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Intrapartum: Acute Tocolysis using Intravenous or Sublingual/Lingual Spray Glyceryl Trinitrate (GTN) for Fetal Entrapment, Retained Placenta or Uterine Inversion in Operating Theatre (OT) and Birth Unit (BU) - WSLHD

Date Created V1.0 June 2014
Last Updated July 2019
Version Number 2.0
This Version Update 2 September 2019
Drug Commitee Approval 2 September 2019
NB: This document will not necessarily apply in all circumstances. It does not replace professional and/or clinical judgement. It may be amended/withdrawn at any time. Printed copies should not be relied upon. ALWAYS refer to the electronic copy. WSYD-PROC201847.pdf • Release 1


Purpose and Scope

  • This document outlines the use of intravenous (IV) or sublingual/lingual spray (SL) glyceryl trinitrate (GTN, also known as nitroglycerin), when necessary, in the management of urgent situations such as:
    • Prevention or management of acute fetal entrapment in the uterus / cervix at the time of birth including breech after-coming head at both caesarean & vaginal birth, and also transverse lie, deeply engaged head or very deflexed head at caesarean birth.
    • Management of retained placenta in the presence of a cervix/uterus constriction ring (but not otherwise)
    • Acute uterine inversion postpartum.
  • This document does not cover use of sublingual GTN tablets (e.g. Anginine®) as these do not act quickly enough to be appropriate (Ducharme 1999).
  • This document does not cover any other aspects of tocolysis, for example the management of:
    • Preterm labour
    • CTG fetal heart rate abnormalities, with or without tachysystole

      Intended Audience

      • This procedure applies to all medical, anaesthetic and midwifery staff in WSLHD caring for intrapartum women.

      Expected Outcomes

      • Staff will understand the appropriate indications, routes and dosages of GTN IV and GTN Sublingual/Lingual for the situations of acute fetal entrapment, uterine inversion and manual removal of placenta in the presence of a cervix/uterus constriction.
      • Staff will understand the potential risk of short-term (up to 15 - 30 minutes) hypotension associated with GTN use.



You can download the full document here

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