title: Intravenous nitroglycerin to relieve intrapartum fetal distress related to uterine hyperactivity: a prospective observational study.
abstract: During a 1-yr period, we evaluated prospectively the use of nitroglycerin (NTG) to relieve severe intrapartum fetal distress related to uterine hyperactivity. Sixty to ninety micrograms of NTG were injected intravenously (i.v.) within 2-5 min after onset of severe fetal distress after oxygen administration, left lateral decubitus, and discontinuation of any ongoing oxytocin infusion (62%) had failed to resolve the fetal heart rate abnormality. A second dose (60 or 90 micrograms) was used 2-3 min later as required. NTG was completely effective in 22 cases (fetal distress resolution within 4-5 min with restoration of normal uterine activity) and partially but sufficiently effective in the remaining 2 cases (fetal distress resolution within 4-5 min with residual mild uterine hyperactivity). However, a second dose was required for nine parturients (38%). Six parturients (25%) developed hypotension 2 min after the first NTG injection, with a mean nadir of 93.2 mm Hg (minimum 85 mm Hg). Hypotension was always rapidly reversed with a small single dose of ephedrine (4.5-6 mg). In conclusion, we found small doses (60-180 micrograms) of IV NTG to be associated with resolution of severe fetal distress related to uterine hyperactivity along with negligible side effects.
authors.affiliation: Département d'Anesthésie-Réanimation, Hôpital Antoine Béclère, Clamart, France.
authors.forename: F J
authors.initials: FJ
authors.lastname: Mercier
authors.forename: M
authors.initials: M
authors.lastname: Dounas
authors.forename: H
authors.initials: H
authors.lastname: Bouaziz
authors.forename: C
authors.initials: C
authors.lastname: Lhuissier
authors.forename: D
authors.initials: D
authors.lastname: Benhamou
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects; D004341:Drug Evaluation; D005260:Female; D005316:Fetal Distress / Q000188:drug therapy* / Q000209:etiology; D006339:Heart Rate / Q000187:drug effects; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007275:Injections, Intravenous; D005996:Nitroglycerin / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D014590:Uterine Contraction; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin