sulprostone and Heart-Arrest

Sulprostone, a synthetic prostaglandin analogue with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case of cardiac arrest in a parturient after Caesarean section during continuous infusion of intravenous sulprostone administered for atonic post-partum haemorrhage. She had cardiopulmonary resuscitation for 25 min before spontaneous circulation returned. The sequence of events, the results of investigations carried out during the intensive care unit stay, and the presence of multiple cardiovascular risk factors, suggest that sulprostone caused coronary spasm, bradycardia, and subsequent asystole, similar to other cases described in the literature.

Topics: Adult; Advanced Cardiac Life Support; Anesthesia, General; Anesthesia, Obstetrical; Anesthesia, Spinal; Cardiopulmonary Resuscitation; Cesarean Section; Dinoprostone; Female; Glasgow Coma Scale; Heart Arrest; Humans; Postoperative Hemorrhage; Pregnancy

Topics: Adult; Cesarean Section; Dinoprostone; Female; Heart Arrest; Humans; Oxytocics; Postpartum Hemorrhage; Pregnancy; Shock, Cardiogenic

We report the case of a 31-year-old woman who delivered twins by Caesarean section in whom atonic uterine haemorrhage developed 6 h postoperatively. During conservative treatment with the high-dose prostaglandin analogs sulprostone (PGE(2)) and dinoprost (PGF(2alpha)), acute pulmonary oedema and cardiac decompensation developed and, subsequently, the patient suffered cardiopulmonary arrest. After a 2h-period of cardiopulmonary resuscitation (CPR), it was possible to restore and stabilize circulation under the highest dose of catecholamines. Despite 2h of CPR, the patient was discharged from hospital 3 months later without any major physical or neurocognitive deficit.

Topics: Adult; Cardiopulmonary Resuscitation; Cesarean Section; Dinoprost; Dinoprostone; Female; Heart Arrest; Heart Failure; Heart Massage; Humans; Oxytocics; Postoperative Hemorrhage; Pregnancy; Pulmonary Edema; Uterine Contraction; Uterine Hemorrhage

Topics: Adult; Anesthesia, Epidural; Delivery, Obstetric; Dinoprostone; Drug Therapy, Combination; Female; Heart Arrest; Hemodynamics; Humans; Labor, Obstetric; Norepinephrine; Oxytocics; Postpartum Hemorrhage; Pregnancy; Respiration, Artificial

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

Sulprostone, a synthetic prostaglandin with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case in which a bolus intravenous injection of sulprostone 30 micrograms was administered to treat postpartum haemorrhage during caesarean section. The 38-year-old patient with no previous cardiac or smoking history developed complete heart block, ventricular fibrillation and subsequent asystole. Cardiopulmonary resuscitation was successful after 45 minutes. Post resuscitation there was no myocardial infarction and she had complete neurological recovery. We postulate that the bolus of sulprostone resulted in possible coronary spasm that resulted in cardiac arrest.

Topics: Adult; Anesthesia, General; Cesarean Section; Dinoprostone; Epinephrine; Female; Heart Arrest; Heart Block; Humans; Injections, Intravenous; Postpartum Hemorrhage; Pregnancy; Resuscitation; Sympathomimetics; 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

Prostaglandins are mainly used in clinical medicine for midterm abortion and to terminate pregnancy. Systemic adverse reactions include nausea and vomiting, which occur in approximately half of the patients and, to a lesser extent, diarrhea. Although bronchospasm occurs infrequently, PGF2 should be avoided in asthmatics. Cardiorespiratory failure culminating in prolonged coma and death has been reported. Moreover, convulsions and EEG changes have been observed in a comparatively small number of cases.

Topics: Abortifacient Agents; Abortion, Induced; Bronchial Spasm; Diarrhea; Dinoprost; Dinoprostone; Female; Heart Arrest; Humans; Pregnancy; Prostaglandins; Prostaglandins E; Prostaglandins E, Synthetic; Prostaglandins F; Seizures; Vomiting