1/44. dexamethasone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets.OBJECTIVE: patients with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (hellp syndrome) are at increased risk for perinatal and maternal morbidity, especially in very preterm gestations. When this condition affects a pregnancy on the cusp of viability, a therapeutic intervention to prolong gestation without undue risk to the mother or fetus could be beneficial. METHOD: A single case report and review of the literature. Result: We report a patient with hellp syndrome in whom antenatal administration of high-dose dexamethasone helped achieve disease stabilization and delivery postponement for 9 days of a very preterm fetus estimated to weight less than 600 g. Both mother and infant did well postpartum. CONCLUSION: Administration of antenatal high-dose dexamethasone can be used in carefully selected preterm patients with hellp syndrome to delay delivery while in utero fetal maturation is accelerated and the maternal condition is optimized. This can be beneficial in carefully selected pregnancies without apparent adverse maternal or perinatal impact.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/44. Preterm labor and accidental hemorrhage after disopyramide therapy in pregnancy. A case report.BACKGROUND: Treatment of arrhythmias during pregnancy is complicated by concerns about the safety of antiarrhythmic therapy. This is the first case report of preterm labor and abruptio placentae following the administration of disopyramide during pregnancy. CASE: A 26-year-old woman, gravida 2, para 1, was diagnosed as having wolff-parkinson-white syndrome during the third trimester of pregnancy. Recurrent episodes of supra-ventricular tachycardia were refractory to medical therapy and required repeated direct current cardioversion. Administration of disopyramide led to the initiation of painful uterine contractions and accidental hemorrhage. CONCLUSION: Caution must be exercised during the use of disopyramide during pregnancy, and intensive monitoring should be instituted to avoid adverse maternal and fetal effects.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/44. acute coronary syndrome associated with oral administration of ritodrine hydrochloride during pregnancy: a case report.We report a case of acute coronary syndrome associated with the oral administration of ritodrine hydrochloride. Ten days following the administration of ritodrine hydrochloride, the patient complained of chest pain, and an electrocardiogram showed ST elevation and ST depression. intensive care was initiated. She recovered without chest pain.- - - - - - - - - - ranking = 6keywords = administration (Clic here for more details about this article) |
4/44. atrial fibrillation in pregnancy associated with oral terbutaline.BACKGROUND: terbutaline has direct effects on the cardiac conduction system, but when used to treat preterm labor it is rarely associated with clinically significant cardiac arrhythmias. Commonly used drug references did not list atrial fibrillation as a complication of terbutaline, and our literature search found only one case of atrial fibrillation that occurred with parenteral administration. CASE: A 30-year-old gravida 1 carrying a twin gestation at 35 weeks was taking 2.5 mg oral terbutaline four times daily for premature labor. She developed atrial fibrillation and was ultimately treated by chemical cardioversion with procainamide to restore normal sinus rhythm. CONCLUSION: This is the first report of atrial fibrillation during pregnancy associated with oral terbutaline. atrial fibrillation should be added as a complication of oral terbutaline therapy.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/44. Short delay of delivery to allow corticosteroid administration in a case of preterm antepartum eclampsia.BACKGROUND: The current recommendation for management of antepartum eclampsia is to take steps to deliver the fetus after stabilization of the maternal condition. We delayed delivery for 60 hours in a case of antepartum preterm eclampsia to allow administration of corticosteroids for fetal lung maturity enhancement. CASE: A primigravida presented with eclamptic seizure at 29 weeks' gestation without focal neurological deficits. Clinical and laboratory assessment ruled out the presence of the syndrome of hemolysis, elevated liver enzymes, low platelets; abruption; disseminated intravascular coagulation; or acute renal failure. The fetal biometry was appropriate for gestational age, and there was a normal amount of amniotic fluid. Fetal testing was reassuring. Expectancy with intravenous magnesium sulfate infusion was continued for 60 hours, allowing administration of a course of corticosteroids for enhancement of fetal lung maturity. Maternal and neonatal outcomes were satisfactory. CONCLUSION: A 2-day delay in delivery in selected patients with preterm antepartum eclampsia allows administration of steroids for fetal lung maturity enhancement.- - - - - - - - - - ranking = 7keywords = administration (Clic here for more details about this article) |
6/44. ritodrine therapy in the presence of chronic abruptio placentae.BACKGROUND: Betamimetic therapy is usually contraindicated for the treatment of premature labor associated with abruptio placentae. We report prolongation of a pregnancy for 7 weeks using ritodrine despite the presence of placental abruption. CASE: A 33-year-old primigravid woman presented at 25 weeks' gestation with irregular uterine contractions, vaginal bleeding, and sonographic evidence of abruptio placentae. Port wine-colored amniotic fluid was found during amniocentesis, and serial hematocrits decreased from 36 to 25%. A diagnosis of abruptio placentae was made, and because the maternal cardiovascular and fetal biophysical indices were normal, tocolytic therapy was started. Before the administration of ritodrine, the patient and her husband were given an extensive review of the risks, including blood transfusion, adult respiratory distress syndrome, disseminated intravascular coagulopathy, and maternal or fetal death. CONCLUSION: Although clinical suspicion of abruptio placentae remains a contraindication to betamimetic therapy, exceptions may be made if fetal and maternal well-being can be monitored and if a fully staffed operating room is always available for immediate cesarean delivery. The benefits of this management may outweigh the associated risks for carefully chosen, very preterm gestations.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/44. Hepatotoxicity with the administration of nifedipine for treatment of preterm labor.nifedipine, a calcium channel blocker, is becoming increasingly popular as a tocolytic medication. Previous reports of hepatitis associated with nifedipine in the medical literature have been published. We present the first case reported of a patient with preterm labor treated with nifedipine who had development of a concurrent elevation in serum liver enzyme levels.- - - - - - - - - - ranking = 4keywords = administration (Clic here for more details about this article) |
8/44. Inadvertent administration of prostaglandin E1 instead of prostaglandin F2 alpha in a patient with uterine atony and hemorrhage.A woman underwent cesarean delivery for premature labor, breech presentation, and ruptured membranes. placenta accreta associated with uterine atony and severe hemorrhage was diagnosed. Prostaglandin E1 instead of prostaglandin F2 alpha was inadvertently administered in an effort to control the hemorrhage. The resulting complications included profound hypotension, disseminated intravascular coagulation, and ventricular tachycardia.- - - - - - - - - - ranking = 4keywords = administration (Clic here for more details about this article) |
9/44. rhabdomyolysis caused by tocolysis with oral ritodrine hydrochloride in a pregnant patient with myotonic dystrophy.Drug-induced rhabdomyolysis during pregnancy is extremely rare. We report here a rare case of ritodrine-hydrochloride-induced rhabdomyolysis in a pregnant patient with myotonic dystrophy. A 32-year-old primigravida was admitted because of premature labor at 31 weeks of gestation. She had been diagnosed as having myotonic dystrophy by electromyographic investigations and abnormal serum creatinine phosphokinase (CPK) levels. tocolysis was initiated with oral ritodrine hydrochloride (15 mg/day) alone. There was a prompt response to the ritodrine hydrochloride. Three days after administration began, serum CPK levels had become markedly elevated to 10,897 mg/dl and myoglobinuria was detected (1,800 ng/dl), suggesting the presence of rhabdomyolysis. There was no evidence of worsening of the myotonic symptoms. tocolysis was stopped immediately, and the laboratory data improved gradually. At 37 weeks of gestation, she spontaneously delivered a healthy male baby. rhabdomyolysis has been recognized as a complication of tocolytic therapy with ritodrine hydrochloride. Therefore, beta-adrenergic agents should be used with great care, especially for patients with myotonic dystrophy, because of these agents' tendency to aggravate or precipitate myotonia and to induce rhabdomyolysis.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
10/44. Renal dysgenesis in a monozygotic twin: association with in utero exposure to indomethacin.We report oligohydramnios and renal dysgenesis in one of identical twins, which might have resulted from in utero exposure to early, prolonged high-dose indomethacin. The proposita was the second of twin girls born at 36 weeks of gestation. pregnancy was complicated initially by polyhydramnios in both amniotic sacs and premature uterine contractions. After administration of indomethacin and terbutaline from 16 to 30 weeks' gestation, serial prenatal ultrasound examinations ultimately showed oligohydramnios in twin B and resolution of polyhydramnios in twin A. On day 5 twin B developed hematuria, hypertension, renal failure, hyponatremia, hyperkalemia, metabolic acidosis, sodium wasting and severe, transient inability to excrete potassium. Renal sonography showed enlarged, hyperechoic kidneys with almost no corticomedullary differentiation. Renal biopsy revealed immature glomeruli, dilated Bowman's spaces, dilated tubules, and interstitial fibrosis. The liver was histologically normal. indomethacin may induce oligohydramnios and transient renal insufficiency in humans and renal dysgenesis in fetal monkeys; it might have induced the abnormalities in this patient.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
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