Treatment of premature labor contractions with combined ritodrine and indomethacine

Abstract

The results of combined ritodrine and indomethacine treatment (RI) in premature labor contractions were compared with ritodrine alone (R). One hundred and twenty patients with threatened premature labor in weeks 26-34 were studied. Sixty RI women received 100 mg ritodrine in infusion followed by 60 mg daily orally until 35 weeks and indomethacine 200 mg on the first day of treatment only. The R group included 60 women with identical tocolysis indices, age of pregnancy and anamnestic parameters who received ritodrine only. The mean prolongation index (PI) was 18.2 in the RI group, against 11.5 in the R patients (P less than 0.05). The mean prolongation of pregnancy was 5.6 weeks in the first and 3.6 in the control group (P less than 0.05). Birthweight and Apgar scores were similar in the two groups. In order to examine the possible early closure of the ductus arteriosus due to the indomethacin therapy, echocardiograms were done on all newborn in the RI group: the pre-ejection period and right ventricular ejection time ratio was 0.19-0.26 after delivery and 0.17-0.22 1 month later, which excludes pulmonary diastolic hypertension due to premature closure of the duct. The combined RI treatment is more effective that R alone and does not give rise to any complications in the mother or the fetus.

Indomethacin in Pregnancy: Applications and Safety

“…Several randomized controlled studies have compared indomethacin with other tocolytics alone or in combination, reporting variable success rates. 24,25,27,29,42,43 Eight trials comparing all COX inhibitors with other tocolytics were included in a Cochrane metaanalysis. 22,24,25,27,29,[44][45][46] A reduction in the number of women delivering prior to 37 weeks of gestation was noted in the COX inhibitor group (RR 0.53, 95% CI 0.31 to 0.94; number needed to treat 8, 95% CI 4 to 50).…”

Outcome of Very Low Birth Weight Infants Exposed to Antenatal Indomethacin for Tocolysis

“…Since that time, several studies have reported various success rates and various side effects with indomethacin use. [12][13][14] Based on a critical analysis of randomized controlled trial data, Higby et al 15 suggested that indomethacin is the most efficacious tocolytic medication.…”

Drug therapy and adverse drug reactions to terbutaline in obstetric patients: a prospective cohort study in hospitalized women

“…In relation to indomethacin, this drug has proved safety and efficacy to inhibit uterine contractions of premature labor [35,36]. Uterine contractility at term and preterm results from an activation of myometrium through several process varying from mechanical stimulation to a complex cascade of endocrine processes [37].…”