Nitroglycerin in Labor

Updated March 2, 2015
Author: Miller

Description: Nitroglycerin is an effective short term uterine relaxant in uterine placental entrapment, fetal head entrapment, and treatment of uterine inversion

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Nitroglycerin as a Uterine Relaxant

The Mercy Pharmacy has agreed to stock 2 kinds of NTG for us on OB for emergent uterine relaxation:

  1. IV NTG in the Pyxis in the clean Utility Room
    1. Indication: for retained placenta, uterine inversion, entrapped breech head, etc.
    2. Dilute to 50-100 mcg/mL;
    3. use 25 to 50 mcg bolus at a time until uterus relaxes (communicate withsurgeon; I've never needed more than 200 mcg);
    4. expect mild, brief hypotension and increased bleeding
      1. oxytocin will reverse the brief relaxation, if needed
  2. NTG spray in the epidural cart
    1. Indication: for uterine artery vasospasm or tetanic contraction, e.g. after intrathecal for labor
    2. one to two sprays sublingually (0.4-0.8 mg)
    3. -shorter duration than terbutaline

References

Treatment of Uterine Inversion in 3rd stage Labor (upToDate, 2015)

Retained Placenta after Vaginal Birth (upToDate, 2015)