{
    "abstract": "A case of severe reaction to extraamniotically administered prostaglandin F2 alpha, with cardiorespiratory collapse and pulmonary oedema necessitating transfer to an intensive care unit, is presented. Attention is drawn to the profound haemodynamic effects of systemically administered prostaglandin, and the need for caution and ready availability of facilities for resuscitation when this potent substance is administered. Treatment for the effects of intravascular absorption of prostaglandin F2 alpha is discussed.\nA case of severe vasoconstriction treated as cardiorespiratory collapse in a woman given extraamniotic PGF2alpha for midtrimester abortion is described, with comments on management of this rare reaction. The patient was having elective termination because of confirmed spina bifida with hydrocephalus by ultrasound and elevated AFP at 18 weeks gestation. She was given a 4 mg test dose of PGF2alpha (Dinoprost, Upjohn Pty, Ltd) in viscous gel (Tylose MH300, Hoechst Australia Ltd) via extraamniotic Foley catheter. She immediately developed dyspnea, abdominal and breast pain, hypotension of 50 mm Hg systolic, peripheral vasoconstriction, cyanosis and confusion. She was treated with iv Hartmann's solution 600 ml, oxygen 8 1/min, and sc adrenaline 1/1000 0.5 ml. She seemed to improve after receiving 500 ml 3.5% polygeline colloid (Haemaccel, Behringwerke AG), and 5 ml 1/10,000 adrenaline iv, as her systolic blood pressure rose to 70 mm Hg measured indirectly. 500 ml more iv colloid was given, and blood pressure rose to 90 mm Hg. Then she suddenly deteriorated with florid pulmonary edema. Oxygen saturation fell and positive pressure ventilation was begun. She was given furosemide 160 mg iv and hydrocortisone 500 mg iv. Anaphylactic reaction was ruled out on the basis of blood count; amniotic fluid embolism was ruled out because of minor changes in clotting parameters. The events seen here most likely occurred as a result of inadvertent injection of PGF2alpha into the arterial circulation, causing increased pulmonary arterial pressure and vascular resistance, systemic vasoconstriction interpreted as hypotension, all exacerbated by adrenaline and exogenous fluid load. Severe hypertension after extraamniotic PGF2alpha has been reported before in a similar case of apparent hypotension treated with agents to increase blood pressure. PGF2a should not be used without facilities to treat such adverse reactions.",
    "authors": [
        {
            "affiliation": "Royal Women's Hospital, Melbourne.",
            "firstname": "P",
            "initials": "P",
            "lastname": "Wein"
        },
        {
            "affiliation": null,
            "firstname": "B",
            "initials": "B",
            "lastname": "Robertson"
        },
        {
            "affiliation": null,
            "firstname": "G J",
            "initials": "GJ",
            "lastname": "Ratten"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1111/j.1479-828x.1989.tb01735.x",
    "journal": "The Australian & New Zealand journal of obstetrics & gynaecology",
    "keywords": [
        "Abortion, Drug Induced--complications",
        "Abortion, Induced",
        "Abortion, Therapeutic",
        "Australia",
        "Biology",
        "Cardiovascular Effects",
        "Case Studies",
        "Developed Countries",
        "Diseases",
        "Endocrine System",
        "Family Planning",
        "Fertility Control, Postconception",
        "Hypertension",
        "Hypotension",
        "Ischemia",
        "Oceania",
        "Physiology",
        "Pregnancy",
        "Pregnancy, Second Trimester",
        "Prostaglandins",
        "Pulmonary Effects",
        "Reproduction",
        "Research Methodology",
        "Studies",
        "Treatment",
        "Vascular Diseases"
    ],
    "methods": null,
    "publication_date": "1989-08-01",
    "pubmed_id": "2604661",
    "results": null,
    "title": "Cardiorespiratory collapse and pulmonary oedema due to intravascular absorption of prostaglandin F2 alpha administered extraamniotically for midtrimester termination of pregnancy.",
    "xml": "<Element 'PubmedArticle' at 0x788505fb29d0>"
}