Cardiac arrest associated with sulprostone use during caesarean section

Area of Science:

• Obstetrics and Gynecology
• Cardiology
• Pharmacology

Background:

• Sulprostone is a synthetic prostaglandin E2 analogue used for its potent uterotonic effects.
• It is generally considered to have a low complication rate in obstetric practice.
• Its use in managing postpartum hemorrhage, particularly during cesarean sections, is established.

Observation:

• A case report details a 38-year-old patient receiving a 30 microgram bolus intravenous injection of sulprostone for postpartum hemorrhage during cesarean delivery.
• The patient had no prior history of cardiac issues or smoking.
• Within a short period, she developed complete heart block, ventricular fibrillation, and asystole.

Findings:

• Cardiopulmonary resuscitation (CPR) was initiated and successful after 45 minutes.
• Post-resuscitation evaluation revealed no evidence of myocardial infarction.
• The patient experienced a complete neurological recovery.

Implications:

• This case highlights a rare but severe adverse cardiac event associated with rapid intravenous sulprostone administration.
• The rapid injection may have induced coronary artery spasm, leading to the cardiac arrest.
• Clinicians should be aware of potential cardiovascular risks, even with agents considered low-risk, and consider slower administration or alternative agents in high-risk patients.