Cardiac arrest during sulprostone administration--a case report

Area of Science:

• Obstetrics and Gynecology
• Cardiology
• Pharmacology

Background:

• Sulprostone is a synthetic prostaglandin analogue used for its strong uterotonic effects.
• It has a reported low complication rate in extensive clinical use.
• Postpartum hemorrhage remains a significant cause of maternal morbidity and mortality.

Observation:

• A case of cardiac arrest occurred in a patient undergoing continuous intravenous sulprostone infusion.
• The infusion was administered to manage atonic postpartum hemorrhage following a Cesarean section.
• The patient required 25 minutes of cardiopulmonary resuscitation before spontaneous circulation returned.

Findings:

• The event sequence, ICU investigations, and patient's cardiovascular risk factors suggest sulprostone-induced coronary spasm.
• Bradycardia and subsequent asystole were observed, consistent with known adverse effects of prostaglandin analogues.
• This case adds to the literature associating sulprostone with severe cardiovascular complications.

Implications:

• Clinicians should be aware of the potential for serious cardiovascular adverse events with sulprostone, even with a low reported complication rate.
• Careful patient selection and monitoring are crucial, especially in those with pre-existing cardiovascular risk factors.
• Further research into the cardiovascular safety profile of sulprostone in high-risk populations is warranted.