[Preventive intravenous nitroglycerin administration in cesarean section to facilitate fetal extraction of infants between 500 and 1500 g--are there negative effects on the newborn infant?].
BACKGROUND
Preterm infants should be delivered with as little trauma as possible. Fetal extraction during cesarean delivery can be facilitated by modification of the incision or by use of short-term tocolytic agents. A possible alternative to intravenous administration of beta-mimetics is i.v. application of nitroglycerin to induce rapid uterine relaxation. This has been recommended by various clinical teams, but with relatively little experience being available regarding preterm births.


METHODS
Retrospective analysis of the perinatal data for all single neonates weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital in the period from 6/1995 to 9/1999 following prophylactic intraoperative i.v. application to the mother of 0.2 mg nitroglycerin (n = 55). Control groups: 1. All infants weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital with no intraoperative application of nitroglycerin (n = 38); 2. All infants weighing 500 to 1500 g delivered by cesarean section included in Berlin perinatal statistics (BePE) 1993-1998 (n = 715).


RESULTS
There were no differences between the groups in terms of Apgar scores or the incidence of arterial umbilical pH values < or = 7.10 or of maternal blood loss > 1000 ml. Within the nitroglycerin group, in a shorter interval between nitroglycerin application and cutting of umbilical cord (< or = 3 min: n = 42; > 3 min: n = 13) 1-minute Apgar scores < 7 were observed more rarely, but no differences in arterial umbilical pH values < or = 7.10.


CONCLUSIONS
1. Intraoperative nitroglycerin application during cesarean section has no unfavorable effect on the condition of newborns < 32 SSW or between 500 and 1500 g. 2. The incidence of intraoperative maternal blood loss > 1000 ml was not increased. 3. Differences in the interval between nitroglycerin application and cutting of the umbilical cord have no clinically relevant effects on Apgar scores or arterial umbilical pH.
David
M
M
Abteilung für Geburtsmedizin, Krankenhaus Berlin-Neukölln. matthias.david@charite.de
Nierhaus
M
M
Schauss
B
B
Vetter
K
K
D000136:Acid-Base Equilibrium / Q000187:drug effects; D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section; D005113:Extraction, Obstetrical; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007262:Infusions, Intravenous; D005996:Nitroglycerin / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011292:Premedication; D012189:Retrospective Studies; D014590:Uterine Contraction / Q000187:drug effects*
D005996:Nitroglycerin