Moise K J
Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX 77030.
Clin Obstet Gynecol. 1991 Jun;34(2):310-8. doi: 10.1097/00003081-199106000-00012.
It appears that maternal indomethacin therapy may be a useful adjunct in selected cases of polyhydramnios. Initial evaluation should include glucose tolerance testing and a thorough search for fetal abnormalities by ultrasonography. In the patient with symptoms such as premature labor or respiratory compromise, an initial amniocentesis should be considered for decompression and fetal karotype. Oral indomethacin therapy can then be started. Although the optimal dose is unknown, a 25-mg oral dose every 6 hours appears adequate. Ultrasound assessment of amniotic fluid volume should be done once or twice weekly. If oligohydramnios develops, the indomethacin should be discontinued, and the amniotic fluid volume serially monitored. Fetal echocardiography should be considered in the first 24 hours after therapy has been initiated and weekly thereafter. Evidence of severe constriction of the ductus arteriosus or tricuspid regurgitation warrants discontinuation of the indomethacin; lesser degrees of ductal constriction can be treated by decreasing the dose of the medication.
看来，母亲使用吲哚美辛治疗在某些羊水过多病例中可能是一种有用的辅助治疗方法。初始评估应包括葡萄糖耐量试验，并通过超声对胎儿异常情况进行全面检查。对于有早产或呼吸功能不全等症状的患者，应考虑首先进行羊膜腔穿刺减压并检查胎儿核型。然后可以开始口服吲哚美辛治疗。虽然最佳剂量尚不清楚，但每6小时口服25毫克似乎就足够了。应每周进行一次或两次超声评估羊水量。如果出现羊水过少，应停用吲哚美辛，并连续监测羊水量。治疗开始后的头24小时内应考虑进行胎儿超声心动图检查，此后每周检查一次。动脉导管严重狭窄或三尖瓣反流的证据表明应停用吲哚美辛；导管狭窄程度较轻的情况可通过减少药物剂量来治疗。
