Prostaglandin inhibitors as tocolytic agents

Vermillion, Stephen T.; Landen, Charles N.

doi:10.1053/sper.2001.27549

Cited by 32 publications

(18 citation statements)

References 32 publications

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“…Similar to other studies, 11,13,16,[19][20][21] we found that the neonatal outcomes among antenatally exposed and non-exposed ELBW infants were similar. More importantly, the incidence of adverse neonatal events in our study is similar to that of other populations of comparable GA who had not been exposed to antenatal indomethacin.…”

Section: Discussionsupporting

confidence: 90%

“…indomethacin) have been used as tocolytics since the 1970s. 11 They have been more effective than placebo in delaying delivery for more than 48 h. 12,13 As indomethacin readily crosses the placenta, it can also inhibit prostaglandin synthesis in fetal tissues creating valid clinical concerns for the fetus and the newborn. 11,13,18 Adverse neonatal events have been associated with the prolonged use of antenatal indomethacin, especially in fetuses of 34 weeks of gestation or older.…”

Section: Discussionmentioning

confidence: 99%

“…11 They have been more effective than placebo in delaying delivery for more than 48 h. 12,13 As indomethacin readily crosses the placenta, it can also inhibit prostaglandin synthesis in fetal tissues creating valid clinical concerns for the fetus and the newborn. 11,13,18 Adverse neonatal events have been associated with the prolonged use of antenatal indomethacin, especially in fetuses of 34 weeks of gestation or older. 18 In a recent meta-analysis on the neonatal safety of indomethacin tocolysis, Loe et al 13 cautiously concluded that before 34 weeks of gestation antenatal indomethacin does not appear to increase adverse neonatal events.…”

Section: Discussionmentioning

confidence: 99%

“…24 In the human, the fetal ductus constricts as early as 24 weeks of GA, but that constriction, independent of indomethacin serum levels, is considered to be 'minimal' at least until 31 weeks. 11,14 Therefore, it is plausible that a minimal ductus constriction in utero in ELBW infants of p27 weeks of gestation may not allow for the vessel remodeling that renders the ductus unresponsive postnatally. In preterm infants, the ductus frequently fails to develop the level of profound ischemia needed to cause remodeling, thus allowing the ductus to remain open, or if it is already closed to reopen.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] Indomethacin tocolysis remains valuable in the management of premature labor, but its unavoidable effects on the fetus and the newborn are of concern. [11][12][13] Observational studies of infants of p32 weeks of gestation suggest that antenatal indomethacin may decrease the responsiveness of an sPDA to postnatal indomethacin. [7][8][9][10] Whether a similar exposure influences the clinical response to indomethacin prophylaxis remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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The effects of indomethacin tocolysis on the postnatal response of the ductus arteriosus to indomethacin in extremely low birth weight infants

et al. 2006

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Background: Antenal indomethacin reportedly decreases the responses of a symptomatic patent ductus arteriosus (sPDA) to postnatal indomethacin treatment. Whether a similar exposure affects the responses to indomethacin prophylaxis is unknown.Objective: To evaluate the clinical responsiveness of ductus arteriosus to indomethacin prophylaxis and to the treatment of sPDA in extremely low birth weight (ELBW) infants following indomethacin tocolysis.Methods: Retrospective cohort study of 58 ELBW infants whose mothers received indomethacin tocolysis (study) and 58 ELBW infants whose mothers did not (controls), matched by gender, gestational age (GA), birth weight and postnatal sPDA management (prophylaxis or early treatment).Results: Indomethacin was used as a tocolytic at a median dose of 250 mg, for a duration of 2 days, and ending 1 day before delivery. Study and control mothers were comparable in demographics, antenatal steroid use, cesarean delivery, but were different in the incidence of preeclampsia and preterm labor. Study and control infants were similar in birth weight, GA, indomethacin prophylaxis, early sPDA treatment, mortality, necrotizing enterocolitis, severe intraventricular hemorrhage and stage 3-5 retinopathy of prematurity. Seventeen of 43 study and 16 of 43 control infants who received indomethacin prophylaxis developed sPDA and were combined with early treatment sPDA infants (15 to each group). Two of 32 study and two of 31 control infants underwent surgical ligation whereas the remaining were treated with indomethacin. Sixteen of 30 (53%) and 13 of 29 (45%) were successfully treated and did not require ligation. Study infants were divided according to their mothers' indomethacin total dose (28 infants received p225 mg and 30 infants received >225 mg). Both subgroups were demographically and clinically comparable and their response to indomethacin prophylaxis and treatment were similar. Conclusion:In ELBW infants, exposure to indomethacin tocolysis does not affect the clinical responsiveness of the ductus arteriosus to prophylaxis or that of the sPDA to indomethacin treatment.

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