BACKGROUND Preterm birth accounts for about 12%of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality.In order to avoid premature birth and prolong gestational age,tocolytics are the...BACKGROUND Preterm birth accounts for about 12%of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality.In order to avoid premature birth and prolong gestational age,tocolytics are the first and the best choice.Ritodrine is the most commonly used tocolytic medication.However,side effects such as pulmonary edema,hypokalemia,and hyperglycemia are known.Here we report a rare but serious side effect–toxic epidermal necrolysis(TEN)–caused by ritodrine.CASE SUMMARY A woman(31 years,gravida 4,para 2)was hospitalized because of premature contractions at 27+6 wk of gestation.A skin rash with pruritus appeared at 32+3 wk of gestation after administration of ritodrine,indomethacin,and dexamethasone,and it spread throughout the whole body in 3 d,particularly the four limbs.After 11 d’treatment,she was diagnosed with TEN.An emergency cesarean section was performed immediately to deliver the baby and intensive symptomatic treatment was promptly commenced after delivery.She recovered from the severe condition without any sequelae except for slight pigmentation after symptomatic treatment.CONCLUSION When a skin rash appears during the administration of ritodrine,we are supposed to consider the risk of TEN.展开更多
Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with thr...Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with threatened preterm labor. Patients and Methods: The current study was randomized controlled trial conducted in Sohag Teaching Hospital between November 2015 and September 2016. Patients were divided into: Group A: 101 patients received intravenous ritodrine infusion;Group B: 101 patients received intravenous magnesium sulfate;Group C: 101 patients received oral nifedipine. Different maternal and neonatal outcomes were assessed. Results: The baseline criteria were homogenous among the study groups with no statistically significant differences. There is no difference between each other group regarding the need for additional tocolysis or the rate of recurrence of labour pains. Nifedipine was associated with the least length of hospital stay. There is no difference between all groups regarding the rate of preterm delivery before full steroid dose (p > 0.05). However, nifedipine group was the least one in the rate of occurrence of preterm delivery within 7 days from initiation of tocolytic therapy. Similarly, nifedipine group was associated with higher gestational age at delivery and significant prolongation of pregnancy than the other groups. Conclusion: Oral nifedipine use was associated with less recurrence of labor pains, less need for additional tocolysis, less duration of hospital stay, and more patient satisfaction in patients with threatened preterm labour.展开更多
Objective:To evaluate the possible effects of ritodrine on the heart structure and function of pregnant women who had threat of preterm birth by echocardiography.Methods:From September 2012 to December 2018,totally 11...Objective:To evaluate the possible effects of ritodrine on the heart structure and function of pregnant women who had threat of preterm birth by echocardiography.Methods:From September 2012 to December 2018,totally 112 women in the second and third trimester pregnancy with sign and symptom of preterm birth were included,and those with contraindication to ritodrine and other several diseases were excluded.Firstly they were divided into four groups according to the time of medication and number of fetuses:Group A:Twin pregnancy,the first time of ritodrine medication was in 48 h;Group B:Twin pregnancy,the last time of ritodrine medication;Group C:Single pregnancy,the first time of ritodrine medication was in 48 h;Group D:Single pregnancy,the last time of ritodrine medication.Secondly,singleton pregnancies were divided into four groups according to the time of ritodrine medication and the age of pregnant women:Group E:Single pregnancy of age 21-34 years old,the first time of ritodrine medication was in 48 h;Group F:Single pregnancy of age 21-34 years old,the last time of ritodrine medication;Group G:Single pregnancy of age 35-49 years old,the first time of ritodrine medication was in 48h;Group H:Single pregnancy of age 35-49 years old,the last time of ritodrine medication.Ehocardiography were used to examine the hearts of pregnant women,and relevant parameters were filed,including LAD1,LAD2,LVD,RA,RVD,IVST,LVPWT,EF,E,A,AVmax,TRVmax,and PE.Results:Comparing the heart parameters between group A and group B,there were no significant difference(all P>0.05);there were significant differences of LAD1,LVD,and EF between group A and group C(P<0.05);there was significant difference in E between group C and group D(P<0.05);Comparing group E with group G,there was only significant difference in PE(P<0.05);Comparing with group H,LVD,E,and TRVmax in group F,there were significant differences(P<0.05).Comparing the rest items,there was no significant difference(all P>0.05).Conclusion:The treatment of preterm birth using ritodrine may bring effect on the heart structure and function of pregnant women,and echocardiography can early find and assess the changes of maternal heart structure and function.展开更多
Segmental arterial mediolysis (SAM), an uncommon arteriopathy putatively caused by norepinephrine released by alpha-1 adrenergic agonists or some Beta-2 agonists capable of releasing norepinephrine from the peripheral...Segmental arterial mediolysis (SAM), an uncommon arteriopathy putatively caused by norepinephrine released by alpha-1 adrenergic agonists or some Beta-2 agonists capable of releasing norepinephrine from the peripheral sympathetic nervous system potentially can present ischemic and organ injury symptoms caused by sequelae created in its reparative phase in lieu of catastrophic hemorrhages announced in its injurious phase. The case documents this presentation—the patient presenting renal infarcts and ischemic lesions causing abdominal angina, hypertension and a nephrectomy event developing 10 years after prolonged ritodrine treatment for premature labor. This agent may have directly caused SAM or sensitized the patient to agonists causing SAM encountered at a latter date. A variety of lesions derived from injurious phase arterial injuries characterize reparative phase SAM. All were encountered in a hilar branch of the resected renal artery. These included side-by-side sequela aneurysms grossly forming a large fusiform aneurysm, granulation tissue filling adventitial medial tear spaces in which a dissecting hematomas developed, medial muscle loss centered to the outer media repaired with fibrous tissue, arterial stenosis created by reparative intimal plaques, and arterial thrombo-embolism. These lesions were mirrored in accompanying radiologic studies. The accompanying renal vein exhibited changes consistent with repair of the spastic venous angiopathy that often accompanies abdominal SAM. This angiopathy, putatively induced by Endothelin-1, suggested that this agent played a role in the genesis of the arterial lesions. Angiographic resolution of non-treated sequelae occurred in 5 months either spontaneously or due to treatment with bosentem. Conclusions: The histologic and angiographic changes demonstrate that the clinical onset of reparative SAM may be significantly delayed to produce ischemic lesions, renal infarction and in this case report, medial fibromuscular dysplasia in the hilar branch of the renal artery.展开更多
文摘BACKGROUND Preterm birth accounts for about 12%of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality.In order to avoid premature birth and prolong gestational age,tocolytics are the first and the best choice.Ritodrine is the most commonly used tocolytic medication.However,side effects such as pulmonary edema,hypokalemia,and hyperglycemia are known.Here we report a rare but serious side effect–toxic epidermal necrolysis(TEN)–caused by ritodrine.CASE SUMMARY A woman(31 years,gravida 4,para 2)was hospitalized because of premature contractions at 27+6 wk of gestation.A skin rash with pruritus appeared at 32+3 wk of gestation after administration of ritodrine,indomethacin,and dexamethasone,and it spread throughout the whole body in 3 d,particularly the four limbs.After 11 d’treatment,she was diagnosed with TEN.An emergency cesarean section was performed immediately to deliver the baby and intensive symptomatic treatment was promptly commenced after delivery.She recovered from the severe condition without any sequelae except for slight pigmentation after symptomatic treatment.CONCLUSION When a skin rash appears during the administration of ritodrine,we are supposed to consider the risk of TEN.
文摘Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with threatened preterm labor. Patients and Methods: The current study was randomized controlled trial conducted in Sohag Teaching Hospital between November 2015 and September 2016. Patients were divided into: Group A: 101 patients received intravenous ritodrine infusion;Group B: 101 patients received intravenous magnesium sulfate;Group C: 101 patients received oral nifedipine. Different maternal and neonatal outcomes were assessed. Results: The baseline criteria were homogenous among the study groups with no statistically significant differences. There is no difference between each other group regarding the need for additional tocolysis or the rate of recurrence of labour pains. Nifedipine was associated with the least length of hospital stay. There is no difference between all groups regarding the rate of preterm delivery before full steroid dose (p > 0.05). However, nifedipine group was the least one in the rate of occurrence of preterm delivery within 7 days from initiation of tocolytic therapy. Similarly, nifedipine group was associated with higher gestational age at delivery and significant prolongation of pregnancy than the other groups. Conclusion: Oral nifedipine use was associated with less recurrence of labor pains, less need for additional tocolysis, less duration of hospital stay, and more patient satisfaction in patients with threatened preterm labour.
基金Hainan Provincial Health and Family Planning Commission Project(1601032064A2001).
文摘Objective:To evaluate the possible effects of ritodrine on the heart structure and function of pregnant women who had threat of preterm birth by echocardiography.Methods:From September 2012 to December 2018,totally 112 women in the second and third trimester pregnancy with sign and symptom of preterm birth were included,and those with contraindication to ritodrine and other several diseases were excluded.Firstly they were divided into four groups according to the time of medication and number of fetuses:Group A:Twin pregnancy,the first time of ritodrine medication was in 48 h;Group B:Twin pregnancy,the last time of ritodrine medication;Group C:Single pregnancy,the first time of ritodrine medication was in 48 h;Group D:Single pregnancy,the last time of ritodrine medication.Secondly,singleton pregnancies were divided into four groups according to the time of ritodrine medication and the age of pregnant women:Group E:Single pregnancy of age 21-34 years old,the first time of ritodrine medication was in 48 h;Group F:Single pregnancy of age 21-34 years old,the last time of ritodrine medication;Group G:Single pregnancy of age 35-49 years old,the first time of ritodrine medication was in 48h;Group H:Single pregnancy of age 35-49 years old,the last time of ritodrine medication.Ehocardiography were used to examine the hearts of pregnant women,and relevant parameters were filed,including LAD1,LAD2,LVD,RA,RVD,IVST,LVPWT,EF,E,A,AVmax,TRVmax,and PE.Results:Comparing the heart parameters between group A and group B,there were no significant difference(all P>0.05);there were significant differences of LAD1,LVD,and EF between group A and group C(P<0.05);there was significant difference in E between group C and group D(P<0.05);Comparing group E with group G,there was only significant difference in PE(P<0.05);Comparing with group H,LVD,E,and TRVmax in group F,there were significant differences(P<0.05).Comparing the rest items,there was no significant difference(all P>0.05).Conclusion:The treatment of preterm birth using ritodrine may bring effect on the heart structure and function of pregnant women,and echocardiography can early find and assess the changes of maternal heart structure and function.
文摘Segmental arterial mediolysis (SAM), an uncommon arteriopathy putatively caused by norepinephrine released by alpha-1 adrenergic agonists or some Beta-2 agonists capable of releasing norepinephrine from the peripheral sympathetic nervous system potentially can present ischemic and organ injury symptoms caused by sequelae created in its reparative phase in lieu of catastrophic hemorrhages announced in its injurious phase. The case documents this presentation—the patient presenting renal infarcts and ischemic lesions causing abdominal angina, hypertension and a nephrectomy event developing 10 years after prolonged ritodrine treatment for premature labor. This agent may have directly caused SAM or sensitized the patient to agonists causing SAM encountered at a latter date. A variety of lesions derived from injurious phase arterial injuries characterize reparative phase SAM. All were encountered in a hilar branch of the resected renal artery. These included side-by-side sequela aneurysms grossly forming a large fusiform aneurysm, granulation tissue filling adventitial medial tear spaces in which a dissecting hematomas developed, medial muscle loss centered to the outer media repaired with fibrous tissue, arterial stenosis created by reparative intimal plaques, and arterial thrombo-embolism. These lesions were mirrored in accompanying radiologic studies. The accompanying renal vein exhibited changes consistent with repair of the spastic venous angiopathy that often accompanies abdominal SAM. This angiopathy, putatively induced by Endothelin-1, suggested that this agent played a role in the genesis of the arterial lesions. Angiographic resolution of non-treated sequelae occurred in 5 months either spontaneously or due to treatment with bosentem. Conclusions: The histologic and angiographic changes demonstrate that the clinical onset of reparative SAM may be significantly delayed to produce ischemic lesions, renal infarction and in this case report, medial fibromuscular dysplasia in the hilar branch of the renal artery.
