Maternal complications induced by digoxin treatment of fetal tachycardia: A retrospective series of 18 cases.

OBJECTIVE: To evaluate maternal tolerance to digoxin, used alone or associated to other antiarrhythmic drugs in the management of fetal tachycardia. PATIENTS AND METHODS: This retrospective study was conducted at Rouen University Hospital between January 2009 and July 2016. All women who have received a treatment by either digoxin alone or associated with another antiarrhythmic drug for fetal tachycardia were included in the study. Maternal cardiac and extracardiac adverse effects were reported and comparisons between electrocardiograms before and during treatment with digoxin alone were performed. RESULTS: Eighteen women were treated by digoxin, either alone or associated with another antiarrhythmic (sotalol, flecainide or amiodarone). During treatment, digoxin overdosing (>2ng/mL) was observed in 11 women (61%), among which 4 women had toxic levels of digoxinemia (>3ng/mL) that was symptomatic in 3 women. Cardiac complications such as sinus bradycardia, first-degree auriculo-ventricular block and Mobitz I second-degree auriculo-ventricular block were reported in four women (18.2%). Extracardiac side effects i.e. neurosensorial or digestive were diagnosed in 35.3% of women. The parameters of the electrocardiogram were not altered before and after treatment with digoxin alone. CONCLUSION: Antiarrhythmics can cause maternal cardiac complications and extracardiac side effects that can sometimes be severe but rapidly reversible upon treatment arrest.

Improvement of digestive complaints in women with severe colorectal endometriosis benefiting from continuous amenorrhoea triggered by triptorelin. A prospective pilot study.

OBJECTIVE: To assess the impact of therapeutic amenorrhoea triggered by triptorelin in the digestive complaints of women with deep endometriosis infiltrating the rectum. DESIGN: Prospective series of consecutive patients with deep endometriosis of the rectum enrolled over a period of 17 consecutive months. SETTING: University tertiary referral center. PATIENTS: Seventy patients. INTERVENTIONS: Medical therapy (triptorelin 11.25 mg and add-back therapy using estradiol) administered for 3.4±1.8months before surgery. MAIN OUTCOME MEASURES: Gastrointestinal standardised questionnaires before beginning medical treatment and the day before surgery. RESULTS: The most frequent digestive complaints at baseline were: defecation pain in 77.1% of patients, bloating in 60%, diarrhoea in 54.3% and constipation in 50%. The largest diameter of the rectal area infiltrated by the disease was <1cm in 12.2% of women, 1 to 2.9 cm in 34.3% and ≥3cm in 51.4%. Multiple colorectal nodules were found in 32.9%. Medical treatment led to disappearance of cyclic defecation pain in 78.6%, dyschesia in 58.3%, diarrhoea in 58.3% and bloating in 50%. Relieving digestive complaints was not significantly related to either length of triptorelin administration or size of rectal infiltration by deep endometriosis. CONCLUSION: Therapeutic amenorrhoea averaging 3 months allowed complete improvement of various cyclic digestive complaints in more than half of patients. In selected patients, continuous therapeutic amenorrhoea could compensate for the lack of complete resection of deep infiltrating endometriosis of the rectum, when this latter is likely to result in a high rate of postoperative morbidity.