title: Is there a role for progesterone in the management of acute organophosphate poisoning during pregnancy?
abstract: Organophosphates are commonly used pesticides and cause about one million unintentional and 2 million suicidal exposures with up to 300,000 fatalities every year around the world. Toxicity of organophosphates is due to inhibition cholinesterase activity and prolonging the effects of acetylcholine in the receptor site. Clinical features of organophosphate poisoning are defecation, urination, miosis, bronchorrhea, emesis, lacrimation and salivation. Spontaneous abortion reported some when in pregnant patients. Intravenous administration of benzodiazepines, atropine and pralidoxime is the formal treatment of this toxicity. Atropine and pralidoxime have been assigned to pregnancy class C by the FDA and should be recommended for use in pregnant women clinically suffer organophosphate poisoning. Benzodiazepines have been assigned to pregnancy class D and should be avoided during pregnancy. Clinical experiments suggest transplacental transfer of organophosphates is possible, and fetal sensitivity is probable, but a single acute overdose most likely don't make any physical deformities, therefore termination of pregnancy is not imperative. Nonetheless, no definite strategy focused on maintaining pregnancy. Here we propose an idea that in any female case of acute organophosphate poisoning in childbearing range of age, maternal serum Beta-HCG should be tested for pregnancy and prophylactic progesterone should be used in pregnant cases of organophosphate poisoning.
authors.affiliation: Department of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Jafarzadeh
authors.forename: Zeynab Nasri
authors.initials: ZN
authors.lastname: Nasrabadi
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Sheikhazadi
authors.forename: Abdollah
authors.initials: A
authors.lastname: Abbaspour
authors.forename: Shayesteh
authors.initials: S
authors.lastname: Vasigh
authors.forename: Vahid
authors.initials: V
authors.lastname: Yousefinejad
authors.forename: Sayed Mahdi
authors.initials: SM
authors.lastname: Marashi
mesh_terms: D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D019468:Disease Management; D005260:Female; D006801:Humans; D008954:Models, Biological; D062025:Organophosphate Poisoning / Q000188:drug therapy*; D010575:Pesticides / Q000506:poisoning*; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D011247:Pregnancy; D011258:Pregnancy Tests; D011374:Progesterone / Q000627:therapeutic use*
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D010575:Pesticides; D011374:Progesterone