sulprostone and Coronary-Vasospasm

Because of intrauterine foetal death at 35 weeks, parturition in a woman aged 35 years was induced by intravenous sulprostone. A few hours after its start she sustained a myocardial infarction for which she was treated. Coronary angiography 4 weeks later showed normal coronary arteries and good left ventricular function. Mild cardiovascular reactions such as bradycardia and mild hypotension are frequently observed adverse effects. In some instances, sulprostone can induce myocardial ischaemia. However, the possibility of a myocardial infarction is not mentioned in the product information of sulprostone. As there was an obvious temporal relationship and other causative factors were sufficiently excluded, the causal relation between the administration of sulprostone and the occurrence of myocardial infarction can be regarded as almost certain. Several experimental studies provide support for the hypothesis that coronary spasms play a major role in the pathophysiology of a myocardial infarction during the administration of sulprostone.

Topics: Abortifacient Agents, Nonsteroidal; Acute Disease; Adult; Coronary Angiography; Coronary Vasospasm; Dinoprostone; Electrocardiography; Female; Fetal Death; Humans; Labor, Induced; Myocardial Infarction; Pregnancy; Pregnancy Complications, Cardiovascular

In a woman aged 39 cardiac arrest occurred 3.5 hours after administration of 250 micrograms sulprostone directly into the uterine wall for a post-partum haemorrhage after manual removal of the placenta. A long period of resuscitation was necessary. After further evaluation the woman demonstrated specific contraindications to the administration of sulprostone. as formulated by the French authorities: age > 35 years, heavy cigarette smoking, and cardiovascular risk factors. In the Netherlands sulprostone is registered for intravenous administration only. We would strongly advise against administration directly into the uterine wall.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Coronary Vasospasm; Dinoprostone; Female; Heart Arrest; Humans; Postpartum Hemorrhage; Pregnancy; Resuscitation; Risk Factors; Ventricular Fibrillation

Reversible ventricular fibrillation occurred in a 35 year old multiparous woman after the administration of the association mifepristone (Mifegyne) and sulprostone (Nalador) for therapeutic abortion. A coronary spasm induced by the analogue of the prostaglandin PGE 2x was though to be the causative mechanism and was reproduced by the Ergonovine test. The evolution of the ECG and myocardial scintigraphy suggested a slowly regressive stunned myocardium.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Coronary Vasospasm; Dinoprostone; Drug Combinations; Electric Countershock; Electrocardiography; Female; Heart; Heart Arrest; Humans; Mifepristone; Pregnancy; Radionuclide Imaging; Risk Factors; Thallium Radioisotopes; Ventricular Fibrillation