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Prolonged intravenous ritodrine therapy: a comparison between multiple and singleton pregnancies
R Gabriel1, G Harika, D Saniez
1Clinique Obstétricale et Gynécologique, Université de Reims, Hôpital Maison Blanche, France.
European Journal of Obstetrics, Gynecology, and Reproductive Biology
|November 1, 1994
Summary
Prolonged intravenous ritodrine for threatened preterm delivery significantly increases maternal adverse effects in multiple pregnancies. Neonatal benefits remain questionable, with higher complication rates observed in these cases.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pharmacology
Background:
- This retrospective study compared the efficacy and safety of prolonged intravenous ritodrine for threatened preterm delivery in multiple versus singleton pregnancies.
- The study included 32 women with multiple gestations and 51 women with singleton gestations, all admitted without ruptured membranes.
Observation:
- Multiple pregnancies showed a significantly longer duration of tocolysis (17.2 vs. 7.6 days) compared to singleton pregnancies.
- The incidence of delivery before 37 weeks was substantially higher in multiple pregnancies (87.5% vs. 35.3%).
- Maternal cardiovascular complications, including pulmonary edema, were markedly increased in the multiple pregnancy group (34.4% vs. 4.0%).
Findings:
- Prolonged intravenous ritodrine therapy for threatened preterm birth is associated with a significant increase in maternal adverse effects in multiple pregnancies.
- While not statistically significant, there was a trend towards earlier delivery before 32 weeks and neonatal death in multiple pregnancies.
- The study suggests that the neonatal benefits of prolonged ritodrine therapy in multiple pregnancies are questionable and difficult to ascertain due to the study's retrospective nature.
Implications:
- Clinicians should exercise caution when using prolonged intravenous ritodrine in multiple pregnancies due to increased maternal risks.
- Further randomized controlled trials are needed to definitively assess the neonatal benefits and optimize treatment strategies for threatened preterm delivery in multiple gestations.
- The findings highlight the need for individualized risk-benefit assessments in managing preterm labor, particularly in high-risk multiple pregnancies.