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Antenatal Indomethacin‐Adverse Fetal Effects Confirmed
Author(s) -
Souter Dereck,
Harding Jane,
McCowan Lesley,
O'Donnell Clare,
McLeay Elisabeth,
Baxendale Helen
Publication year - 1998
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1998.tb02949.x
Subject(s) - medicine , ductus arteriosus , gestation , tocolytic agent , adverse effect , incidence (geometry) , gestational age , obstetrics , fetus , tocolytic , rupture of membranes , pregnancy , betamethasone , indometacin , retrospective cohort study , anesthesia , preterm labor , cyclooxygenase , prostaglandin endoperoxide synthase , biochemistry , chemistry , genetics , physics , optics , biology , enzyme
Summary: We examined the association between antenatal indomethacin exposure and adverse neonatal outcome in a matched retrospective cohort study of infants born to 72 mothers at less than 31 weeks' gestation. Indomethacin‐exposed mothers were matched to controls by gestational age at delivery, antenatal corticosteroid exposure, prolonged spontaneous rupture of membranes, multiple pregnancy, thyrotrophin‐releasing hormone (TRH) exposure, and neonatal sex. Peri ventricular haemorrhage was significantly increased for infants delivered within 48 hours of maternal indomethacin exposure (Grade 1 and 2 19% versus 6%, and Grades 3 and 4 28% versus 3% (p<0.03)). Persistent patent ductus arteriosus was more common in those infants delivered within 48 hours of maternal indomethacin exposure (40% versus 20% (p<0.04)). More neonates exposed to antenatal indomethacin failed to respond to postnatal indomethacin to close a patent ductus arteriosus, 60% versus 0% (p<0.04). There were no adverse effects demonstrated of indomethacin administered greater than 48 hours from delivery. We have confirmed a probable association between antenatal indomethacin administration and an increased incidence of neonatal periventricular haemorrhage, patent ductus arteriosus, and impaired renal function. The adverse neonatal effects appear to be greatest when indomethacin is administered within 48 hours of delivery. We recommend that indomethacin should be used with caution as a tocolytic agent for the treatment of preterm labour at gestations less than 31 weeks.