sulprostone and Ventricular-Fibrillation

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