ABSTRACT
The purpose of this study was to describe the fetal and newborn safety profile of prolonged indomethacin treatment during pregnancy. A retrospective cohort of 124 pregnant women treated with indomethacin was used to assess the outcomes of oligohydramnios, constriction of the ductus arteriosus, and composite neonatal morbidity. Eight patients (6.5%) developed ductal constriction and nine patients (7.3%) developed oligohydramnios. Composite morbidity occurred in 36 neonates (29%). Ductal constriction, oligohydramnios, and composite morbidity were not associated with duration of therapy, gestational age at start or stop of therapy, time between dosing and delivery, or dose regimen. Prolonged indomethacin therapy rarely is associated with ductal constriction and oligohydramnios.
KEYWORDS
Indomethacin - oligohydramnios - fetal ductus arteriosus
REFERENCES
-
1
Hendricks S K, Smith J R, Moore D E, Brown Z A.
Oligohydramnios associated with prostaglandin synthetase inhibitors in preterm labour.
Br J Obstet Gynaecol.
1990;
97
312-316
-
2
Respondek M, Weil S R, Huhta J C.
Fetal echocardiography during indomethacin treatment.
Ultrasound Obstet Gynecol.
1995;
5
86-89
-
3
Moise Jr K J, Huhta J C, Sharif D S et al..
Indomethacin in the treatment of premature labor. Effects on the fetal ductus arteriosus.
N Engl J Med.
1988;
319
327-331
-
4
Moise Jr K J.
Effect of advancing gestational age on the frequency of fetal ductal constriction in association with maternal indomethacin use.
Am J Obstet Gynecol.
1993;
168
1350-1353
-
5
Vermillion S T, Scardo J A, Lashus A G, Wiles H B.
The effect of indomethacin tocolysis on fetal ductus arteriosus constriction with advancing gestational age.
Am J Obstet Gynecol.
1997;
177
256-259
(discussion 259-261)
-
6
Mittendorf R, Dambrosia J, Pryde P G et al..
Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants.
Am J Obstet Gynecol.
2002;
186
1111-1118
-
7
Gerson A, Abbasi S, Johnson A, Kalchbrenner M, Ashmead G, Bolognese R.
Safety and efficacy of long-term tocolysis with indomethacin.
Am J Perinatol.
1990;
7
71-74
-
8
Levy R, Matitiau A, Ben Arie A, Milman D, Or Y, Hagay Z.
Indomethacin and corticosteroids: an additive constrictive effect on the fetal ductus arteriosus.
Am J Perinatol.
1999;
16
379-383
-
9
Niebyl J R, Blake D A, White R D et al..
The inhibition of premature labor with indomethacin.
Am J Obstet Gynecol.
1980;
136
1014-1019
-
10
Zuckerman H, Shalev E, Gilad G, Katzuni E.
Further study of the inhibition of premature labor by indomethacin. Part II: double-blind study.
J Perinat Med.
1984;
12
25-29
-
11
Vermillion S T, Newman R B.
Recent indomethacin tocolysis is not associated with neonatal complications in preterm infants.
Am J Obstet Gynecol.
1999;
181
1083-1086
-
12
Gardner M O, Owen J, Skelly S, Hauth J C.
Preterm delivery after indomethacin. A risk factor for neonatal complications?.
J Reprod Med.
1996;
41
903-906
-
13
Dudley D K, Hardie M J.
Fetal and neonatal effects of indomethacin used as a tocolytic agent.
Am J Obstet Gynecol.
1985;
151
181-184
-
14
Abbasi S, Gerdes J S, Sehdev H M, Samimi S S, Ludmir J.
Neonatal outcome after exposure to indomethacin in utero: a retrospective case cohort study.
Am J Obstet Gynecol.
2003;
189
782-785
-
15
Niebyl J R, Witter F R.
Neonatal outcome after indomethacin treatment for preterm labor.
Am J Obstet Gynecol.
1986;
155
747-749
-
16
Major C A, Lewis D F, Harding J A, Porto M A, Garite T J.
Tocolysis with indomethacin increases the incidence of necrotizing enterocolitis in the low-birth-weight neonate.
Am J Obstet Gynecol.
1994;
170
102-106
-
17
Souter D, Harding J, McCowan L, O’Donnell C, McLeay E, Baxendale H.
Antenatal indomethacin-adverse fetal effects confirmed.
Aust N Z J Obstet Gynaecol.
1998;
38
11-16
-
18
Norton M E, Merrill J, Cooper B A, Kuller J A, Clyman R I.
Neonatal complications after the administration of indomethacin for preterm labor.
N Engl J Med.
1993;
329
1602-1607
-
19
Parilla B V, Dooley S L, Minogue J P, Socol M L.
The efficacy of oral terbutaline after intravenous tocolysis.
Am J Obstet Gynecol.
1993;
169
965-969
-
20
Rautonen J, Makela A, Boyd H, Apajasalo M, Pohjavuori M.
CRIB and SNAP: assessing the risk of death for preterm neonates. [see comments].
Lancet.
1994;
343
1272-1273
-
21
Pollack M M, Koch M A, Bartel D A et al..
A comparison of neonatal mortality risk prediction models in very low birth weight infants.
Pediatrics.
2000;
105
1051-1057
Hyagriv N SimhanM.D. M.S.C.R.
Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital
300 Halket Street, Pittsburgh, PA 15213
