Premature labor and indomethacin.

Administration of indomethacin to 29 women in the 26th--37th week of gestation with premature labor contractions was followed in 26 by a significant decrease of uterine activity. The effect of therapy was monitored by serial external tocometry recordings and by plasma concentrations of estriol, h.P.L., alpha-fetoprotein, and estriol/creatinine ratio in urine. The labor was monitored by cardiotocography; the new born infants were examined by the pediatrician. Following oral indomethacin treatment (25 mg every 6 Hours for 5 days) no untoward effects was observed on maternal and fetal wellbeing during pregnancy and labor. Four out 29 newborn infants, all appropriate for gestational age of 36--40 weeks, had one-minute Apgar scores less than 7, cyanosis, tachypnea, hypoxemia and serious oxygen dependency for several days. All the infant survived. These abnormalities may be due to short-term exposure to indomethacin and consequent inhibition of cyclo-oxygenase, impairement of prostaglandin-dependent physiological regulation of vessel tone during fetal life and circulatory disorders at birth.     

Premature babies and pharmacology.

In his research on the action of various drugs in newborns, Dr. Jacob Aranda of the Centre for Perinatal and Developmental Pharmacology Research in Montreal draws upon his expertise in both neonatology and pharmacology. His work has led to the acceptance of caffeine as a standard treatment of apnea in premature infants, and his current studies of ibuprofen as a possible treatment of cerebral intraventricular hemorrhage, a serious problem in some premature babies, have yielded promising results. Other areas being tackled by Aranda and his colleagues include pain control for newborns and the elusive pathology of sudden infant death syndrome. By shedding more light on neonatal development and the principles of drug action in newborns, these research projects will help to improve the odds for many babies who suffer the setback of being born too soon.     

Premature labor and indomethacin.

Women in the 29th - 32nd week of gestation were admitted to hospital following the onset of premature labor contractions. After treatment with bed rest and beta-stimulating drugs, those patients with persistent uterine contractions were treated with oral indomethacin (25 mg every 6 hours for 5 days). The effect of indomethacin therapy was monitored by serial external tocometry recordings. This treatment schedule with indomethacin was repeated on several occasions at intervals of 5 to 10 days. Using a standardized technique, uterine contractility was monitored every second or third day throughout the entire treatment period. In this way, the frequency of contractions was evaluated in the presence or absence of indomethacin therapy. Following indomethacin treatment, there was a significant decrease in the frequency of contractions in all cases and a complete arrest of contractions occurred in some women. An increased frequency of contractions was observed during those times that the patient did not receive indomethacin. The plasms concentration of 15-keto-13, 14-dihydro-PGF2alpha, the major serum metabolite of PGF2alpha, was determined by the gas chromatography - mass spectrometry method before and after indomethacin in a limited number of cases. At the doses given for the duration of therapy used, no untoward effects could be detected in either the mother or the infant. These results indicate that indomethacin is a potent and useful drug in the treatment of premature labor.