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Miscellaneous Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Terbutaline, and ritodrine previously, may be used to relax the uterus prior to attempting external version of breech presentations. Preference has been to use terbutaline in a dose of 0.25 mg intravenously. If ritodrine is chosen, a dose of 1–3 mg intravenously over two minutes should be used (Fernandez et al., 1996).
Preterm Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Dose: Ritodrine: 50–100 mg/minute IV initial dose, increase 50 mg/minute q10min (max 350 mg/min) [PO: 1–20 mg q2–4h]. Terbutaline: 0.25 mg SQ q20min at first, then 2–3 hours; or 5–10 mg/min IV, max 80 mg/min; or 2.5–5 mg PO q2–4h (hold for maternal HR >120/minute).
The twentieth century
Published in Michael J. O’Dowd, The History of Medications for Women, 2020
Of the many drugs which have been used to inhibit uterine activity in premature labor, the beta-adrenergic agents such as Isoxsuprine, mesuprine and orciprenaline (derivatives of epinephrine) were the most widely studied. The modern beta-receptor agonists, fenoterol, ritodrine, salbutamol and terbutaline were found to be effective uterine relaxants. Wesselius de Casparis and associates (1971) demonstrated that ritodrine postponed premature labor for longer than either sedation or placebo. Ingemarsson (1984), in an article on the pharmacology of tocolytic agents, concluded that beta-receptor agonists were the drugs of choice in the treatment of preterm labor. Rare but serious side-effects of pulmonary edema, myocardial ischemia and possible adverse influences on carbohydrate metabolism, were reported when beta-agonists were combined with corticosteroids (RCOG, 1997).
A delayed diagnosis of acute myeloid leukaemia during pregnancy using an old blood cell analyser
Published in Journal of Obstetrics and Gynaecology, 2019
Daisuke Inoue, Koji Nishijima, Jin Takahashi, Yoshio Yoshida
A 36-year-old woman, who was pregnant with twins, was treated using ritodrine hydrochloride infusion for impending premature labour at 26 weeks of gestation. She complained of a general malaise. During her admission at another hospital, the patient’s CBC and differential WBC were checked every week using an old automated blood cell analyser (HmX Hematology Analyzer with Autoloader; Beckman Coulter Inc., Brea, CA) which had been manufactured in 1999. The patient’s platelet count gradually decreased to 5.0 × 104/µL, and she was referred to our hospital at 33 weeks of gestation for a detailed examination and treatment. We performed blood testing using a newer automated CBC analyser model (CELL-DYN Sapphire; Abbott Diagnostics, Santa Clara, CA), which revealed thrombocytopenia, anaemia, and a ‘BLAST flag’ which suggested the existence of abnormal cells (Table 1). A manual blood smear review revealed there was a large number of blast cells. A bone marrow biopsy was performed immediately, and the patient was diagnosed with AML.
Effects of acute tocolysis using ritodrine hydrochloride on foetal heart rate patterns in intrauterine foetal resuscitation: a retrospective, single-centre observational study
Published in Journal of Obstetrics and Gynaecology, 2022
Tsuyoshi Murata, Hyo Kyozuka, Shun Yasuda, Toma Fukuda, Aya Kanno, Akiko Yamaguchi, Masatoshi Jimbo, Hidekazu Nishigori, Keiya Fujimori
Apgar scores <7 were defined as low (Committee on Obstetric Practice American Academy of Paediatrics – Committee on Foetus and Newborn 2015). Blood samples from the umbilical artery were collected immediately after delivery from a double-clamped cord in all participants with a heparinised 1-mL plastic syringe and subsequently analysed on a Corning 170 pH/Blood Gas Analyser System (AACC, Washington, USA). Foetal acidosis was defined as UmA-pH <7.20 and <7.00 (Andres et al. 1999; Victory et al. 2004). UmA-BE <-12.0 was defined as low base excess (Low et al. 1997). Additionally, the total ritodrine hydrochloride dosage, total MRA duration, and time needed to eliminate decelerations in the AT group were evaluated.
Successful perinatal management of a dichorionic diamniotic twin pregnancy in an anaemic kidney transplant patient treated with Darbepoetin alfa: a case report
Published in Journal of Obstetrics and Gynaecology, 2020
Satoshi Tamaki, Kazunobu Shinoda, Tadashi Matsumoto, Shinya Morita, Hiroshi Asanuma, Tadashi Yoshida, Mototsugu Oya
In the 25th week of gestation, emergency hospitalisation was required with a diagnosis of threatened premature delivery. Ritodrine hydrochloride treatment was introduced immediately at admission. Because her haemoglobin level dropped to less than 8 g/dl, the dose of darbepoetin alfa was increased to 60 μg (Figure 1(C)); no hypertensive effects were observed after dose escalation (Figure 1(D)). However, anaemia developed in the 30th week of gestation despite the increased dose of darbepoetin alfa, and she received two units of transfusion. Following transfusion, her haemoglobin level was stable at 8 ±0.9 g/dl with darbepoetin alfa. On day 5 of the 33rd week of gestation, her serum creatinine level increased to 3.45 mg/dl. We assumed that the acute impairment of the kidney function was due to the compression by the uterus. The patient underwent a caesarean section to deliver twins who weighed 1095 and 1859 g. The ultrasound examinations in the prenatal period revealed that one of the twins had a unilateral multicystic dysplasia of the kidney and the other had no obvious anomalies. However, both newborns had a mutation in HNF1B gene, one of the major causes of congenital anomalies of the kidney and urinary tract (CAKUT). Therefore, the cause of unilateral multicystic dysplasia of the kidney in one twin was probably related, not to a darbepoetin-induced side effect but to a gene mutation for CAKUT. The haemoglobin level of the patient on the day of the delivery was 8.1 g/dl. The haemoglobin levels of the twins were 12.6 and 13.4 g/dl, without the evidence of polycythaemia. After delivery, the mother’s serum creatinine level immediately decreased to below 2.5 mg/dl, and her haemoglobin level increased to 10 ±0.4 g/dl without the use of darbepoetin alfa (Figure 1(C)).