Nitroglycerin and Uterine Relaxation

Bell, E.

doi:10.1097/00000542-199609000-00030

Cited by 18 publications

(11 citation statements)

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“…In a survey, NTG was the most commonly used drug for intraoperative emergent situations that needed uterus relaxation. It was used by 39.2% in comparison with the use of halogenated agents (27.4%) and ß-sympathomimetic drugs (16%) [28].…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Intravenous Nitroglycerin in the Management of Retained Placenta

Chedraui

Insuasti²

2003

Gynecol Obstet Invest

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“…Langevin et al 60 have suggested that changes in uterine compliance are perceived by manual palpation and that this is not recorded by intrauterine pressure monitoring. In contrast, the report by Bell 21 clearly demonstrated a change in the intra-uterine transducer tracing chronologically related to GTN administration. Two other animal reports also indicate intrauterine pressure monitoring is an objective measure of the myometrial effects of GTN 61,62 .…”

Section: Resultsmentioning

confidence: 75%

“…Arrabel and Nagey 70 found that assessment of activity by palpation of the uterus, by obstetricians, senior trainees, residents and midwives was accurate only 48% of the time when compared with intrauterine pressure monitoring. Only two reports used intrauterine pressure measurements to assess GTN effect 21,30 . Ley et al 30 configured an intrauterine pressure transducer from a 7.0 mm internal diameter endotracheal tube, with the cuff partially inflated with saline, and the cuff port connected to a transducer system.…”

Section: Case Reviewsmentioning

confidence: 99%

“…Although the intrauterine pressure fell from 38 mmHg to 23 mmHg following 500 µg of GTN, their catheter system has not undergone the rigorous validation process of new catheters, as described by Dowdle 71 . The case report by Bell 21 includes a copy of the tocodynamometer strip, with annotations indicating the timing of GTN administration (800 µg SL). A definite change in the tracing lasting six minutes is apparent.…”

Section: Case Reviewsmentioning

confidence: 99%

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Glyceryl Trinitrate and Acute Uterine Relaxation: A Literature Review

Caponas

2001

Anaesth Intensive Care

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The use of nitro-vasodilators for achieving rapid uterine relaxation in the resolution of obstetric emergencies has been documented for nearly 120 years. Glyceryltrinitrate (GTN) is the most commonly used nitro-vasodilator for this purpose, with the presumed mechanism of action being via nitric oxide and cyclic guanosine monophosphate (cGMP) mediated processes. GTN is known to release nitric oxide to effect smooth muscle relaxation and some dose response data is available for its vasodilator activity. Human myometrium is known to synthesize and respond to nitric oxide, with changes in the production of and sensitivity to nitric oxide being subject to the cyclical and gestational state of the uterus. Experimental data on the efficacy of GTN in reliably producing uterine relaxation is conflicting and inconsistent. A total of 32 studies and case reports on the use of GTN in achieving rapid uterine relaxation have appeared in the English language literature. Case reports are subject to reporting bias and prospective randomized controlled trials are not without design flaws. Indications for the use of GTN in achieving rapid uterine relaxation cover the antepartum, intrapartum and postpartum periods. The safety of GTN during obstetric emergencies appears high, with no adverse maternal or neonatal outcomes. To establish the efficacy of GTN in reliably achieving uterine relaxation, well designed randomized controlled trials in labouring women are required.

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“…Clinical situations requiring prompt uterine relaxation include acute uterine inversion, [1][2][3][4] uterine hyperstimulation, 5,6 retained placenta, [7][8][9][10][11][12][13] difficult fetal extraction at vaginal or cesarean delivery, 2,8 -15 and version and extraction for multiple gestations. 13,16,17 The techniques generally available for tocolysis include the induction of general anesthesia and the parenteral administration of various tocolytic drugs.…”

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confidence: 99%