Ritodrine Should Be Carefully Administered during Antenatal Glucocorticoid Therapy Even in Nondiabetic Pregnancies.

Aim. Antenatal glucocorticoid therapy (AGT) has been commonly used recently. However, this therapy has severe harmful effects such as maternal hyperglycemia. In Japan, ritodrine hydrochloride has been used as a tocolytic agent. In this study, we performed retrospective casecontrol study to clarify whether concomitant use of ritodrine and glucocorticoid was safe to pregnant women without diabetes mellitus. Methods. We reviewed the computerized records of pregnant women with pregestational diabetes (n = 9) and nondiabetes (n = 45) who gave birth at our hospital between 2002 and 2011. Cases and controls received AGT. Blood glucose after the therapy was analyzed, and additional volume of insulin was compared to that before the therapy. Results. From this study, 30 units of insulin were necessary when performing AGT in diabetic pregnant women. And also, an increase in blood glucose of 40 mg/dL was seen after the therapy even in nondiabetic pregnant women. Blood glucose increased significantly in the group that also received ritodrine, and it was shown that the number of pregnant women who might develop ketoacidosis might increase 11-fold. Conclusions. Ritodrine should be carefully administered during antenatal glucocorticoid therapy. It may be necessary to adequately monitor blood glucose, when performing the therapy, even in nondiabetic pregnant women.

Umbilical artery pH may be a possible confounder for neonatal adverse outcomes in preterm infants exposed to antenatal magnesium.

OBJECTIVES: To determine the normal range of ionized magnesium (IMg) levels in cord blood during preterm gestation and to investigate whether antenatal Mg administration affects neonatal intraventricular hemorrhage (IVH) or patent ductus arteriosus (PDA). METHODS: In this retrospective case-control study, we reviewed 118 pregnant women with antenatal Mg administration and their infants after they gave birth at one tertiary care center between January 2006 and December 2010. Thirty-seven cases with IVH and/or PDA were compared to 81 controls by multiple logistic regression analysis. The normal range of IMg levels was determined by another 79 subjects without any tocolytic agents and possible confounders. Perinatal and neonatal characteristics were then compared between three groups divided by the IMg levels in cord serum. RESULTS: The normal range of IMg levels in cord blood was determined to be 0.47 ± 0.07 mmol/L, regardless of gestational weeks. IMg level in cord serum could not be a risk factor for IVH or PDA. Elevation of IMg level in cord blood resulted in an increased incidence of IVH and a decreased incidence of PDA, but not significantly. IMg level in cord blood was inversely correlated with umbilical artery pH (p = 0.067). CONCLUSIONS: There was no significant relationship between the IMg levels in cord serum and neonatal IVH and PDA. Umbilical artery pH may be a possible confounder.

Levels of soluble endothelial selectin in umbilical cord serum are influenced by gestational age and histological chorioamnionitis, but not by pre-eclampsia.

AIMS: The aim of this study was to examine the factors that influence soluble endothelial selectin (sE-selectin) levels in umbilical cord serum. MATERIALS AND METHODS: sE-selectin levels in umbilical cord serum were measured in 144 patients using enzyme-linked immunosorbent assay. We examined the association of sE-selectin levels with gestational age, pre-eclampsia (PE), histological chorioamnionitis (HCAM), preterm premature rupture of membranes, magnesium sulfate use, birthweight, and placental weight. RESULTS: A significant positive correlation was observed between sE-selectin levels and gestational age in the patients who had neither PE nor HCAM (r = 0.559, P < 0.0001). This statistically positive correlation persisted in patients with PE without HCAM (n = 25, r = 0.644, P < 0.001), but not in patients with HCAM without PE (n = 58, r = 0.102, P = 0.448). In matched gestational age analysis, sE-selectin levels were increased in the presence of HCAM (P = 0.0006), but were not influenced by the presence of PE (P = 0.127), preterm premature rupture of membranes (P = 0.352) or magnesium sulfate use (P = 0.337). CONCLUSION: sE-selectin levels in umbilical cord serum were positively correlated with gestational weeks. sE-selectin levels in umbilical cord serum were higher in mothers with HCAM but not with PE, when compared with gestational-age-matched controls.

Short- and long-term outcomes in babies born after antenatal magnesium treatment.

AIM: To identify the prenatal events associated with adverse outcome in babies born at less than 32 weeks' gestation, including antenatal magnesium sulfate treatment. METHODS: A case-control study was performed to examine the effect of long-term tocolysis with MgSO4. Long-term neonatal and infantile adverse outcomes were defined as one of the following: intraventricular hemorrhage, periventricular leukomalacia, cerebral palsy and infantile death. RESULTS: Data were analyzed for 425 cases (236 who received magnesium sulfate and 189 control cases who did not). Perinatal deaths included 13 cases that had received magnesium (5.5%) and 17 control cases (9.0%). Long-term neonatal and infantile adverse outcomes were noted in 80 cases. The factor associated with an increased risk of combined adverse outcome after adjustment for confounding effects was the administration of corticosteroids (adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27-0.81), but not magnesium sulfate (OR 0.82, 95% CI 0.48-1.40). In the subgroup that also received ritodrine (n = 315), magnesium sulfate was given to 195 cases. In this group, the factor associated with an increased risk of combined adverse outcome (n = 64) after adjustment for the confounding effects was also corticosteroids (adjusted OR 0.25, 95% CI 0.13-0.49), but magnesium sulfate was not associated with an increase in risk (OR 0.64, 95% CI 0.34-1.22). CONCLUSIONS: Long-term tocolysis with magnesium sulfate is not a significant factor related to the occurrence of neonatal and infantile adverse outcomes. Further study is needed to clarify the dose-response effect of magnesium sulfate.

Case of asymptomatic portal vein thrombosis after cesarean delivery.

We report a case of acute portal vein thrombosis (PVT) after a cesarean delivery. The patient was admitted for treatment of severe pre-eclampsia. On the second day after cesarean delivery, the elevations of aspartic aminotransferase and alanine aminotransferase were observed. Thereafter, acute PVT was diagnosed with ultrasonography. Although early anticoagulant therapy seems to be effective in the treatment of acute PVT, close observation must be made due to the risk of bleeding.