Carboprost

Abstract

Generalised tonic-clonic seizures and increased blood pressure following off-label use: case report A 21-year-old woman developed generalised tonic-clonic seizures and increased BP during treatment with carboprost for atonic postpartum haemorrhage via unapproved route [dosage not stated]. The pregnant woman was admitted for the emergency caesarean section in the setting of failed induction of labour. Her preoperative laboratory work-up was found to be normal. She was administered spinal anaesthesia with 1.8mL of 0.5% bupivacaine [hyperbaric bupivacaine]. Her post-procedural vital signs were normal and after confirming the level of anaesthesia, surgery was initiated. After 7 minutes of incision, she delivered a baby and oxytocin was initiated. Due to atonic uterus, methylergometrine was administered. Atony persisted with ongoing bleeding and an estimated blood loss was 800mL. Then, she received intramyometrial carboprost injection. She reported severe headache after 30s and her BP increased to 190/110mm Hg. Within the next 20–30s, she experienced an episode of generalised tonic-clonic seizures. Postpartum haemorrhage was noted. The woman underwent a rapid sequence induction of general anaesthesia using thiopentone, succinylcholine and placing a cuffed 7mm tracheal tube. Anaesthesia was maintained at 50:50 using oxygen: nitrous oxide and fentanyl. As her postpartum haemorrhage was under control, the abdomen was closed and the uterus was contracted. She was extubated and was monitored in the operating theatre for 15 minutes in case of recurrent seizure. Her post-procedural vital sign measurement showed heart rate 95 beats/minutes and BP at 140/78mm Hg. She was attentive, and following commands with a full Glasgow coma scale. Her neurological findings did not show any abnormalities and she was seizure-free. She was discharged after 5 days of hospitalisation.