Fejgin M D, Delpino M L, Bidiwala K S
Department of Obstetrics and Gynecology, Michael Reese Medical Center, Chicago, Illinois.
Am J Perinatol. 1994 Jul;11(4):295-6. doi: 10.1055/s-2007-994596.
Indomethacin, a prostaglandin synthetase inhibitor, is an effective tocolytic agent that may have adverse fetal side effects such as constriction of the ductus arteriosus, pulmonary hypertension, and reduced urine production. We describe an unusual neonatal complication following 6 days of tocolysis with indomethacin. A 22-year-old gravida 5, para 3104 was admitted at 25 weeks of gestation in labor. Attempts to stop labor using magnesium sulfate and terbutaline failed. The contractions stopped following the administration of indomethacin, which was continued for 6 days. On day 7, due to contractions and vaginal bleeding, she underwent a classic cesarean section. The female newborn, weighting 1044 g, did well for 2 days, when she developed pneumoperitoneum. On laparotomy, an isolated midileal perforation was found, with otherwise normal-appearing bowel. Isolated intestinal perforation has been described in premature neonates who were treated with indomethacin for patent ductus arteriosus. This complication is caused by splanchnic ischemia secondary to the loss of the vasodilatory effect of prostaglandins. This case indicates that this rare but serious complication may also follow intrauterine exposure to indomethacin.
吲哚美辛是一种前列腺素合成酶抑制剂，是一种有效的宫缩抑制剂，但可能会对胎儿产生不良副作用，如动脉导管收缩、肺动脉高压和尿量减少。我们描述了一例使用吲哚美辛进行6天宫缩抑制治疗后出现的罕见新生儿并发症。一名22岁、孕5产3104的孕妇在妊娠25周时因临产入院。使用硫酸镁和特布他林抑制宫缩的尝试失败。使用吲哚美辛后宫缩停止，并持续使用了6天。在第7天，由于宫缩和阴道出血，她接受了经典剖宫产。女婴体重1044克，出生后2天情况良好，之后出现气腹。剖腹探查时，发现孤立的回肠中段穿孔，其余肠段外观正常。在因动脉导管未闭接受吲哚美辛治疗的早产儿中曾有孤立性肠穿孔的报道。这种并发症是由前列腺素血管舒张作用丧失继发的内脏缺血引起的。该病例表明，这种罕见但严重的并发症也可能发生于宫内接触吲哚美辛之后。
