nitroglycerin and Delayed Postpartum Hemorrhage studies

Nitroglycerin: A volatile vasodilator which relieves ANGINA PECTORIS by stimulating GUANYLATE CYCLASE and lowering cytosolic calcium. It is also sometimes used for TOCOLYSIS and explosives.
nitroglycerol : A nitrate ester that is glycerol in which nitro group(s) replace the hydrogen(s) attached to one or more of the hydroxy groups.
nitroglycerin : A nitroglycerol that is glycerol in which the hydrogen atoms of all three hydroxy groups are replaced by nitro groups. It acts as a prodrug, releasing nitric oxide to open blood vessels and so alleviate heart pain.

Research Excerpts

Excerpt	Relevance	Reference
"Intravenous nitroglycerin and combined spinal-epidural anesthesia may offer an alternative to GA for achieving uterine relaxation in patients with PPP and a predicted difficult airway undergoing PTUI CS to control postpartum hemorrhage."	9.05	Use of nitroglycerin for parallel transverse uterine cesarean section in patients with pernicious placenta previa and placenta accrete and predicted difficult airway: A case report and review of literature. ( Jiang, X; Lin, X; Ma, Y; You, Y, 2020)
"After these two UAE procedures, no recurrence of bleeding was observed."	5.42	Use of intra-arterial nitroglycerin during uterine artery embolization for severe postpartum hemorrhage with uterine artery vasospasm. ( Chiba, E; Hamamoto, K; Horiuchi, I; Matsuura, K; Mikami, Y; Okochi, T; Takagi, K; Wang, L, 2015)
"Intravenous nitroglycerin and combined spinal-epidural anesthesia may offer an alternative to GA for achieving uterine relaxation in patients with PPP and a predicted difficult airway undergoing PTUI CS to control postpartum hemorrhage."	5.05	Use of nitroglycerin for parallel transverse uterine cesarean section in patients with pernicious placenta previa and placenta accrete and predicted difficult airway: A case report and review of literature. ( Jiang, X; Lin, X; Ma, Y; You, Y, 2020)
" Nitroglycerin administration was not associated with an increase in headaches (RR 1."	4.91	Nitroglycerin for management of retained placenta. ( Abdel-Aleem, H; Abdel-Aleem, MA; Shaaban, OM, 2015)
"Currently, the only effective treatments for a retained placenta are the surgical procedures of manual removal of placenta (MROP) and uterine curettage, which are not universally available, particularly in low- and middle-income countries."	2.90	Nitroglycerin for treatment of retained placenta: A randomised, placebo-controlled, multicentre, double-blind trial in the UK. ( Brewin, J; Carruthers, KF; Chua, GN; Denison, FC; Hallowell, N; Hudson, J; Lawton, J; McPherson, G; Norman, JE; Norrie, J; Peace, M; Scotland, G, 2019)
"The only way to treat a retained placenta is for a trained doctor to remove it by an operation in theatre."	2.90	Glyceryl trinitrate to reduce the need for manual removal of retained placenta following vaginal delivery: the GOT-IT RCT. ( Brewin, J; Brook-Smith, S; Carruthers, KF; Chua, GN; Clarkson, C; Denison, FC; Hallowell, N; Hudson, J; Lawton, J; McPherson, G; Norman, JE; Norrie, J; Peace, M; Scotland, G, 2019)
"A retained placenta is diagnosed when the placenta is not delivered following delivery of the baby."	2.84	A pragmatic group sequential, placebo-controlled, randomised trial to determine the effectiveness of glyceryl trinitrate for retained placenta (GOT-IT): a study protocol. ( Brewin, J; Brook-Smith, S; Carruthers, KF; Clarkson, C; Denison, FC; Forrest, M; Hallowell, N; Hodges, L; Hudson, J; Lawton, J; McDonald, A; McPherson, GC; Morrow, S; Norman, JE; Norrie, J; Peace, M; Scotland, G, 2017)
"The rates of successful removal of the retained placenta in the study (n=20) and control (n=20) groups were compared, as were blood pressure, pulse rate, blood loss, and adverse effects."	2.76	Intravenous nitroglycerin for controlled cord traction in the management of retained placenta. ( Permpolprasert, L; Prechapanich, J; Suksopee, P; Suwanvichai, S; Visalyaputra, S; Yimyam, S, 2011)
"After these two UAE procedures, no recurrence of bleeding was observed."	1.42	Use of intra-arterial nitroglycerin during uterine artery embolization for severe postpartum hemorrhage with uterine artery vasospasm. ( Chiba, E; Hamamoto, K; Horiuchi, I; Matsuura, K; Mikami, Y; Okochi, T; Takagi, K; Wang, L, 2015)
"Postpartum haemorrhage due to retained placenta is one of the commonest life-threatening conditions during the third stage of labour."	1.32	Intravenous nitro-glycerine versus general anaesthesia for placental extraction--a sequential comparison. ( Chiu, JW; Jha, S; Yeo, IS, 2003)

Research

Studies (9)

Authors

Clinical Trials (2)

Trial Overview

Trial Outcomes

APGAR at 5 Minutes

Timeframe	Studies, this research(%)	All Research%
pre-1990	0 (0.00)	18.7374
1990's	0 (0.00)	18.2507
2000's	1 (11.11)	29.6817
2010's	7 (77.78)	24.3611
2020's	1 (11.11)	2.80

Authors	Studies
Denison, FC	3
Carruthers, KF	3
Hudson, J	3
McPherson, G	2
Chua, GN	2
Peace, M	3
Brewin, J	3
Hallowell, N	3
Scotland, G	3
Lawton, J	3
Norrie, J	3
Norman, JE	3
Brook-Smith, S	2
Clarkson, C	2
Ma, Y	1
You, Y	1
Jiang, X	1
Lin, X	1
McPherson, GC	1
McDonald, A	1
Forrest, M	1
Morrow, S	1
Hodges, L	1
Wang, L	1
Horiuchi, I	1
Mikami, Y	1
Takagi, K	1
Okochi, T	1
Hamamoto, K	1
Chiba, E	1
Matsuura, K	1
Abdel-Aleem, H	1
Abdel-Aleem, MA	1
Shaaban, OM	1
Isquick, S	1
Henry, D	1
Nakagawa, S	1
Moghadassi, M	1
Thiet, MP	1
Norton, M	1
Lucero, J	1
Visalyaputra, S	1
Prechapanich, J	1
Suwanvichai, S	1
Yimyam, S	1
Permpolprasert, L	1
Suksopee, P	1
Jha, S	1
Chiu, JW	1
Yeo, IS	1

Trial	Phase	Enrollment	Study Type	Start Date	Status
GOT-IT Trial: A Pragmatic Group Sequential Placebo Controlled Randomised Trial to Determine the Effectiveness of Glyceryl Trinitrate for Retained Placenta.[NCT02085213]	Phase 4	1,107 participants (Actual)	Interventional	2014-09-30	Completed
Randomized Controlled Trial of IV Nitroglycerin in Cesarean Deliveries After Second Stage Arrest for the Prevention of Uterine Extension[NCT02265965]	Phase 4	18 participants (Actual)	Interventional	2015-10-31	Completed
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

The APGAR scale is determined by evaluating the newborn baby on five simple criteria -- Appearance, Pulse, Grimace, Activity, Respiration -- on a scale from zero to two, then summing up the five values thus obtained. The resulting APGAR score ranges from zero to 10. Zero is the worst possible score and 10 is the highest possible score. (NCT02265965)
Timeframe: Immediately after cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Fetal Extraction Time in Seconds

Intervention	score on a scale (Median)
Intravenous Nitroglycerin	9
Intravenous Saline	9

Time from uterine incision to delivery (body of neonate fully extracted from uterus) (NCT02265965)
Timeframe: At time of cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Number of Participants With Deliveries After Which Neonate is Admitted to NICU

Intervention	seconds (Mean)
Intravenous Nitroglycerin	104.9
Intravenous Saline	131

(NCT02265965)
Timeframe: After cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Number of Participants With Deliveries in Which Cord Blood Base Deficit is More Negative Than or Equal to Negative 12

Intervention	Participants (Count of Participants)
Intravenous Nitroglycerin	1
Intravenous Saline	2

A cord blood base deficit more negative than negative 12 is abnormal and a sign of metabolic acidosis. (NCT02265965)
Timeframe: At time of cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Number of Participants With Uterine Extension of Hysterotomy

Intervention	Participants (Count of Participants)
Intravenous Nitroglycerin	7
Intravenous Saline	11

Obstetrician determined whether the subject had an uterine extension. (NCT02265965)
Timeframe: During cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Surgical Blood Loss

Intervention	Participants (Count of Participants)
Intravenous Nitroglycerin	3
Intravenous Saline	4

Total blood loss will be measured (NCT02265965)
Timeframe: During and after cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Total Operative Time in Minutes

Intervention	ml (Mean)
Intravenous Nitroglycerin	935.7
Intravenous Saline	1036.4

Time from uterine incision to out of room (NCT02265965)
Timeframe: After cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Umbilical Artery Blood pH

Intervention	minutes (Mean)
Intravenous Nitroglycerin	68.3
Intravenous Saline	74.2

Measure of umbilical artery blood pH (NCT02265965)
Timeframe: At time of cesarean delivery, estimated to be within 4 hours after diagnosis of second stage arrest

Article	Year
Use of nitroglycerin for parallel transverse uterine cesarean section in patients with pernicious placenta previa and placenta accrete and predicted difficult airway: A case report and review of literature. Medicine, 2020, Volume: 99, Issue:5 Topics: Administration, Intravenous; Adult; Cesarean Section; Female; Humans; Nitroglycerin; Placenta Accret	2020
Nitroglycerin for management of retained placenta. The Cochrane database of systematic reviews, 2015, Nov-12, Issue:11 Topics: Administration, Sublingual; Female; Headache; Humans; Nitroglycerin; Oxytocics; Oxytocin; Placenta,	2015

Article	Year
Nitroglycerin for treatment of retained placenta: A randomised, placebo-controlled, multicentre, double-blind trial in the UK. PLoS medicine, 2019, Volume: 16, Issue:12 Topics: Administration, Sublingual; Adult; Cost-Benefit Analysis; Delivery, Obstetric; Double-Blind Method;	2019
Glyceryl trinitrate to reduce the need for manual removal of retained placenta following vaginal delivery: the GOT-IT RCT. Health technology assessment (Winchester, England), 2019, Volume: 23, Issue:70 Topics: Administration, Sublingual; Adolescent; Adult; Blood Transfusion; Cost-Benefit Analysis; Double-Blin	2019
A pragmatic group sequential, placebo-controlled, randomised trial to determine the effectiveness of glyceryl trinitrate for retained placenta (GOT-IT): a study protocol. BMJ open, 2017, 09-18, Volume: 7, Issue:9 Topics: Administration, Sublingual; Blood Volume; Cost Savings; Cost-Benefit Analysis; Double-Blind Method;	2017
Intravenous nitroglycerin for controlled cord traction in the management of retained placenta. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2011, Volume: 112, Issue:2 Topics: Adult; Blood Pressure; Female; Heart Rate; Humans; Injections, Intravenous; Nitroglycerin; Placenta,	2011

Article	Year
Use of intra-arterial nitroglycerin during uterine artery embolization for severe postpartum hemorrhage with uterine artery vasospasm. Taiwanese journal of obstetrics & gynecology, 2015, Volume: 54, Issue:2 Topics: Adult; Cesarean Section; Combined Modality Therapy; Constriction, Pathologic; Female; Humans; Nitrog	2015
The association between nitroglycerin use and adverse outcomes in women undergoing cesarean delivery in the second stage of labor. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2017, Volume: 30, Issue:11 Topics: Administration, Intravenous; Administration, Sublingual; Adult; Cesarean Section; Female; Humans; La	2017
Intravenous nitro-glycerine versus general anaesthesia for placental extraction--a sequential comparison. Medical science monitor : international medical journal of experimental and clinical research, 2003, Volume: 9, Issue:7 Topics: Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Female; Fentanyl; Hemodynami	2003

nitroglycerin and Delayed Postpartum Hemorrhage