目的:虽然环氧合酶抑制剂能有效抑制子宫收缩,胎儿动脉导管(DA)的收缩和羊水过少是主要问题。塞来昔布,选择性环氧合酶2抑制剂,是一种潜在的强效溶菌药,但是没有研究评估塞来昔布对孕妇胎儿超过48小时的有益或不利影响。因此,我们旨在评估中期长期塞来昔布给药对妊娠中期胎儿的影响,特别是在胎儿DA和羊水量方面。
方法:我们回顾性地提取并回顾了2016年至2020年期间接受塞来昔布治疗超过48小时的早产患者的数据。塞来昔布仅在常规保胎药物治疗无效时才用于保胎治疗。收集了动脉导管收缩期峰值速度(PSV-DA)和最大垂直口袋(MVP)的数据。
结果:共有15名患者符合条件。塞来昔布引入时的中位胎龄为22.6周,中位给药期为9天(范围3-40天)。分娩时的中位胎龄为27.1周,从最初塞来昔布给药到分娩的中位持续时间为40天。塞来昔布给药后,PSV-DA和MVP的Z评分无明显变化。在管理期间,PSV-DA超过相应正常参考范围的第95百分位数3例,但在减少或停止治疗后水平恢复正常。治疗期间没有羊水过少。
结论:在妊娠中期塞来昔布给药超过48小时,只要进行仔细的超声监测,就胎儿PSV-DA和羊水容量而言,可能是安全和可耐受的。塞来昔布可能是早产的替代方案,当常规的分娩不有效时。
OBJECTIVE: Although cyclooxygenase inhibitors effectively suppress uterine contraction, constriction of the fetal ductus arteriosus (DA) and oligohydramnios are major concerns.
Celecoxib, a selective cyclooxygenase 2 inhibitor, is a potential potent tocolytic agent, but there are no studies that have evaluated the beneficial or adverse effects of
celecoxib use on fetuses for more than 48 hours in pregnant women. We therefore aimed to evaluate the effect of middle-long-term celecoxib administration on the fetus during the second trimester of pregnancy, particularly in terms of fetal DA and amniotic fluid volume.
METHODS: We retrospectively extracted and reviewed data from patients with preterm labor who received celecoxib for tocolysis for more than 48 hours between 2016 and 2020. Celecoxib was used for tocolysis only when treatment of patients with conventional tocolytic agents was ineffective. Data on the peak systolic velocity in ductus arteriosus (PSV-DA) and the maximum vertical pocket (MVP) were collected.
RESULTS: A total of 15 patients were eligible. The median gestational age at celecoxib introduction was 22.6 weeks, and the median period of administration was 9 days (range 3-40 days). The median gestational age at delivery was 27.1 weeks, and the median duration from initial
celecoxib administration to delivery was 40 days. The Z scores of PSV-DA and MVP did not change significantly after
celecoxib administration. During administration, PSV-DA exceeded the 95th percentile of the corresponding normal reference range in three cases, but the levels returned to normal after reduction or discontinuation of treatment. There was no oligohydramnios during the treatment.
CONCLUSIONS: Celecoxib administration for more than 48 hours in the second trimester of pregnancy might be safe and tolerable in terms of fetal PSV-DA and amniotic fluid volume as long as careful ultrasound monitoring is performed.
Celecoxib could be an alternative for preterm labor when conventional tocolysis is not effective.