Indomethacin-induced colon perforation in Bartter's syndrome.

Bartter's syndrome (BS) is an inherited renal tubular disorder characterized by hypokalemia, hypochloremic metabolic alkalosis, and hyperaldosteronism with normal blood pressure. A 22-year-old woman was referred at 23 week of gestation. Polyhydramnios was detected and the chloride level of the amniotic fluid was high. The mother was treated with indomethacin from 26 to 31 week of gestation. The newborn was delivered at 34 week of gestation. At 8th day of life, indomethacin was also started for the baby. After three days, a colonic perforation developed. Indomethacin-induced colon perforation is uncommon in antenatal Bartter's syndrome. This patient indicates that administration of indomethacin in both antenatal and/or early postnatal period may be associated with colonic perforation.

Indomethacin therapy in hydramnios.

AIM: The use of indomethacin in treatment of hydramnios was evaluated. SUBJECTS & METHODS: Twelve patients with symptomatic hydramnios were treated with indomethacin (2.2- 3.0 mg/kg body weight/day). RESULTS: The treatment was started at a gestational age of 31.17-/+7.94 weeks and continued for 3.74-/+2.3 weeks. Eleven patients responded to the therapy both subjectively and objectively and pregnancies were prolonged by 4.6-/+3.1 weeks (range 0.1-10 weeks). Five women had term deliveries. Six patients had a favourable perinatal outcome. Four patients who had a known congenital anomaly in the foetus, delivered stillborn babies or had an early neonatal death. One patient who did not follow up after commencing therapy delivered a full-term stillbirth. One patient delivered within 1 day of starting therapy. Indomethacin therapy caused no maternal complications. CONCLUSION: Indomethacin was effective in the management of hydramnios and preventing it's complications.

Terapia con indometacina en el tratamiento del polihidramnios / Indomethacin therapy in the treatment of hydramnios

Se estudiaron 8 embarazadas con polihidramnios, 4 de ellas con síntomas de amenaza de parto pretérmino o disnea ligera que fueron tratadas con indometacina oral (100 mg/ diarios por 7 d en 3 ciclos). El tiempo del diagnóstico y comienzo de la terapia fue de 27 ñ 3 semanas. Se realizó biometría fetal semanalmente, así como ecocardiografía para valorar constricción del ductus, no se demostró que ocurriera en los casos tratados. Se encontró en los 8 casos que el 62,5 porciento nació después de las 37 semanas, con 3 bajo peso (37,5 porciento) y 1 de ellos presentaba crecimiento intrauterino retardado. El índice de bolsones se normalizó entre el 50 y 95 percentil en 6 de los casos después del tercer ciclo de tratamiento. Se realizó el estudio seriado de vejiga fetal por ecografía antes y después de la terapia con indometacina observándose una declinación significativa de la diuresis fetal. En 3 de los 8 casos se pudo determinar la causa del hidramnios. Hubo una muerte anteparto en un gemelar y otra neonatal. Se recomienda esta terapia con indometacina en los hidramnios con un seguimiento estricto de los parámetros expuestos para la evolución

Indomethacin treatment of polyhydramnios, a controlled study

Indomethacin has recently been used to treat polyhydramnios. It is not known if its use will prolong pregnancy. A controlled study was undertaken to evaluate its use and its side effects. 23 pregnant mothers with polyhydramnios were studied. 14 patients were given indomethacin, 9 patients acted as a control. In the indomethacin group, the mean gestational age before starting therapy was 30.1 SD 3.5 weeks and 37.07 SD 3.4 at the time of delivery. The mean duration of indomethacin treatment was 17.2 days. The mean of the largest amniotic fluid pocket depth was 10.07 SD 1.5 before treatment, and after treatment, it was 5.9 cm SD 1.8 cm. In the control group, no change in liquor volume occurred in 5 cases, in one case hydramnios resolved spontaneously and in 3 cases liquor volume increased. The mean gestational age at the time of delivery was 37 weeks SD 3.8. The mean birth weight in the indomethacin group was 2828.2 grams [gm.] SD 659 and for the control group it was 3111 SD 1004 gm. There was no neonatal cardiovascular, renal or coagulation problems. The follow-up period was 1 year. There were 2 perinatal deaths in the control group and 1 perinatal and 1 neonatal death in the indomethacin group. It is concluded that indomethacin therapy in polyhydramnios did not prolong pregnancy