Lack of reactivity of uterine arteries from patients with obstetric hemorrhage
- 1 May 1992
- journal article
- Published by Elsevier BV in American Journal of Obstetrics and Gynecology
- Vol. 166 (5), 1436-1443
- https://doi.org/10.1016/0002-9378(92)91616-i
Abstract
Obstetric hemorrhage may occur throughout pregnancy and the puerperium. The purpose of this study was to investigate the reactivity of isolated, suffused uterine arteries from obstetric patients with uncontrollable uterine bleeding and to compare those blood vessels with uterine arteries from patients undergoing cesarean hysterectomy for other medical reasons (control patients). The uterine arteries from the control patients (n = 9) responded with maximal or near-maximal constriction to norepinephrine (30 mumol/L, 3.6 +/- 1 gm), potassium chloride (75 mmol/L, 10.2 +/- 3 gm), prostaglandin F2 alpha (30 mumol/L, 1.8 +/- 1 gm), and arginine vasopressin (1 mumol/L, 18.8 +/- 2.6 gm). In uterine arteries from five patients with uncontrollable bleeding, the constrictor responses to the same drugs were markedly depressed: norepinephrine (30 mumol/L, 0.5 +/- 0.2 gm), potassium chloride (75 mmol/L, 1.9 +/- 0.8 gm); prostaglandin F2 alpha (30 mumol/L, 0 gm), and arginine vasopressin (1 mumol/L, 0.2 +/- 0.05 gm). Uterine arteries from two patients exhibited no constrictor responses to norepinephrine (30 mumol/L), potassium chloride (75 mmol/L), prostaglandin F2 alpha (30 mumol/L), or arginine vasopressin (1 mumol/L). The impaired responses to the vasoconstrictor drugs were not reversed by indomethacin (1 mumol/L), which is an inhibitor of prostaglandin synthetase; methylene blue (10 mumol/L), which is a blocker of endothelium-derived relaxing factor activation of guanylate cyclase; or propranolol (1 mumol/L), a beta-adrenergic receptor antagonist. The levels of adenosine 3':5'-cyclic monophosphate were not elevated in the uterine arteries from the patients with obstetric hemorrhage. The impaired reactivity to the multiple vasoconstrictors implies that a mechanism involved in constriction common to all of the constrictors is depressed or blocked. Furthermore, the depression or lack of reactivity of these isolated uterine arteries is not mediated by vasodilatory prostaglandins, endothelium-derived relaxing factor, beta-adrenergic receptors, or elevated levels of adenosine 3':5'-cyclic monophosphate. The results suggest that obstetric hemorrhage involves, in part, a lack of constrictor reactivity of the uterine vasculature.Keywords
This publication has 11 references indexed in Scilit:
- Magnesium sulfate-induced relaxation of uterine arteries from pregnant and nonpregnant patientsAmerican Journal of Obstetrics and Gynecology, 1991
- In vitro release of endothelium-derived relaxing factor by acetylcholine is increased during the guinea pig pregnancyAmerican Journal of Obstetrics and Gynecology, 1989
- Comparison of Nitroprusside and Hydralazine in Isolated Uterine Arteries from Pregnant and Nonpregnant PatientsAnesthesiology, 1988
- Parathyroid hormone-induced changes in cyclic nucleotide levels during relaxation of the rat aortaLife Sciences, 1987
- In vitro prostacyclin production by ovine uterine and systemic arteries. Effects of angiotensin II.JCI Insight, 1985
- Pregnancy: Increased effect of verapamil in human uterine arteriesEuropean Journal of Pharmacology, 1985
- The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholineNature, 1980
- Effect of the Ovine Conceptus on in vitro Responses of Uterine Arteries to Prostaglandin E2 and Norepinephrine1Biology of Reproduction, 1979
- In vitro Response of Ovine and Bovine Uterine Arteries to Prostaglandin F2α and Periarterial Sympathetic Nerve Stimulation1Biology of Reproduction, 1976
- A direct method for recording tension changes in the wall of small blood vessels in vitroInflammation Research, 1972