Transient myocardial ischemia may occur following subendometrial vasopressin infiltration

A case of transient myocardial ischemia following subendometrial vasopressi n infiltration in intractable intra-operative postpartum bleeding due to pl acenta accreta is described. In our experience, the rate of this side effec t is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patient s. Nevertheless, this case emphasises that extreme precaution is needed wit h subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection o f vasopressin solution can precipitate acute arterial hypertension, bradyca rdia and even death. We suggest that local vasopressin infiltration into th e placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers ha ve failed. (C) 2000 Published by Elsevier Science Ireland Ltd. All rights r eserved.