The effect of indomethacin tocolysis on fetal ductus arteriosus constriction with advancing gestational age☆,☆☆,★
Section snippets
Material and methods
The obstetric and neonatal records for all patients receiving indomethacin therapy for tocolysis between September 1991 and September 1995 at the Medical University of South Carolina in Charleston were reviewed. Only those patients meeting the following inclusion criteria were studied: All patients had accurate gestational age dating with ultrasonographic confirmation on initiation of indomethacin therapy. Only patients receiving an initial dosing of 50 mg rectally followed by 25 mg orally
Results
Sixty-one women with 72 fetuses, including 9 multifetal pregnancies (7 twins, 2 triplets), were studied. Indomethacin tocolysis was initiated at a mean gestational age of 28.9 ± 3.2 weeks. All patients received betamethasone on admission; betamethasone was repeated in 24 hours and weekly thereafter until 34 weeks' gestation if delivery did not occur. A total of 193 fetal echocardiograms were reviewed (2.7 ± 1.6 fetal echocardiograms per patient). Thirty-five cases of ductal constriction (50%)
Comment
Indomethacin has been reported to be an effective agent in the treatment of preterm labor.1, 9 Concerns with premature closure of the fetal ductus arteriosus during indomethacin therapy have led to recommendations for serial fetal echocardiography. Additionally, the current recommendation restricting its use to pregnancies <32 weeks is because of the reported increased incidence of ductal constriction that occurs beyond that gestational age.8 The current study was undertaken to determine the
References (23)
- et al.
Possible association between maternal indomethacin therapy and primary pulmonary hypertension of the newborn
Am J Obstet Gynecol
(1976) - et al.
Clinical note: relationship of maternal treatment with indomethacin to persistence of fetal circulation syndrome
J Pediatr
(1978) - et al.
Fetal and neonatal effects of indomethacin used as a tocolytic agent
Am J Obstet Gynecol
(1985) - et al.
Neonatal outcome after indomethacin treatment for premature labor
Am J Obstet Gynecol
(1986) Effect of advancing gestational age on the frequency of fetal ductal constriction in association with maternal indomethacin use
Am J Obstet Gynecol
(1993)- et al.
Indomethacin—placental transfer, cytotoxity, and teratology in the rat
Am J Obstet Gynecol
(1981) - et al.
The effects of indomethacin and a beta-sympathomimetic agent on the fetal ductus arteriosus during treatment of premature labor: a randomized double-blind study
Am J Obstet Gynecol
(1991) - et al.
Neonatal outcome after indomethacin treatment for premature labor
Am J Obstet Gynecol
(1986) Effect of advancing gestational age on the frequency of fetal ductal constriction in association with maternal indomethacin use
Am J Obstet Gynecol
(1993)- et al.
Inhibition of human premature labor by indomethacin
Obstet Gynecol
(1974)
Effects on neonate of maternal treatment with indomethacin
J Pediatr
Cited by (153)
Targeted drug delivery for maternal and perinatal health: Challenges and opportunities
2021, Advanced Drug Delivery ReviewsDiseases and conditions that impact maternal and fetal health and the potential for nanomedicine therapies
2021, Advanced Drug Delivery ReviewsUterotonics and tocolytics
2021, Clinical Pharmacology During Pregnancy
- ☆
From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina.
- ☆☆
Reprint requests: Stephen T. Vermillion, MD, Department of Obstetrics and Gynecology, 171 Ashley Ave., Charleston, SC 29425.
- ★
6/6/82720