A randomized double-dummy comparison between indomethacin and nylidrin in threatened preterm labor

Article Abstract:

Studies have indicated that both beta-mimetic drugs such as nylidrin and the anti-inflammatory drug indomethacin are effective in stopping uterine contractions associated with premature labor (tocolytic action). Studies comparing the effectiveness of the two types of drugs have been hindered by the fact that nylidrin and other mimetics are given intravenously, while indomethacin is given orally. Complicating the different modes of administration are findings that intravenous infusion of saline solution alone arrests premature uterine contractions in many cases. This study compared the two drugs by using a double-dummy protocol. Sixty pregnant women experiencing early uterine contractions and threatening preterm labor were enrolled in the study. Indomethacin was given in suppository and oral forms to 30 women and intravenous nylidrin was given to the other 30 women. Intravenous saline was given to the women receiving indomethacin and placebo suppository and oral agents were given to the women receiving nylidrin. Both drug regimens postponed delivery in all the women by at least one day. Seven women receiving nylidrin and one receiving indomethacin delivered the next day, a significant difference. Women given indomethacin were significantly more likely to progress beyond 37 weeks gestation (70 percent) than were women given nylidrin (43 percent). Side effects from the drugs were reported by 6 women (20 percent) who received indomethacin and by 25 women (83 percent) who received nylidrin. The results indicate that indomethacin is more effective as a tocolytic agent and caused fewer side effects than nylidrin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Nylidrin

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Indomethacin for preterm labor: fetal toxicity in a dizygotic twin gestation

Article Abstract:

Indomethacin has been used for preventing premature labor and for treating polyhydramnios (an abnormally large amount of amniotic fluid in the sac surrounding the developing fetus). However, this drug can cause heart problems and oligohydramnios (lack of amniotic fluid) in the developing fetus, and so its use in treating pregnant women has been limited. The case of a 27-year-old pregnant woman who was treated with indomethacin is described. The woman was pregnant with twins and began having contractions at week 33 of pregnancy. An ultrasound examination showed two normal, healthy fetuses with normal amounts of amniotic fluid. To prevent premature labor, the woman was treated with indomethacin (50 milligrams every 6 hours) and terbutalin (2.5 milligrams every 4 hours). When an ultrasound was performed seven days after drug treatment was been started, it was discovered that one of the twins had an abnormally large heart and both twins had oligohydramnios. Treatment with indomethacin was discontinued, and seven days later both twins were normal. At week 37 of pregnancy the woman gave birth to healthy twins weighing 6.9 and 5.6 pounds. It is concluded that treatment with indomethacin late in pregnancy can have serious toxic effects on the fetus. Therefore, if indomethacin must be used, the fetus should be monitored closely for signs of toxicity. The toxic effects can be reversed by discontinuing the medication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Causes of, Fetus, Oligohydramnios, Fetal heart

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Prenatal administration of indomethacin as a tocolytic agent: effect on neonatal renal function

Article Abstract:

Prostaglandins (PGs), hormones that are produced locally and act locally, play an important role in causing cervical ripening (softening), which is necessary for labor to occur. Indomethacin, a drug that inhibits PG synthesis, is an effective treatment for halting premature labor. Some studies have suggested that this treatment affects neonatal tissues, such as the kidneys, digestive tract, and cardiovascular system. However, recent studies reported that short-term indomethacin treatment did not cause adverse effects in the newborn. The effects of long-term intrauterine indomethacin treatment on kidney function were studied in 14 premature infants. The findings were compared with 10 untreated premature infants. Indomethacin was administered for an average of 39 days. Gestational age, birth weight, and size were similar in both groups. All infants experienced changes in kidney function over the first 10 postnatal days, but the two groups did not differ significantly. The lack of neonatal effects might be related to the lower dose of indomethacin used in this study, or to the small number of infants studied. A larger study is required to definitively rule out adverse effects of long-term indomethacin on neonatal health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Infants (Newborn), Newborn infants

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