The potential use of terlipressin in urgent gynecology

DOI

https://dx.doi.org/10.18565/aig.2024.184

Ivanova N.A., Tsypin A.V., Ponomareva S.G.
1) Petrozavodsk State University, Petrozavodsk, Russia; 2) Republican Hospital of Emergency and Urgent Medical Care, Petrozavodsk, Russia

The use of terlipressin to reduce blood loss during surgical procedures is due to its pronounced vasoconstrictor effect on the microcirculatory system of abdominal organs and tissues, the rapid onset of the effect, the absence of systemic effects in local application, and the rare occurrence of adverse reactions. Terlipressin has several advantages over vasopressin because of its selectivity for V1α receptors. In gynecological practice, the drug is usually given intravenously, paracervically or intramyometrically. Terlipressin can be used both in planned surgical procedures (laparoscopic myomectomy, hysteroresectoscopy, cervical conization) and in emergency gynecological care (ectopic pregnancy, abdominal pregnancy, bleeding during endometrial scraping after miscarriage).
Case report: The article presents two clinical cases of successful use of combined administration of terlipressin in urgent situations. The drug was administered off-label after the patients signed an informed consent. In the first case, a 34-year-old woman with abnormal uterine bleeding (AUB) that occurred after taking anticoagulants following a recent iliofemoral thrombosis and pulmonary embolism was given a simultaneous paracervical and intravenous injection of terlipressin due to contraindications to all known recommended methods for arresting AUB; the patient’s bleeding decreased dramatically after 10 minutes and stopped completely after 2 hours. In the second case, a 47-year-old woman was admitted with hemorrhage due to a submucosal myomatous node in a bad condition, with severe post-hemorrhagic anemia (Hb 61 g/L) that required a hemotransfusion of a red blood cell mass. Terlipressin was administered simultaneously paracervically and intravenously prior to removal of the node, which stopped bleeding after 12 minutes and allowed virtually bloodless removal of the node using a twisting technique without the need for hysterectomy. No side effects or complications were observed in either of the two patients.
Conclusion: The presented cases demonstrate the successful use of combined administration of terlipressin in urgent gynecology to stop uterine bleeding of various etiologies in the absence or contraindication of other recommended methods.

Authors’ contributions: Ivanova N.A. – processing the data, writing the text; Tsypin A.V., Ponomareva S.G. – collecting the data.
Conflicts of interest: The authors declare that they have no conflicts of interest.
Funding: The authors declare the absence of any financial and sponsorship support in preparing this manuscript.
Patient Consent for Publication: The patients provided an informed consent for the publication of their data.
For citation: Ivanova N.A., Tsypin A.V., Ponomareva S.G. The potential use of terlipressin in urgent gynecology.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (11): 235-239 (in Russian)
https://dx.doi.org/10.18565/aig.2024.184

terlipressin

abnormal uterine bleeding

vasoconstrictor

submucosal myomatous node

blood-saving techniques

vasopressin

Full text (in Russian)

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Received 31.07.2024

Accepted 10.08.2024

Natalya A. Ivanova, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Dermatovenereology, Petrozavodsk State University,
185910, Russia, Republic of Karelia, Petrozavodsk, Lenin str., 33, natalia-691969@mail.ru, https://orcid.org/0000-0001-5380-6006
Alexey V. Tsypin, Obstetrician-Gynecologist, Resident at the Surgical Department No. 2, Republican Hospital of Emergency and Urgent Medical Care,
185031, Russia, Republic of Karelia, Petrozavodsk, Kirov str., 40.
Svetlana G. Ponomareva, Obstetrician-Gynecologist, Resident at the Surgical Department No. 2, Republican Hospital of Emergency and Urgent Medical Care,
185031, Russia, Republic of Karelia, Petrozavodsk, Kirov str., 40.
Corresponding author: Natalya A. Ivanova, natalia-691969@mail.ru

The potential use of terlipressin in urgent gynecology

Ivanova N.A., Tsypin A.V., Ponomareva S.G.

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