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Korean Journal of Obstetrics & Gynecology 2009;52(5):571-575.
Published online May 1, 2009.
High fever, coronary artery spasm and convulsion associated with prostaglandin E2 in atonic uterine bleeding.
Joon Cheol Park, Jin Gon Bae, Jong In Kim, Jeong Ho Rhee
Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu, Korea. rl670416@dsmc.or.kr
Abstract
Postpartum hemorrhage is a serious condition related with maternal morbidity and mortality. Prior to surgical treatment, oxytocin and prostaglandin analogs administration are common. Pyrexia after prostaglandin E1 was well known, but PG E2 has been shown to have a few complication even though coronary arterial spasm was rarely reported. The 38-year old woman who delivered 3rd baby by Cesarean section was developed the atonic uterine bleeding. During the treatment with high dose sulprostone (PG E2), she complained the anterior chest pain, her body temperature was elevated to 41.2 degrees C, and then convulsion with stuporous mentality was developed. EKG revealed inverted T wave in II. III, aVF lead, and CK-MB, troponin I was elevated. The laboratory test revealed elevated SGOT/SGPT, myoglobin, and metabolic acidosis. But CSF study, blood culture, direct/indirect Coomb's test, brain CT, and echocardiography were all negative. After supportive care, she came to be alert after 10 hours, body temperature was returned to normal after 22 hours, and the laboratory tests were eventually returned to normal within 6 days. She was discharged from the hospital without any complication. We postulate that high dose PG E2 resulted in high fever, coronary artery spasm, and convulsion
Key Words: Postpartum hemorrhage, Sulprostone, Coronary artery spasm, Convulsion
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