMID 28400446. Jayne DR, Merkel PA, Schall TJ, Bekker P (February 2021). "Avacopan for the Treatment of ANCA-Associated Vasculitis". N Engl J Med. 384 (7): 599–609. doi:10.1056/NEJMoa2023386. PMID 33596356. Merkel PA, Jayne DR, Wang C, Hillson J, Bekker P (April 2020). "Evaluation of the Safety and Efficacy of Avacopan, a C5a Receptor Inhibitor, in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Treated Concomitantly With Rituximab or Cyclophosphamide/Azathioprine: Protocol for a Randomized, Double-Blind, Active-Controlled, Phase 3 Trial". JMIR Res Protoc. 9 (4): e16664. doi:10.2196/16664. PMC 7175182. PMID 32088663. Merkel PA, Niles J, Jimenez R, Spiera RF, Rovin BH, Bomback A,  et al. (November 2020). "Adjunctive Treatment With Avacopan, an Oral C5a Receptor Inhibitor, in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis". ACR Open Rheumatol. 2 (11): 662–671. doi:10.1002/acr2.11185. PMC 7672305. PMID 33128347. External links
"Avacopan". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT02994927 for "A Phase 3 Clinical Trial of CCX168 (Avacopan) in Patients With ANCA-Associated Vasculitis (ADVOCATE)" at ClinicalTrials.gov
Cesarean delivery, especially after prolonged labor, may cause the muscles of the uterus to become tired and stop contracting or contraction can be inhibited at the surgical site. Epidemiology
Uterine atony occurs during 1 in 40 births in the United States and is responsible for at least 80% of cases of postpartum hemorrhage. Pathophysiology
The uterus is composed of an interconnected muscle fibers known as the myometrium. The blood vessels that provide the blood supply to the placenta pass through this muscle. After labor it is the contraction of these muscles that physically squeeze the blood vessels so that hemostasis can occur after the delivery of the fetus and the placenta. Local hemostatic factors like tissue factor type-1 plasminogen activator inhibitor and platelets and clotting factors aid in stopping the blood flow.This physiological contraction does not occur if the myometrium becomes atonic. Oxytocin is released continuously during labor to stimulate uterine muscle contraction so the that the fetus can be delivered and it is continued to be released after delivery to stop blood flow. If the oxytocin receptors become desensitized and no longer respond to the hormone then the uterus does not contract. The uterus can also be structurally damaged or distended to prevent contraction. Therefore, as placenta is delivered arteries are damaged and without the muscle contractions hemostasis cannot be reached.Blood loss is an expected part of labor and less than 500 mL is considered normal. Generally, primary PPH is classified as being more than 500 mL of blood lost in the first 24 hours following delivery.