Uterine spasm

Improvement in menstrual cydes by balancing the hor-monesand reducing uterine spasms... 

Ergotamine Mixed partial agonist effects at 5-HT2 and (X adrenoceptors Causes marked smooth muscle contraction but blocks cx-agonist vasoconstriction Migraine and cluster headache Oral, parenteral duration 12-24 h Toxicity Prolonged vasospasm causing gangrene uterine spasm... 

N.A. Pedicularis palustris L. P. canadensis L. Alkaloids, phenyl-propanoid glycosides, iridoid glucosides.303 Treat swelling internally, coughs, uterine spasms, with antioxidant property. 

Increased uterine tone and uterine spasms have been reported in human and animal studies of isolated compounds of blue cohosh (Ferguson and Edwards 1954 Pilcher et al. 1916 Pilcher and Mauer 1918 Vinks et al. 1982). 

The compound sparteine was found to cause uterine spasms in a small percentage ( 5%) of women who were unable to metabolize the compound (Eichelbaum et al. 1979 Vinks et al. 1982). 

A 30-year-old woman developed uterine atony and bleeding after induced abortion because of fetal death at 17 weeks of gestation (4). Sulprostone was given intravenously at a rate of 500 micrograms/hour. When additional sulprostone was injected into the uterine cervix, the patient sustained a myocardial infarction, with ventricular fibrillation and cardiocirculatory arrest, most probably due to coronary artery spasm. She was resuscitated and recovered completely. 

The changes associated with OPC effects on the M-cholinoreactive system are of no small importance in the development of poisoning. OPC induce contraction of the orbicular muscle of eye, which results in pupil narrowing (miosis) and accommodation spasm, bronchial musculature (bronchospasm), musculature of the gastro-intestinal tract, bladder, uterine as well as amplify secretory function of the stomach and intestine. All these effects are determined by the anti-cholinesterase action of OPC on the peripheral M-cholinoreactive systems. 

Christison [26] has reviewed the therapeutic uses of Cannabis in mid-19th century England. The analgetic power of hemp tincture was stressed, in particular in rheumatic and tooth pains. A marked mitigation of various types of spasm, the relief of asthmatic paroxysms and hypnotic effects were noted. A remarkable power of increasing the force of uterine contractions, together with... 

As a result of their ability to relax smooth muscle, calcium channel blocking drugs have numerous therapeutic applications, mainly in the treatment of cardiovascular disorders but possibly also in therapy for bronchial asthma, gastrointestinal muscle spasms and uterine disorders. The in vivo effects of the... 

The uterine actions of this alkaloid have been studied chiefly by Japanese tinvestigators. The isolated uterus of the guinea pig, rabbit, and cat shows increased tonus and amplitude of contractions with low concentrations spasm is induced as the concentration increases. However, very strong solutions cause a diminution in both tonus and activity. Intravenous injections increase the activity of the uterus in situ in these three species... 

Smooth muscle Opioids cause contraction of biliary tract smooth muscle (which may cause biliary spasm), increased ureteral and bladder sphincter tone, and a reduction in uterine tone that may contribute to prolongation of labor. 

For this reason, when an embolotherapy is planned we recommend immediate cessation of prostaglandin Ej agonist infusion. In case of arterial spasm at the ostium of the uterine artery, the use of a coaxial system with a microcatheter is then required. It is possible to successfully catheterize the distal part of the uterine artery in most cases. In these circumstances, the preferred embolic agent is the one that can be easily delivered through a microcatheter, such as PVA (Polyvinyl alcohol) or Embospheres. We prefer to use particles with larger diameters, such as Embospheres 700-900 mg. Even if these particles are used for the above-mentioned reasons, additional Gelfoam embolization of internal iliac arteries is performed because of the extensive collateral pathways of the female pelvis. 

In the absence of arterial spasm, embolization with Gelfoam pledge of both uterine and internal iliac arteries is always performed in order to obtain a bilateral proximal and distal embolization to prevent rebleeding. Even with Gelfoam pledge, we always use large-cut sizes to prevent embolization that is too distal. Embolization with coils is not per-... 

Fig.9.6a-c. Spasm of uterine artery involving proximal segment (a), and distal segments (b,c). Spasm induced a complete occlusion of the distal artery in (c) (arrows)... 

The benefit of this type of catheter is that essentially the entire catheterization can be performed without having a guidewire in the internal iliac or uterine artery thus helping to prevent spasm. In addition since the catheter is being maneuvered without a wire in place, injection of the contrast allows for visualization of the vessels and consequently a much faster catheterization with minimal fluoroscopy time. 

This dependence on the guidewire for location of the uterine artery, and advancement of the catheter is much more likely to lead to spasm than used of the long reversed curve catheter. If spasm occurs, then nitroglycerin (100-200 meg) can be given to help relieve the spasm. Alternatively, slow injection of saline may break the spasm and allow resumption of flow [30]. 

Arterial vasospasm is the most common complication associated with passage of the guidewire and catheter into the uterine artery. Because of its diameter and tortuosity, the uterine artery is prone to spasm. In theory, embolization of an artery in spasm may not result in a lasting occlusion since relaxation of the vessel can increase luminal diameter enough to allow flow around the embolization particles [2], This may lead to a false angiographic end-point with secondary redistribution of the embolization particles [2, 10]. The systematic use of microcatheters and microguidewires has been shown to minimize the occurrence of spasm and medications such nitroglycerin or papaverine maybe effective to treat spasm [2]. 

Several causes of failure associated with UFE have been identified. These include the inability to can-nulate uterine arteries, arterial spasm, flow restriction, variation of vascular anatomy, and/or misdiagnosis of fibroids as a cause of symptoms. Another important cause of failure is insufficient embolization, with recanalization of the fibroid vasculature occurring minutes to hours after the procedure s completion [5]. 

Embolization of uterine arteries for fibroids is based on preferential flow to the tumors, also called flow-directed embolization. The occurrence of spasm results in reduced flow to the perifibroid plexus, which is the target of embolization (Fig. 10.5.4). Thus, spasm may lead to insufficient delivery of embolic material to the fibroid tumors [5]. 

The most common cause for spasm is related to the catheterization. Careful catheterization is essential, although spasm can occur even in experienced hands. Use of a smaller catheter size (4 F) with hydrophilic coating and smaller hydrophilic guidewires (0.021 instead of0.035 ) may reduce the occurrence of spasm. Systematic usage of the microcatheter is now recommended. The guiding catheter is placed at the origin of the uterine artery or even in the internal iliac artery. However, even with the systematic use of a microcatheter, spasm was present in 31% of cases in a recent study by Spies et al [Ij. 

In our experience, use of vasodilators in the presence of spasm was not very helpful. When spasm occurs, the guiding catheter needs to be pulled out of uterine artery until the spasm is resolved. Sometimes the microcatheter should be pulled out of uterine artery as well. In cases of persistent spasm of the left uterine artery, one can remove the catheter and proceed to the embolization of the right uterine artery before re-catheterization of the left side. If a flow-limiting spasm persists, the use of smaller sized... 

Fig.10.5. 4a-f. A 37-year-old patient with heavy bleeding related to a 7-cm intramural fibroid. a,b Right uterine artery angiogram demonstrates spasm (arrow) due to catheterization, c Left uterine artery angiogram shows the feeding artery to the fibroid (arrow), d Embolization of the main feeding artery and patency of the myometrial arteries, e MRI obtained prior to the embolization shows a large intramural mass, f MRI obtained 10 months after the embolization shows an almost normal uterus... 

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