The haemodynamic and respiratory effects of intravenous nimodipine used in the treatment of eclampsia

Objective To establish the antihypertensive properties of intravenous nimodipine used to treat eclamptic patients. To assess the effects of intravenous nimodipine on oxygen delivery and consumption.
Design A prospective observational study.
Setting The Maternity Centre Obstetric Intensive Care Unit, Groote Schuur Hospital.
Participants Four unselected patients presenting with proteinuric hypertension and seizures.
Methods Haemodynamic observations were obtained by a radial artery catheter and right heart catheterisation with a pulmonary artery flow directed thermodilution catheter. Observations were obtained prior to and after the administration of nimodipine.
Resuts A significant reduction in mean arterial pressure occurred in all patients after administration of nimodipine. This was due to a significant reduction in systemic vascular resistance. Neither oxygen delivery to the tissues nor peripheral oxygen consumption changed significantly during nimodipine infusion. No adverse effects related to the use of nimodipine were documented.
Conclusions Nimodipine is an effective vasodilator. There may be a role for nimodipine as a single agent for the management of eclampsia.     

Double-blind evaluation of ritodrine sustained release for oral maintenance of tocolysis after active preterm labour

Objective To evaluate the effect of ritodrine sustained release capsules for maintaining uterine quiescence after successful treatment of active preterm labour.
Design Multicentre placebo-controlled trial. Setting Five teaching hospitals in the Netherlands.
Participants Women (   n = 95  ) at less than 35 weeks of gestation in whom active preterm labour had been stopped with intravenous ritodrine.
Interventions Women received either two 40 mg ritodrine sustained release capsules (   n = 50  ) or identical placebo capsules (   n = 45  ) three times a day for seven days.
Results The proportion of women who received another course of active treatment was significantly smaller with the sustained release than with placebo (1 of 50 versus 11 of 45:   P = 0.003  ) as was the number delivering because of preterm labour during treatment (0 of 50 versus 4 of 45:   P = 0.04  ). There were no other significant differences between the two groups.
Conclusions Maintenance treatment with ritodrine sustained release capsules after arrest of preterm labour reduces the risk of recurrences of preterm labour that necessitate treatment or precipitate delivery.     

Protective effect of depot-medroxyprogesterone acetate on surgically treated uterine leiomyomas: a multicentre case-control study

Objective To assess the protective effect of depot-medroxyprogesterone acetate (DMPA) on uterine leiomyomas. DMPA has been widely used in Thailand for many years; uterine leiomyomas is the most common female tumour.
Design A multicentre hospital-based case-control study.
Setting University and regional hospitals.
Patients Cases were all newly diagnosed patients with pathologically proven diagnosis of uterine leiomyomas, who were admitted to eight hospitals in three regions of Thailand from January 1991; to June 1993;. Three controls matched with cases by sex, age within five years and date of admission within three months were recruited.
Main outcome measures Information on socio-demographic factors, personal and family history, current disease, reproductive and contraceptive history was collected from cases and controls by interview.
Results There were 910 cases and 2709; controls. After univariate and unconditional multiple logistic regression analysis, risk factors associated positively with uterine leiomyomas are tubal ligation, family history of uterine leiomyomas, higher education, obesity and abortion. In contrast, DMPA, use of oral contraceptives, higher parity and smoking are associated with a lower relative risk suggesting that they have a protective effect against uterine leiomyomas. This causative relation is further strengthened by the strong duration-response relation between DMPA and uterine leiomyomas. This protection may persist for more than 10 years after the last dose.
Conclusion We have demonstrated a strong, duration dependent protective effect of DMPA against uterine leiomyomas.