Abstract
Sulprostone, a syntetic E2 analogue is given to increase uterine muscle tone and recommended for second –line treatment of atonic postpartum hemorrhage. Actually, his use in current clinical practice is increasing, specially after cesarean section; few clinical reports of side effects have been published and a recent large population-based study describe a low rates of severe side effects. We present two cases of acute pulmonary edema in two patients after Cesarean section with sulprostone administration directly into the myometrium.
Highlights
Sulprostone is a synthetic prostaglandin E2 analogue (PGE2), and has a dilating effect on the cervix uteri and stimulates the uterus muscles
Despite the potential of the drug to cause pulmonary edema and coronary artery spasm, severe cardiovascular or respiratory side effects are “uncommon” in a large, prospective, population-based cohort of women with postpartum hemorrhage in France [8], and more frequently in smokers and in women above 35 years old or with cardiac diseases
We describe two cases of pulmonary edema after sulprostone administration directly into uterine wall, if intramuscular or intramyometrial administration is controindicated for a possible high plasmatic levels and induced side effects [7,17]
Summary
Sulprostone is a synthetic prostaglandin E2 analogue (PGE2), and has a dilating effect on the cervix uteri and stimulates the uterus muscles. After successful discharge of the placenta, an oxytocin 5 U.I. bolus i.v. was given; despite a good uterine contractility, sulprostone 500 mcg into uterine wall was made by total diuresis was 250 ml loss was 300 mL; the patient received a total of 700 mL of isotonic crystalloid during caesarean section with a total dieresis of 250 ml. She remained in the post-anesthetic care room of delivery unit with a prescribed fluid therapy at 70 ml/h with furosemide 0.8 mg/h; post-operative analgesia was set with intravenous infusion of tramadolo 100 mg, ketoralac 30 mg and metoclopramide 10 mg. The patient was discharged home ten days later asymptomatic and with the advice to periodic cardiological control
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