Severe Uterine Hypertonus during Cesarean Section Relieved by Large Doses of Nitroglycerin

Abstract

A 36 years old female Gravida 3 Para 1 Aborta 1 presented at 35 +2 weeks of gestation with increased frequency and intensity of her uterine contractions. An epidural catheter was inserted at L3-L4 interspace for labor analgesia. A decision was made for Cesarean delivery due to the transverse presentation of the baby. The epidural catheter was loaded by a bolus of 10 ml lidocaine 2%, 5 ml bupivacaine 0.1% and 1ml of fentanyl 50 mcg/ml. Few minutes later; severe uterine hypertonus was noted impairing the delivery of the baby. Very large doses of nitroglycerin (a total dose of 1.3 mg) were needed for uterine relaxation.