Shinohara Satoshi, Sunami Rei, Uchida Yuzo, Hirata Shuji, Suzuki Kohta
Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan.
BMJ Open. 2017 Dec 29;7(12):e018118. doi: 10.1136/bmjopen-2017-018118.
Pulmonary oedema is recognised as a severe side effect of ritodrine hydrochloride. Recently, the number of twin pregnancies has been increasing. Few studies have reported the association between total dose of ritodrine hydrochloride prior to delivery and pulmonary oedema in twin pregnancy. We aimed to examine this association and determine the optimal cut-off threshold of total ritodrine hydrochloride dose to predict the incidence of pulmonary oedema in twin pregnancy based on obstetric records.
Retrospective cohort study.
Yamanashi Prefectural Central Hospital, Japan.
Two hundred and twenty-six women with twin pregnancy who delivered at Yamanashi Prefectural Central Hospital between September 2009 and November 2016.
The obstetric records of the participants were analysed. We defined 1 unit of ritodrine hydrochloride as 72 mg per 24 hours continuous transfusion at 50 µg/min to calculate the dose of ritodrine used for tocolysis.
Multivariable logistic regression analysis was performed to examine the association between total dose of ritodrine hydrochloride used for threatened preterm labour and pulmonary oedema, while controlling for potential confounding factors. Then, a receiver-operating characteristic curve was used to determine the optimal cut-off of total ritodrine dose to predict pulmonary oedema incidence.
Mean maternal age was 32 (range, 18-46) years; 143 participants were nulliparous (63.3%), 109 had (48.2%) term deliveries and 194 (85.8%) had caesarean deliveries. The overall incidence of pulmonary oedema was 13.7% (31/226). Multivariable analysis showed that the total dose of ritodrine was significantly associated with pulmonary oedema (adjusted OR 1.02; 95% CI 1.004 to 1.03). The best cut-off point to predict the incidence of pulmonary oedema was 26 units (1872 mg) (sensitivity, 61.3%; specificity, 87.8%).
Our results suggest that consideration of the total dose of ritodrine hydrochloride is helpful in the management of patients with threatened preterm labour in twin pregnancy.
肺水肿被认为是盐酸利托君的一种严重副作用。近年来，双胎妊娠的数量一直在增加。很少有研究报道双胎妊娠分娩前盐酸利托君的总剂量与肺水肿之间的关联。我们旨在基于产科记录研究这种关联，并确定预测双胎妊娠肺水肿发生率的盐酸利托君总剂量的最佳临界阈值。
回顾性队列研究。
日本山梨县立中央医院。
2009年9月至2016年11月在山梨县立中央医院分娩的226例双胎妊娠妇女。
分析参与者的产科记录。我们将1单位盐酸利托君定义为以50μg/min持续输注24小时的72mg，以计算用于保胎治疗的利托君剂量。
进行多变量逻辑回归分析，以研究用于先兆早产的盐酸利托君总剂量与肺水肿之间的关联，同时控制潜在的混杂因素。然后，使用受试者工作特征曲线确定预测肺水肿发生率的利托君总剂量的最佳临界值。
产妇平均年龄为32岁（范围18 - 46岁）；143例参与者为初产妇（63.3%），109例（48.2%）足月分娩，194例（85.8%）行剖宫产。肺水肿的总体发生率为13.7%（31/226）。多变量分析显示，利托君总剂量与肺水肿显著相关（校正比值比1.02；95%可信区间1.004至1.03）。预测肺水肿发生率的最佳临界点为26单位（1872mg）（敏感性61.3%；特异性87.8%）。
我们的结果表明，考虑盐酸利托君的总剂量有助于双胎妊娠先兆早产患者的管理。
