How safe is gemeprost? A case report of a middle-aged female developing acute myocardial infarction after insertion of gemeprost vaginal pessary and a review of its usage.

Introduction Gemeprost is a prostaglandin E1 analogue and has been in use in our institutions to induce uterine contraction for termination of pregnancy and also for cervical dilatation for dilatation and curettage. We report the case of a 63year-old female presenting for curettage of the uterus who developed acute myocardial infarction 10 minutes after vaginal insertion of gemeprost. She was given sublingual nitroglycerin followed by intravenous morphine for analgesia. The retrosternal chest pain improved rapidly and the patient was sent to the intensive care ward immediately. Intravenous infusion of nitroglycerin was started immediately and blood was taken for assessment of cardiac enzymes. The patient was subsequently sent to another institution with coronary care unit for further management. The patient recovered with minimal haemodynamic changes. There was no further elevation of cardiac enzymes at the Cardiac Critical Care (CCU) and no further electrocardiogram (ECG) changes. The patient, however, refused further intervention and hence was not able to confirm that this was strictly a coronary vasospasm event. Gemeprost is a drug to be used with caution in patients with risk factors of ischaemic heart disease.