Myocardial necrosis in a newborn after long-term maternal subcutaneous terbutaline infusion for suppression of preterm labor

Article Abstract:

A number of drugs are now in use to prevent preterm labor. Terbutaline, a beta-sympathomimetic agent, is used for long-term suppression of labor. Previously, no complications to either the mother or fetus have been reported from use of this drug. The case is reported of a newborn who had myocardial tissue damage thought to be caused by terbutaline. Drug therapy to prevent premature labor was begun at 25 weeks' gestation. The mother received a continuous infusion of terbutaline under the skin until the infant was born at 37 weeks of pregnancy. The infant appeared normal until his breathing rate became very rapid. Cardiac abnormalities were detected and the infant was treated for congestive heart failure. A biopsy of tissue taken from the right ventricle showed myocardial fiber degeneration. No infectious or metabolic cause of this degeneration could be found. The infant recovered and developed normally. Long-term therapy with this drug is relatively new. In another study, heart autopsies performed on infants who died from being born prematurely and whose mothers received these types of drugs showed myocardial necrosis. The effects of long-term use of terbutaline on the fetal heart are clearly in need of further evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Complications and side effects, Drug therapy, Premature labor, Fetal heart, Terbutaline

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Outpatient triplet management: a contemporary review

Article Abstract:

New reproductive technology is considered responsible for a recent increase of triplet pregnancies. The likelihood for a poor outcome is high in these pregnancies and the selective removal of one or two of the fetuses (to yield a twin or singlet pregnancy), now medically possible, is based on earlier findings that triplet pregnancies are difficult to manage. To determine the current status of triplet pregnancy management and survival, a review of 198 women who delivered triplets between 1985 and 1988 was performed. The medical management of the triplet pregnancies before birth included bed rest, drugs to prevent early labor, and careful monitoring of patient symptoms by nurses visiting the woman at home. The most common complication was early labor (66.2 percent). The age of the fetus at the time of delivery was increased; most were delivered between 32 and 37 weeks and fewer were born before 29 weeks of pregnancy. Most of the triplets were delivered by cesarean section (surgical removal of the fetus through the abdomen). The care of preterm fetuses has been greatly improved and the survival rate with home management of triplet pregnancy is 95 percent. It is suggested that the factors that influence the outcome of triplet pregnancies the most should be further investigated.

Care and treatment, Research, Puerperium, Triplets, Multiple birth

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Interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements

Article Abstract:

There appears to be more consistency between examiners when ultrasound scans are used to measure cervical length compared to manual examinations. Ultrasound and manual measurements were each performed by two examiners on 43 women. There was 74% agreement on ultrasound measurements and 35% agreement on manual measurements when agreement was defined as within 1 millimeter (mm). Agreement on ultrasound measurements was even higher when the margins for variability were within 4 mm or 10 mm.

Usage, Ultrasound imaging, Measurement, Medical examination, Pregnant women, Cervix uteri

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