Prophylactic intravenous nitroglycerin application during cesarean sectionto facilitate fetal extraction of preterm infants weighing 500 to 1500 g: Are there negative consequences for the neonates?

Background: Preterm infants should be delivered with as little trauma as po ssible. Fetal extraction during cesarean delivery can be facilitated by mod ification of the incision or by use of short-term tocolytic agents. A possi ble alternative to intravenous administration of beta -mimetics is IV appli cation of nitroglycerin to induce rapid uterine relaxation. This has been r ecommended by various clinical teams, but with relatively little experience being available regarding preterm births. Patients and Methods: Retrospective analysis of the perinatal data for all single neonates weighing 500 to 1500g delivered by cesarean section at the Berlin-Neukolln Hospital in the period from 6/1995 to 9/1999 following prop hylactic intraoperative IV application to the mother of 0.2 mg nitroglyceri n (n = 55). Control groups: 1. All infants weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukolln Hospital with no intraoperative application of nitroglycerin (n = 38); 2. All infants weighing 500 to 1500 g delivered by cesarean section included in Berlin perinatal statistics (B ePE) 1993 - 1998 (n = 715). Results: There were no differences between the groups in terms of Apgar sco res or the incidence of arterial umbilical pH values less than or equal to 7.10 or of maternal blood loss > 1000 ml. Within the nitroglycerin group, i n a shorter interval between nitroglycerin application and cutting of umbil ical cord (less than or equal to 3 min: n = 42; > 3 min: n = 13) 1-minute A pgar scores < 7 were observed more rarely, but no differences in arterial u mbilical pH values 7.10. Conclusions: 1. Intraoperative nitroglycerin application during cesarean se ction has no unfavorable effect on the condition of newborns < 32 SSW or be tween 500 and 1500 g. 2. The incidence of intraoperative maternal blood los s > 1000 ml was not increased. 3. Differences in the interval between nitro glycerin application and cutting of the umbilical cord have no clinically r elevant effects on Apgar scores or arterial umbilical pH.