Intravenous Nitroglycerin for Uterine Relaxation in the Postpartum Patient with Retained Placenta

Peng, Alfred T.C.; Gorman, Roger S.; Shulman, Steven; DeMarchis, E.; Nyunt, Kyaw; Blancato, Louis S.

doi:10.1097/00000542-198907000-00039

Cited by 99 publications

(28 citation statements)

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“…These haemodynamic findings are similar to those of Peng et a1 (12), who used GTN in 15 patients and found an 8% and 5% fall in systolic and diastolic blood pressure respectively, although they found no significant increase in heart rate. Although the systolic and diastolic blood pressure dropped by a mean of 6.9% and 9.2% respectively, and the mean increase in puke was 8.8%, none of the patients experienced any clinically significant symptoms or side-effects.…”

Section: Discussionsupporting

confidence: 90%

Safety of Intravenous Glyceryl Trinitrate in Management of Retained Placenta*

Lowenwirt

Zauk

Handwerker

1997

Aust NZ J Obst Gynaeco

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A retrospective chart review of all anaesthesia consultations for retained placenta at 28 weeks' gestational age or more was performed to determine the safety and efficacy of intravenous glyceryl trinitrate therapy in the management of retained placenta. Of the 33 patients who received glyceryl trinitrate, 1 received a total dose of 50 micrograms and the remainder received 100 to 200 micrograms. All placentas were extracted within 4 minutes of the first bolus. The systolic and diastolic blood pressures and the haematocrit fell by a mean of 8.1 +/- 5.3 mmHg, 6.0 +/- 3.5 mmHg, and 2.6 +/- 1.7%, respectively (mean difference +/- SD, p < 0.05 for each). The pulse rose by a mean of 7.7 +/- 4.5 bpm (p < 0.001). Only 1 patient required ergometrine for continued atony. None of the patients required transfusions or operative therapy other than dilatation and curettage. The use of glyceryl trinitrate in doses of 200 micrograms or less for retained placenta appears efficacious and safe, and may obviate the need for general anaesthesia for uterine relaxation.

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Section: Discussionsupporting

confidence: 90%

Safety of Intravenous Glyceryl Trinitrate in Management of Retained Placenta*

Lowenwirt

Zauk

Handwerker

1997

Aust NZ J Obst Gynaeco

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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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“…Nitric oxide (NO) may play a role in human uterine contractility, because NO donors decrease the magnitude of oxytocininduced contractions (12), are used postpartum to relax the uterus for extraction of retained placenta (13), and may suppress uterine contractions in women in preterm labor and prolonged gestation (14). In vitro studies favor a role in the maintenance of myometrial quiescence (15)(16)(17) and placental vessel tone (18) during human pregnancy.…”

mentioning

confidence: 99%

Up-regulation of nitric oxide synthase and modulation of the guanylate cyclase activity by corticotropin-releasing hormone but not urocortin II or urocortin III in cultured human pregnant myometrial cells

Aggelidou

Hillhouse

Grammatopoulos

2002

Proc. Natl. Acad. Sci. U.S.A.

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The biological actions of corticotropin-releasing hormone (CRH) in the human myometrium during pregnancy and labor are unknown. We hypothesized that CRH may modulate the nitric oxide system, and influence myometrial relaxation͞contractility. Incubation of myometrial cells with CRH, but not urocortin II or urocortin III, for 8 -16 h significantly induced mRNA and protein expression of endothelial and brain but not inducible nitric oxide synthase (NOS) isoforms. This action resulted in increased activity of soluble guanylate cyclase (GC s), demonstrated by the enhanced cGMP-producing capacity of the NO donor, sodium nitroprusside. CRH also caused acute activation of the membrane-bound GC, shown by increased basal or atrial natriuretic peptide (ANP)-stimulated cGMP production. These effects appeared to be mediated via the R1 receptors because the CRH receptor antagonists, astressin and antalarmin but not anti-sauvagine 30, could block them. The acute effects of CRH were significantly reduced by inhibition of protein kinase A (PKA) activity, suggesting it is partially PKA dependant. Activation of protein kinase C (PKC) resulted in significant inhibition of both ANP-and CRH-stimulated cGMP production, suggesting a direct effect of PKC on membrane-bound GC. In conclusion, CRH appears to have a dual effect on myometrial NOS͞GC pathway, a short term effect predominantly mediated by PKA, and a long-term effect increasing constitutive NOS expression, mediated by a PKA-independent mechanism. This mechanism could potentially be active during human pregnancy, and, because cGMP stimulates myometrial relaxation, these findings further suggest that during pregnancy CRH primarily activates intracellular signals that contribute to the maintenance of myometrial quiescence.

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Intravenous Nitroglycerin for Uterine Relaxation in the Postpartum Patient with Retained Placenta

Cited by 99 publications

References 0 publications

Safety of Intravenous Glyceryl Trinitrate in Management of Retained Placenta*

Safety of Intravenous Glyceryl Trinitrate in Management of Retained Placenta*

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

Up-regulation of nitric oxide synthase and modulation of the guanylate cyclase activity by corticotropin-releasing hormone but not urocortin II or urocortin III in cultured human pregnant myometrial cells

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