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Intravenous Nitroglycerin for Internal Podalic Version of the Second Twin in Transverse Lie

DUFOUR, P. MD; VINATIER, D. MD; VANDERSTICHELE, S. MD; DUCLOY, A. S. MD; DEPRET, S. MD; MONNIER, J. C. MD
Obstetrics & Gynecology: September 1998
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Objective To report our experience with high doses (0.1–0.2 mg per 10 kg pregnant weight) of intravenous (IV) nitroglycerin as a uterine relaxing agent for managing internal podalic version of the second twin in transverse lie with unruptured membranes.

Methods Between August 1994 and December 1997, we managed 22 cases of internal podalic version of the second twin with the administration of high doses of IV nitroglycerin.

Results Twenty internal podalic versions were completed successfully, and two cases failed. One failure was considered not related to IV nitroglycerin because the patient had a panic attack, requiring general anesthesia for sedation. The internal podalic version then succeeded. The patient with true failure of IV nitroglycerin required emergency cesarean because of acute fetal bradycardia and a nonrelaxed uterus. This was the only nontransverse lie, but with a very high face presentation. One internal podalic version was complicated by hemorrhage (2000 mL).

Conclusion Intravenous nitroglycerin to induce uterine atonia, with epidural analgesia, avoids general anesthesia and makes internal podalic version easier. In 22 cases (with success in 20) of internal podalic version of the second twin in transverse lie with unruptured membranes, IV nitroglycerin induced transient and prompt uterine relaxation without affecting maternal and fetal outcomes.

Address reprint requests to: P. Dufour, MD, Department of Obstetrics and Gynecology, Hôpital Jeanne de Flandre, University of Lille, 59037 Lille Cedex, France

© 1998 The American College of Obstetricians and Gynecologists