Intravenous Nitroglycerin Aids Manual Extraction of a Retained Placenta

DeSimone, Cheryl A.; Norris, Mark C.; Leighton, Barbara L.

doi:10.1097/00000542-199010000-00031

Cited by 86 publications

(22 citation statements)

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“…This was well correlated with uterine relaxation. Peng et al [19] and DeSimone et al [18] obtained relaxation within 75-95 and 30-40 s, respectively, after drug administration. We obtained initial uterine relaxation by 80 B 20 s, after which uterine contraction ensued without any complications.…”

Section: Discussionmentioning

confidence: 96%

“…Numerous reports using low-dose NTG for emergent uterus relaxation have been made, and its use in RP has been demonstrated to be safe and effective [18,26,27]. In a survey, NTG was the most commonly used drug for intraoperative emergent situations that needed uterus relaxation.…”

Section: Discussionmentioning

confidence: 99%

“…Terbutaline and magnesium sulfate have been used as uterine muscle relaxants; however, some of their side effects, such as tachycardia, hypotension, thoracic pain and pulmonary edema, can be deleterious and persistent [12]. NTG is currently being used in obstetrics in situations such as breech delivery [13], second twin extraction [14,15], uterine inversion [16,17], placental retention [18][19][20][21], external version [22], and now as a tocolytic agent in threatened preterm labor [23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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Intravenous Nitroglycerin in the Management of Retained Placenta

Chedraui

Insuasti²

2003

Gynecol Obstet Invest

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Thirty patients in the third stage of delivery complicated by retained placenta were prospectively managed with intravenous nitroglycerin. We studied the effect of nitroglycerin on the hemodynamics and characteristics of the procedure, and also analyzed labor and maternal and neonatal data. Intravenous nitroglycerin effectively aided the extraction of the retained placenta in all cases. The average procedure time was 5.3 ± 1.1 min, and the dose range was 50–200 µg. Systolic and diastolic blood pressure fell significantly from 111 ± 7.5 to 103 ± 6 mm Hg and from 74 ± 6.7 to 67 ± 6.6 mm Hg, respectively (p < 0.05). Although statistically significant, this was not evident clinically and there were no complications. Intravenous nitroglycerin at a dose of 200 µg or less is safe, effective and predictable in the management of retained placenta and could obviate the need of general anesthesia.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intravenous Nitroglycerin in the Management of Retained Placenta

Chedraui

Insuasti²

2003

Gynecol Obstet Invest

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“…Nitroglycerin, a NO donor, has been employed in some observational or casuistic studies to induce relaxation of the human uterus using intravenous nitroglycerin [17,38,43]. Nitroglycerin use was also reported in the case of an inverted uterus [2], and in woman with abruptio placentae and hypertonia leading to in utero fetal death and difficult delivery [18].…”

Section: Clinical Studies With No Donorsmentioning

confidence: 99%

Role of nitric oxide in the uterus and cervix: Implications for the management of labor

Chwalisż¹,

Garfield²

1998

Jpme

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The results of our experimental studies indicate that that parturition is composed principally of two major phases, a relatively long conditioning (preparatory) phase followed by a short and probably irreversible active labor phase. The major events of conditioning phase are: (i) the progression of uterine contractility from an inactive to a vigorously active state, (ii) cervical ripening, and (iii) activation of fetal membranes. Our experimental and molecular studies indicate that nitric oxide (NO) is an important element in controlling uterine and cervical functions during the transition from pregnancy to the conditioning phase of labor. These studies show that NO acts in concert with progesterone to regulate uterine quiescence and cervical rigidity. In the rat uterus and cervix NO is produced mainly by the cytokine-inducible NO synthase (iNOS) which expression is gestationally-regulated and progesterone-dependent. During pregnancy iNOS expression is up-regulated in the uterus and down-regulated in the cervix. Opposite changes occur during term and antiprogestin-induced preterm labor. Our studies with NOS-inhibitors and NO donors suggest that in the uterus a decrease in NO production contributes to the initiation of labor, whereas in the cervix NO acts as a final metabolic mediator of cervical ripening. The evidence also indicates that NO donors have therapeutic potential as tocolytic agents. On the other hand, locally applied NO donors can be used to induce cervical ripening. In addition iNOS, may represent a new target for novel therapeutic agents capable of promoting or inhibiting uterine of both contractility and cervical ripening. There is an urgent need for controlled studies demonstrating clinical efficacy and safety of NO donors in obstetrics.

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“…More recently, nitroglycerin has been used for this purpose (Axemo et al, 1998;DeSimone et al, 1990;Peng et al, 1989). Nitroglycerin has also been successful in facilitating breech delivery (Greenspoon and Kovacic, 1991), treating uterine inversion (Altabef et al, 1992), and aiding in cesarean section (Axemo et al, 1998) and difficult vaginal deliveries (Dessard et al, 1998;Dufour et al, 1997a;Johansson and Helgadottir, 2001;Wessen et al, 1995).…”

Section: Obstetric Emergenciesmentioning

confidence: 99%