Re: Use of Nitroglycerine as tocolytic??

[Guest guest]

Theresa~

Thanks for the info! I'm sooooo excited about the new information....now

isn't this what these lists are all about?! New info and of course the

humor!!!!

Thanks again

[Guest guest]

NTG SL works much more rapidly than even terb SQ.

Quickest way to relax a hypertonic uterus that I have seen.

First time I'd seen it used was in the OR during a C/S when the uterus

clamped down and the OB couldn't deliver the baby's head during a breech

delivery. Worked within seconds. This particular OB had just finished her

residency in San Francisco and learned it there. I admit, I was surprised.

Second time I used it, I suggested it to another OB when the uterus

partially inverted and clamped down on his fist. We struggled and

struggled. Finally, I suggested NTG SL. He'd never heard of it, but his

eyes lit up because he immediately understood the efficacy of it. Worked

also within seconds. We were waiting for OR crew to set up when we tried

it. This saved that lady's uterus!

Next time I used it, it was at the second OB's request. She was a multip

who had been on Pit for several hours. It took two doses, but worked

quickly after the second dose. She was not hypertonic until the delivery of

the placenta.

I've only used it a few times. I'd use it again.

Significant bleeding, though.

Gay Marie

Having the courage to ask for what you want is half the battle.

Re: [OBnurses] Use of Nitroglycerine as tocolytic??

> From: SWIL379@...

>

> I have been a nurse for 25 years and have never heard of nitro in L & D. The

> drugs' main purpose is to improve blood flow to arteries, can't see how

this

> would help when the baby is going to take a breath and sufficate anyway.

> Wonder why they did not use a shot of sub q terb to help release the lower

> uterine segment and maybe facilitate the delivery of the head. Proper

> positioning of the fetus can also help pop the head out of a clamped

cervix.

> I can't imagine this case going anywhere due to the severe prematurity of

the

> fetus, but one never knows when dealing with litigation. My bet would have

> been on sub Q terb. which we use for all fetal distress cases or tetanic

> contractions, and it helps relax the uterus the best. Mag would have taken

> too long to get a therapeudic level and do any good for this baby. Hope

this

> helps.

> Sandy, RN

>

> > Welcome to the OBnurses List at www.onelist.com

>

[Guest guest]

[OBnurses] Use of Nitroglycerine as tocolytic??

>From: GIN11153@...

>

>I am reviewing a malpractice case where a 23 week

>breech was being delivered and the head became entrapped when the cervix

>clamped down.

HI there all ,

I have been a labor and delivery nurse for only 10 months and have ( I

am embarassed to admit) never heard of this happening. Can someone please

tell me what this is like, the cervix actually clamps down???? When might

this happen, I have read the posts and have come to understand that it is a

result of hyperstimulation but if someone could please explain or describe

what I might see or feel should this happen. Also , after the

administration of meds does the cervix go back to previous state of

dilitation? I hope these are not silly questions and look forward to

learning from all of your experience. Thanks a lot

>

>>Welcome to the OBnurses List at www.onelist.com

>

[Guest guest]

>

Can someone please

> tell me what this is like, the cervix actually clamps down???? When might

> this happen, I have read the posts and have come to understand that it is

a

> result of hyperstimulation but if someone could please explain or describe

> what I might see or feel should this happen.

, these are not silly questions at all. This is how we all learn. I

see several others have already answered, so I will only say that I have

seen this happen--a cervix clamping around the baby's head in a breech

delivery--very emergent situation! And the force by which the cervix closes

is tremendous--it's a very strong muscle.

----Jeanine

[Guest guest]

In a message dated 12/14/99 2:04:47 PM Eastern Standard Time,

GIN11153@... writes:

<< he head became entrapped when the cervix

clamped down. Doc ordered Nitro stat, and since it's not an L & D stock drug,

had to wait for pharmacy to bring it. >>

I also was involved in a case where it was a very preterm baby came in crownin

g breech, at 0130! Luckily, despite being a very small hospital and the

middle of the night, we were preparing to do a C/S on a laboring pt so we had

the OB, ped, anestheisa etc there. The breech delivered, head did

not....anesthesia wheeled their anesthesia cart quickly in provided rapid

sequence general and OB attempted to deliver head...nitro was called for, we

too do not stock in OB, pharmacy sent stat, approximately 4 minutes later,

head was delivered, fetus was dead.

I have heard of nitro being used in these situations before. This is not an

experiment but a proven way to totally relax that cervix. I cannot provide

you with any research data on this but I do recall (and this was a long time

ago) the doctor showing us a paper about this use.

I can not see how a mag bolus would have accomplished the relaxation of the

cervix, simply a cessation of contraction and would that be neccessary when

the breech had already delivered? I think not. A mag bolus to the degree

necessary to obtaint hat relaxation would also induce respiratory arrest and

who's life are we trying to save here? Risks vs benefits of that risky of a

tx.

Of note here is that despite an attempt upon arrival to the dept to obtain

FHR(on the way to DR) FHR was never actucally heard.

Not having nitro in the delivery room is in no way malice if you ask me. I

dont know all the details of the case either, was she laboring and

progressing to delivery? Did they attempt to stop labor? Where there

reason for not stopping labor? Was she infected, was there some other

problem with the pregnancy? Lots of questions!!!!

Jan

[Guest guest]

I read with much interest the responses to the use of nitro for relaxing the

cervix. I now work in ER and the though of using nitro in the labor and

delivery unit seems so foreign, but at the same time very intriguing. Having

been a nurse for 25 years, I am always amazed at the new things being tried

and done to improve medicine. This just goes to show you can teach old dogs

new tricks, LOL. Keep up the good information, this is a cool site.

Sandy, RN

Midland, Texas

[Guest guest]

The times that we are referring to are after delivery, or during delivery.

Yes, the uterine muscle contracts in a hyperstimulated fashion. The entire

uterus contracts and since the cervix is part of the uterus, the whole

muscle contracts. It strikes me that it occurs as a result of irritablity,

like the uterus can't take one more thing and just clamps down. Extremely

painful for the pt. Imagine having a charlie horse in your uterus, the

world's worst charlie horse. And, that sucker just won't let up. These

poor women are in terrible pain. Since it's post delivery, it doesn't

matter what cervical dilation they are at. Thankfully, it is not a common

occurrence, so you could go years without ever encountering it. The OB who

had his fist entrapped in the partially inverted uterus, said it felt like

the whole uterus was molded to his fist, rock hard. His fist was in there

because he recognized that she had partially inverted and was attempting to

reinvert the uterus with a somewhat rounded object. His wrist was clamped

down on and surrounded by the cervix.

Rereading this, it seems like such a clumsy answer. Best I can do right

now...I just woke up.

Gay Marie

Having the courage to ask for what you want is half the battle.

Re: [OBnurses] Use of Nitroglycerine as tocolytic??

>

> HI there all ,

> I have been a labor and delivery nurse for only 10 months and have

I

> am embarassed to admit) never heard of this happening. Can someone

please

> tell me what this is like, the cervix actually clamps down???? When might

> this happen, I have read the posts and have come to understand that it is

a

> result of hyperstimulation but if someone could please explain or describe

> what I might see or feel should this happen. Also , after the

> administration of meds does the cervix go back to previous state of

> dilitation? I hope these are not silly questions and look forward to

> learning from all of your experience. Thanks a lot

[Guest guest]

I've never seen NTG used for a 'clamped cervix' but I have seen it used for a

cerclage, especially when membranes were right there. Gave NTG (IV) and the

uterus relaxed, membranes back, cerclage in.

gmt wrote:

>

>

> NTG SL works much more rapidly than even terb SQ.

>

> Quickest way to relax a hypertonic uterus that I have seen.

>

> First time I'd seen it used was in the OR during a C/S when the uterus

> clamped down and the OB couldn't deliver the baby's head during a breech

> delivery. Worked within seconds. This particular OB had just finished her

> residency in San Francisco and learned it there. I admit, I was surprised.

>

> Second time I used it, I suggested it to another OB when the uterus

> partially inverted and clamped down on his fist. We struggled and

> struggled. Finally, I suggested NTG SL. He'd never heard of it, but his

> eyes lit up because he immediately understood the efficacy of it. Worked

> also within seconds. We were waiting for OR crew to set up when we tried

> it. This saved that lady's uterus!

>

> Next time I used it, it was at the second OB's request. She was a multip

> who had been on Pit for several hours. It took two doses, but worked

> quickly after the second dose. She was not hypertonic until the delivery of

> the placenta.

>

> I've only used it a few times. I'd use it again.

>

> Significant bleeding, though.

>

> Gay Marie

> Having the courage to ask for what you want is half the battle.

>

> Re: [OBnurses] Use of Nitroglycerine as tocolytic??

>

> > From: SWIL379@...

> >

> > I have been a nurse for 25 years and have never heard of nitro in L & D. The

> > drugs' main purpose is to improve blood flow to arteries, can't see how

> this

> > would help when the baby is going to take a breath and sufficate anyway.

> > Wonder why they did not use a shot of sub q terb to help release the lower

> > uterine segment and maybe facilitate the delivery of the head. Proper

> > positioning of the fetus can also help pop the head out of a clamped

> cervix.

> > I can't imagine this case going anywhere due to the severe prematurity of

> the

> > fetus, but one never knows when dealing with litigation. My bet would have

> > been on sub Q terb. which we use for all fetal distress cases or tetanic

> > contractions, and it helps relax the uterus the best. Mag would have taken

> > too long to get a therapeudic level and do any good for this baby. Hope

> this

> > helps.

> > Sandy, RN

> >

> > > Welcome to the OBnurses List at www.onelist.com

> >

>

> > Welcome to the OBnurses List at www.onelist.com