Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2010 Dec;49(4):495-9. doi: 10.1016/S1028-4559(10)60103-9.
Pregnancies with extremely preterm premature rupture of membranes (EPPROM), especially before 20 weeks of gestation, are usually considered to be a termination of pregnancy. By improvement of obstetric and neonatal care, we can prolong the pregnancy across the threshold of survival by aggressive tocolysis.
Using intrauterine insemination, a 32-year-old woman became pregnant with twins (first pregnancy). Threatened abortion occured since 9 weeks of gestation and EPPROM of the upper twin was noted at 18 weeks. Massive vaginal bleeding and vigorous uterine contractions occurred at 22 weeks. Poor control of preterm labor occurred using ritodrine and MgSO(4). Atosiban was applied to calm uterine activities. After discontinuation of atosiban at 30 weeks, the uterine contractions became severe again and an emergency cesarean section was performed to deliver two live, premature babies weighing 1,518 g and 830 g, respectively. Twin A was healthy, weighing 2,030 g at 35 days after birth and subsequently discharged. The smaller twin B was dependent on continuous positive airway pressure and died of pulmonary infection 120 days after birth.
Comparing to other tocolytic agents, Atosiban has few side effects and assisted in prolonging a pregnancy involving twins that experienced EPPROM.
极早产胎膜早破（EPPROM）的妊娠，特别是在 20 周之前的妊娠，通常被认为是终止妊娠。通过产科和新生儿护理的改善，我们可以通过积极的保胎来延长妊娠时间，使其跨越生存的门槛。
一位 32 岁的女性通过宫内授精怀孕了双胞胎（第一次怀孕）。妊娠 9 周时发生先兆流产，18 周时发现上胎胎膜早破。22 周时发生大量阴道出血和强烈的子宫收缩。使用利托君和硫酸镁（MgSO4）难以控制早产。阿托西班用于抑制子宫活动，阿托西班在 30 周时停药后，子宫收缩再次加剧，紧急剖宫产娩出两个活的早产儿，体重分别为 1518 克和 830 克。胎儿 A 健康，出生后 35 天体重为 2030 克，随后出院。较小的胎儿 B 需要持续的正压通气，出生 120 天后死于肺部感染。
与其他保胎药物相比，阿托西班副作用较少，有助于延长经历 EPPROM 的双胞胎的妊娠时间。
