Continuous long-term intravenous beta-sympathomimetic tocolysis

This report concerns the clinical course and outcome of 16 patients treated by continuous long-term intravenous beta-sympathomimetic tocolysis (greater than or equal to 1 week's intravenous therapy). Half of the patients received such therapy for at least 5 weeks. Intravenous tocolysis was adjusted to decrease uterine activity and maintain a satisfactory pulse and blood pressure. Parenteral tocolysis was continued until there was a successful transition to oral therapy, until fetal maturity, or until maternal/fetal indications for delivery were noted. Data indicate that the cardiovascular and metabolic effects were pronounced mostly during the first 3 to 4 days of therapy and then returned toward pretreatment values. In none of the study patients was the treatment discontinued because of drug-related problems, electrocardiogram changes, chorioamnionitis, or fever. The experience indicates that, in a selected group of patients and under close supervision, continuous long-term intravenous beta-sympathomimetic tocolysis may be considered a safe therapeutic modality able to prolong pregnancy with a more desirable outcome.     

Prophylactic long-term oral tocolysis of multiple pregnancies

Summary. After admission to hospital for bed rest, 200 women with multiple pregnancies were randomly allocated to receive either 4 mg of salbutamol orally five times daily, or to receive no drug. After an average of 6 weeks treatment, no difference between the experimental groups could be detected with respect to duration of gestation, birth-weight or any other of the outcomes of pregnancy observed.     

Prophylactic long-term oral tocolysis of multiple pregnancies

After admission to hospital for bed rest, 200 women with multiple pregnancies were randomly allocated to receive either 4 mg of salbutamol orally five times daily, or to receive no drug. After an average of 6 weeks treatment, no difference between the experimental groups could be detected with respect to duration of gestation, birthweight or any other of the outcomes of pregnancy observed.     

Safety and efficacy of long-term tocolysis with indomethacin

Indomethacin was utilized in 24 pregnancies (31 exposed fetuses) in preterm labor who labored despite intravenous tocolysis. The mean gestational age at the start of indomethacin therapy was 25.1 weeks (+/- 4.4), mean duration of indomethacin therapy was 43.9 days (+/- 31.4), mean gestational age at delivery 33.1 weeks (+/- 3.7). Neonatal follow-up revealed the same incidence of complications in these indomethacin-exposed infants, when they were compared with all other infants born in the same time period and exposed to intravenous tocolytics only when matched for gestational age at delivery.     

Use of the subcutaneous terbutaline pump for long-term tocolysis

Nine patients in preterm labor requiring long-term tocolysis were managed with subcutaneous terbutaline administered via a portable infusion pump. All had failed oral tocolytic therapy and were therefore faced with prolonged hospitalization. In this feasibility study, the patients were treated at home and monitored with portable tocodynamometers and home nursing visits. Uterine activity data were transmitted via telephone to the study center and terbutaline pump infusion rates were adjusted accordingly. Terbutaline pump therapy consisted of a combination of low-dose continuous basal infusion supplemented with intermittent high-dose boluses. Total daily drug dosage remained exceptionally low (less than 3 mg/24 hours). The mean gestational age at initiation of therapy was 29.6 +/- 3.7 weeks, and pregnancy was prolonged an average of 9.2 +/- 4.3 weeks. The minimum gestational age at delivery was 37.3 weeks. Patient tolerance was excellent and, in a total 394 patient-days of therapy, there were no significant complications. We conclude that the portable subcutaneous terbutaline pump may be a promising new method for long-term outpatient tocolysis in patients who cannot be maintained on oral therapy.     

Comparison of the effectiveness of Partusisten and ethanol tocolysis. I: long-term tocolysis with Partusisten or ethanol

Effectiveness of long term tocolysis with fenoterol (Partusisten) (n = 124) or ethanol (n = 117) has been compared in a retrospective study of the years 1978 to 1980. Situation of starting therapy has been estimated by Bishop-Score, tocolysis index and gestational week. Criterias of success were duration of gestation (reaching greater than or equal to 37th gestational week), neonatal parameters (weight greater than or equal to 2500 g, RDS morbidity, neonatal mortality) and prolongation index by Richter and success score by Weidinger. Fenoterol (Partusisten) is the better drug for treatment of premature labor. In cases of contraindications or incompatibility ethanol tocolysis is justified.     

Fatal intrapartum pulmonary embolus during tocolysis

Intrapartum pulmonary embolus, especially in association with hypercapnea, is an extremely dangerous situation requiring immediate detection and aggressive management. The predisposing factors of obesity and bed rest must be assessed, with strong consideration given to the use of prophylactic heparin.     

Acinetobacter as a problem pathogen in patients with long-term tocolysis

A hospital outbreak of Acinetobacter Calcoaceticus in a ward with patients with intravenous tokolysis is reported. Within 2 months 9 pregnant women who had tokolysis for premature labour developed septic fever that only subsisted after the administration of tokolysis was stopped. In 7 cases blood culture was positive for Acinetobacter Calcoaceticus. This endemic outbreak was responsible for premature deliveries in four cases, leading top post partum death of two infants. Source identification was inconclusive, no further outbreaks have occurred since the reported endemic occurrence. Dangers of nosocomial infections in patients with intravenous tokolysis are discussed.     

血清肌酸激酶及同工酶在胎盘植入中的诊断价值

目的 探讨血清肌酸激酶(CK)及同工酶测定在胎盘植入中的诊断价值.方法 2004年1月至2007年1月在中山市人民医院测定33例正常产妇及85例临床疑诊胎盘植入产妇血清CK及同工酶.结果 胎盘植入产妇31例血清CK水平为(143.1±28.5)U/L,其中MBl3%,MM87%,BB未测出,胎盘粘连产妇26例血清CK水平为(76.3±25.4)U/L,其中MB4%,MM96%,BB未测出;其他产妇38例血清CK水平为(69.3±24.4)U/L,其中MB 5%,MM 95%,BB未测出.正常产妇33例血清CK水平为(68.4±24.4)U/L,其中MB 4.5%,MM 94.5%,BB未测出.胎盘植入组产妇血清CK水平明显高于胎盘粘连组、其他产妇组和正常产妇组,差异有统计学意义(P＜0.01),且其中MB型所占比例明显升高,各组BB型均未测出,以CK活性为96U/L作为诊断胎盘植入的界值,敏感性为91.3%,特异性为89.0%,阳性预测值83.8%,阴性预测测值96.9%.结论 测定血清肌酸激酶及其同工酶在胎盘植入中的产前诊断有重要的临床意义.     

Cardiac isoenzymes and electrocardiographic changes during ritodrine tocolysis

To investigate the potential myocardial ischemic effects of ritodrine, we studied 36 singleton and four twin preterm pregnancies during ritodrine therapy. We serially determined serum creatinine phosphokinase (CPK-MB fraction) and lactic dehydrogenase isoenzymes and performed electrocardiography before and during ritodrine infusion and again within the first 24 hours of oral drug therapy. We observed that serum CPK-MB and lactic dehydrogenase isoenzymes remained within the normal range during therapy periods. The incidence of sinus tachycardia and non-specific T wave changes were 100% and 25%, respectively. In three of four twin pregnancies, ST-T segment depression in leads I, V4, V5, and V6 of the electrocardiogram was noted. Our study suggests that (1) the recommended ritodrine regimen does not produce direct myocardial damage, and (2) ritodrine may cause cardiac ischemia as determined by electrocardiography, which theoretically would progress to myocardial damage if not treated properly.     

Fetal cardiovascular function during prolonged magnesium sulfate tocolysis

The purpose of this study was to evaluate the fetal cardiovascular function during prolonged magnesium sulfate tocolysis. We performed a fetal ultrasonographic examination in 15 patients (Mg group) during magnesium sulfate tocolysis for the treatment of preterm labor. The maternal serum magnesium concentration was 5.7 +/- 0.5 mg/dl at the time of the examination. Sixteen fetuses in normal pregnancies at similar gestational ages were used as the control group. The fetal heart rate and the middle cerebral artery pulsatility index in the Mg group were lower than in the control group (p < 0.01). Fractional shortening (FS) of the right ventricle in the Mg group was lower (p < 0.01), while FS of the left ventricle was higher (p < 0.01) than in the controls. The calculated blood flow through the tricuspid orifice in the Mg group was lower than in the control group (p < 0.01). In contrast, the blood flow through the mitral orifice in the Mg group was higher than in the control group (p < 0.01). In conclusion, in spite of the fact that the right ventricular function is depressed, the fetus maintains its cardiac output during prolonged hypermagnesemia by increasing its left ventricular function. These results indicate the different fetal intracardiac and peripheral circulation, especially in the brain, from normal fetuses.     

Comparison of the effectiveness of Partusisten and ethanol tocolysis. III: Comparison of long-term and short-term tocolysis with Partusisten and ethanol

The effectivity of Partusisten or ethanol long term respectively short term tocolysis by combination of a retrospective and a prospective-randomised study has been compared. Long term tocolysis was better than short term tocolysis. Partusisten was more effective than ethanol. Partusisten long term tocolysis was different to other forms or treatment with a high significance. 70% of newborns after Partusisten long term tocolysis had a birth weight of 2500 g or more.     

Evaluation of serum creatine kinase in ectopic pregnancy with reference to tubal status and histopathology

Objective To study the value of creatine kinase in ectopic pregnancy with reference to tubal histopathology.
Design Prospective controlled study.
Setting Academic tertiary-care institution.
Population Thirty-two women with ectopic pregnancy and 20 controls with intrauterine pregnancies.
Methods Creatine kinase and β-hCG levels were measured on admission. Ectopic pregnancies were removed at surgery and examined histologically.
Main outcome measures Tubal localisation and integrity of ectopic pregnancies as judged at surgery and later histologically, and placental growth patterns in unruptured ectopic pregnancies classified as intraluminal, extraluminal or mixed as determined histologically.
Results Creatine kinase levels were higher in isthmic than ampullary ectopic pregnancies (   P = 0.011  ), and higher in ruptured than in unruptured cases (   P = 0.003  ) and normal pregnancies (   P < 0.0001  ). A creatine kinase value >120iu/L was 65% sensitive and 87% specific in discriminating ruptured from unruptured ectopic pregnancies. Creatine kinase levels were above this cutoff in two of five unruptured ampullary ectopic pregnancies with invasive trophoblastic growth, yet in none of nine cases with intraluminally confined placentation (   P = 0.04  ). Creatine kinase was positively correlated with gestational age in ruptured (   P = 0.007  ), but not in unruptured ectopic pregnancies or normal pregnancies.
Conclusions Serum creatine kinase may help in discriminating ruptured from unruptured ectopic pregnancies, while it is not useful for the primary diagnosis of ectopic pregnancy. An increase in creatine kinase levels accompanying muscular damage in ectopic pregnancy probably antedates tubal rupture, and may be related to trophoblastic growth patterns.     

Radioimmunoassay procedure of serum myoglobin in case of a long-term tocolysis with beta-sympathomimetics

In order to establish early recognition of possible myocardial damage, the serum myoglobin level was determined by radioimmunological methods in 115 patients who were treated - due to anticipated premature birth - with tocolytically operating beta-sympathomimetics during a period of up to 10 weeks.