Oligohydramnios associated with prostaglandin synthetase inhibitors in preterm labour

Article Abstract:

Preterm labor is associated with a poor pregnancy outcome. Hormone-like substances called prostaglandins are involved in preparing the cervix for the onset of labor. Some studies have shown that inhibiting the production of prostaglandins with prostaglandin synthetase inhibitors is effective in reducing preterm delivery. However, previous research has reported that prostaglandin synthetase inhibitors cause the early closure of a normal fetal blood vessel communication (ductus arteriosus) when the drugs are given for more than 72 hours. Bleeding disorders and high blood pressure have also been reported. Few adverse effects are seen when the drugs are given for less than 72 hours. Some studies report a decrease in amniotic fluid (oligohydramnios) associated with the prostaglandin synthetase inhibitor indomethacin. Two prostaglandin synthetase inhibitors, indomethacin and ibuprofen, were given for more than 72 hours to 67 women in early labor (18 to 31.5 weeks of pregnancy). The amniotic fluid volume was measured by serial ultrasonographic imaging of the fluid surrounding the fetus. The amniotic fluid volume was compared with amniotic fluid volume in a group of women given conventional agents used to prevent premature delivery, magnesium sulphate and ritodrine. Amniotic fluid was reduced in 26 out of 37 women (70 percent) receiving indomethacin and in eight out of 30 women (27 percent) receiving ibuprofen. Only two patients receiving conventional treatment developed oligohydramnios; these cases were both associated with fetal growth retardation. Normal fluid volumes returned when the patients receiving the prostaglandin synthetase inhibitors discontinued the medication. The two pregnancies complicated by oligohydramnios and fetal growth retardation did not have amniotic fluid volume return to normal levels when conventional medications were stopped. None of the infants in either treatment group developed bleeding complications, early closure of the ductus arteriosus, or kidney problems. It is concluded that women in early labor treated with prostaglandin synthetase inhibitors are likely to develop oligohydramnios. However, no drug-related complications were experienced by the mother or the fetus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Measurement, Causes of, Drug therapy, Ibuprofen, Amniotic fluid, Oligohydramnios, Indomethacin

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How accurate is a woman's diagnosis of threatened preterm delivery?

Article Abstract:

Premature, or preterm labor, the onset of labor prior to the 38th week of completed pregnancy, is associated with a poor pregnancy outcome. It is difficult to tell which women in preterm labor will have progressive labor resulting in delivery. Preterm delivery can be delayed if prevention strategies are implemented early. Early diagnosis of preterm labor is hampered by the lack of effective and predictable diagnostic signs and symptoms. Progressive dilatation of the opening of the cervix and regular uterine contractions indicate the onset of true labor. Distinguishing between vague abdominal symptoms and true uterine contractions can be difficult. To see if warning signs and symptoms experienced by pregnant women are accurate in predicting preterm labor, 178 women between the 20th and 37th completed weeks of pregnancy who were in suspected preterm labor were evaluated. Of the 70 women experiencing contractions 17 (24 percent) delivered in 48 hours. Of the 59 women experiencing watery discharge 26 (44 percent) delivered within 48 hours. Of the 33 women experiencing bloody discharge, only three (9 percent) delivered within 48 hours. None of the 16 women experiencing abdominal pain delivered within the following week. Preterm labor was verified when measures to control preterm labor were implemented within 48 hours. Overall, 63 women (35 percent) had confirmed preterm labor. The 45 women (25 percent) who did not require any further intervention were sent home. In general, women experiencing signs and symptoms of preterm labor were reasonably accurate in their assessments. Over 75 percent of the women who thought something was wrong were either admitted to the hospital or gave birth. Methods to differentiate contractions leading to delivery from contractions not leading to delivery would help improve a woman's own diagnosis of preterm labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Complications and side effects, Prognosis, Pregnancy, Complications of, Pregnancy complications, Labor, Complicated, Labor complications

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