Acute cutaneous vasculitis associated with prolonged intravenous ritodrine hydrochloride therapy

Article Abstract:

Preterm delivery is when labor occurs before 37 weeks of pregnancy, and affects 5 to 10 percent of pregnancies in the US, resulting in fetal death in 60 to 90 percent of cases. Preterm contractions can be treated with beta-sympathomimetic amines, such as ritodrine, which causes relaxation of the uterine muscle. The side effects of ritodrine include a rapid heart rate, nausea, low blood levels of potassium, and flushing. Serious side effects of ritodrine develop in 1 to 5 percent of treated patients and include low blood pressure, abnormal heart rhythms, insufficient blood supply to the heart, and accumulation of fluid in the lungs. A case is described of a 30-year-old woman with a twin pregnancy who developed vasculitis, the inflammation of the blood vessels, after treatment with ritodrine to stop early uterine contractions at 29 weeks of pregnancy. After more than four weeks of treatment with ritodrine, the patient developed a rash consisting of small, purplish, bleeding spots on the skin of the arms and legs. Blood analysis showed that she had a prolonged bleeding time, but only slightly decreased numbers of platelets (cells involved in blood coagulation). The patient was diagnosed with vasculitis and treated with hydrocortisone. Therapy with ritodrine was discontinued and the twins were delivered by cesarean section. The infants did not have abnormal bleeding or platelet irregularities. A skin biopsy taken from the abdomen during the cesarean section confirmed the diagnosis of vasculitis, which was associated with the presence of neutrophils (a type of white blood cell) and fibrin (a thin whitish protein) in the walls of the small arteries. The rash improved and the patient was discharged five days after the operation. Physicians should be aware of the variety of potential skin and blood related complications caused by prolonged ritodrine treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Drug therapy, Premature labor, Vasculitis, Ritodrine

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Elastase activity of anaerobes isolated from amniotic fluid with preterm rupture of membranes

Article Abstract:

Many microorganisms in the vagina produce an enzyme that can damage fetal membranes. The enzyme elastase breaks down a protein called elastin, which is a normal component of connective tissue. Researchers measured elastase in 131 microorganisms isolated from amniotic fluid taken from pregnant women who had premature rupture of membranes. Seventy-one percent overall produced elastase. This may explain why premature rupture of membranes can lead to infections of the fetal membranes.

Measurement, Physiological aspects, Premature rupture of membranes, Premature rupture of the membrane, Anaerobic bacteria, Elastases

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