[Peculiarities of treatment of ulcerative gastrointestinal hemorrhage in pregnant women].

The occurrence rate of gastrointestinal hemorrhage (GIH) of nonvaricosal genesis in pregnant women was analyzed. The risk of complications occurrence in the pregnancy course while performing local endoscopic hemostasis and prophylaxis of the hemorrhage recurrence occurrence was established. Application of elaborated treatment method for GIH of nonvaricosic genesis in pregnant women have promoted reduction of the severe complications rate in the pregnancy course, applying elimination of the vasoconstrictor and uterotonic effects of adrenalin, reduction of esophagogastroduodenoscopy duration. While application of this procedure in pregnant women of a main group operative cessation of GIH was not applied. In a comparison group a hemostasis, using operative way, was done in 2 (13.3%) women patients with subsequent occurrence of preeclampsy, what resulted in antenathal fetal death.

Tocolysis with the ß-2-sympathomimetic hexoprenaline increases occurrence of infantile haemangioma in preterm infants.

BACKGROUND: Infantile haemangioma (IH) is the most commonly observed tumour in children. Off-label pharmacological treatment of IH with the beta-blocker propranolol induces regression of IH. Based on the fact that IH are more frequently observed in premature babies than in mature babies and the evidence that beta-blocker therapy leads to regression of IH, the authors generated the hypothesis that the use of ß-2-sympathomimetics during pregnancy for inhibiting premature labour might increase occurrence of IH in preterm infants. METHODS: For group comparison t test, Mann-Whitney U test and Fisher's exact test were used. Logistic regression was carried out by the forward stepwise method with Wald statistics. RESULTS: Data of 328 preterm infants (<32 gestational weeks) or with a birth weight of less than 1500 g (<36 gestational weeks) born between January 2006 and December 2008 were analysed. A total of 15 were excluded due do death within the 1st month of life, 38 because of lost to follow-up and six due to incomplete data. Complete data of 269 preterm infants were retrospectively analysed. During the follow-up period of median 1.6 years, 50 infants developed one or more IH within their first 6 months of life. IH occurred in 40/181 patients with intrauterine exposure to the ß-2-sympathomimetic hexoprenaline and in 10/88 without exposure (OR=4.3; 95% CI 1.4 to 13.8). Furthermore, the influence of antenatal exposure to glucocorticosteroids for induction of lung development was analysed. Prenatally exposed subjects showed reduced occurrence of IH (OR=0.2; 95% CI 0.05 to 0.8). CONCLUSION: Intrauterine exposure to the ß-2-sympathomimetic hexoprenaline might increase the occurrence of IH in preterm infants.

[Comparison of the cost of treatment of premature labor with atosiban or beta-sympathomimetics from the perspective of the health care payer--a pharmacoeconomic model]. / Srovnání nákladu na lécbu predcasného porodu atosibanem nebo beta-sympatomimetiky z perspektivy plátce zdravotní péce--farmakoekonomický model.

OBJECTIVE: To evaluate the cost of treating premature delivery with atosiban or beta-sympatomimetic drugs (fenoterol and hexoprenalin) from the perspective of health care payer--the medical insurance company. DESIGN: A pharmaco-economic model based on the results of randomized, controlled clinical study. SETTING: Hospital Pharmacy at Vitkovice Hospital of Blessed Mary Antonia, Ostrava. METHODS: The study is based on the application of clinical decision-making analysis, which includes results of a randomized controlled clinical study as well as data on the cost of clinical interventions and cost of drug therapy. The pharmaco-economic model was created from the perspective of the payer of health care--the insurance company. This model presumes the administration of atosiban or beta-sympatomimetic drugs (fenoterol and hexoprenalin) for the period of 18 and 48 h and the therapy of possible untoward effects for the next 72 h after the administration of the drugs. The analysis of sensitivity of pharmacokinetic model also employs so called low and high estimate of supplementary cost for the treatment of untoward effects. RESULTS: After the administration of the drugs for the period of 18 h the total cost of the payer of medical care was in the range of 21,914.5-21,974.4 CKr in atosiban, 19,878.7-22,661.4 CKr in fenoterol and 19,942.9-21,974.4 CKr in hexoprenalin. In the administration of the drugs for 48 h, the overall cost of the payer of medical care was in the range of 43,082.5-43,142.4 CKr in atosiban, 19,960.3-23,150.7 CKr in fenoterol and 20,131.3-23,574.0 in hexoprenalin. CONCLUSIONS: This study compared overall cost associated with hospitalization of a premature delivery from the perspective of the medical care payer, i.e. the health insurance company. The authors applied a pharmaco-economic model evaluating hospitalization for the period of 48 h and subsequent therapy of possible untoward effects for the period of up to 72 h. In case of a shorter administration of atosiban (up to 18 h) the overall cost of hospitalization for premature delivery for the period of 48 h from the point of view of medical insurance company is basically comparable with the administration of beta-sympatomimetic drugs. If atosiban is administered for more than 18 h, the overall cost of hospitalization is higher than with beta-sympatomimetic drugs, and the cost increases in relation to the duration of atosiban administration.

Management of supraventricular tachycardia during hexoprenaline therapy for preterm labour: benefit of cardioselective beta blockade?

A 29-year-old woman presented with preterm labour at 32 weeks of gestation. Tocolytic treatment was started with intravenous hexoprenaline. Twenty-four hours after initiation of treatment, the patient developed supraventricular tachycardia, resistant to digoxin and verapamil. Medical treatment with metoprolol finally restored sinus rhythm. We observed no adverse effects on the fetal heart rate nor on the umbilical cord blood flow.

Randomized, double blind, placebo controlled comparison of ritodrine and hexoprenaline for tocolysis prior to external cephalic version at term.

External cephalic versions in the study period were performed in a double blind design by 2 experienced practitioners. Sixty-three patients were allocated to treatment with either placebo, ritodrine or hexoprenaline. The main outcome measure studied was successful completion of external cephalic version. Hexoprenaline, but not ritodrine, was statistically more likely to be associated with successful version than placebo (p = 0.04 versus p = 0.22).

[Lesional pulmonary edema associated with tocolysis by hexoprenaline sulfate]. / Oedème pulmonaire lésionnel associé à une tocolyse par le sulfate d'hexoprénaline.

We report the case of a 24-year-old white female in need of tocolysis during the 25th week of pregnancy with i.v. hexoprenaline, while suffering from a discrete influenza-like syndrome with nasal discharge and sinusitis. A few hours later fulminant acute adult respiratory distress syndrome (ARDS) developed. ARDS is a rare (0.5-5%) but feared complication of tocolysis with beta-2 mimetic agents and magnesium sulfate. Its physiopathology is obscure, but iatrogenic hyperhydration and lesions of the alveolar-capillary membrane are suspected. In this case both factors were involved, but lesions of the alveolar-capillary membrane were predominant. A direct toxic effect of beta-2 mimetic agents on the alveolar-capillary membrane has not been demonstrated and other factors favoring pulmonary edema during tocolysis with beta-2 mimetic agents, especially infections, are discussed.

Severe fetal tachycardia after administration of hexoprenaline to the mother. A case report.

A fetus developed extreme supraventricular tachycardia (210/min) after intravenous hexoprenaline 10 micrograms was administered to the mother for intrapartum fetal distress. Urgent caesarean section resulted in the birth of a male baby with a reduced Apgar score; the infant survived after being ventilated for 24 hours.

Pulmonary oedema after hexoprenaline administration in preterm labour. A report of 4 cases.

Despite the widespread use of beta-sympathomimetic agents for preterm labour there appears to be a limited appreciation of the need for cardiovascular monitoring in the mother. Four patients in whom pulmonary oedema developed during tocolysis with hexoprenaline are described and the aetiological factors and pathogenesis of this potentially lethal complication discussed. Guidelines for the safe use of hexoprenaline in preterm labour are suggested.

Determination of light-chain myosin in pregnancy and under tocolysis.

Cardiac toxicity of tocolysis containing hexoprenaline (0.3 microgram/min) and the beta 1-blocking agent metoprolol (0.01 mg/min) was investigated using a recently developed monoclonal antibody arised against light-chain myosin in 15 patients and compared with the results in 51 control subjects. There was an increase in the median and 80th percentile values 2, 6, 12 and 24 hours after the beginning of tocolysis but no statistically significant difference between these values and the normal ones could be shown.

[Heart function in infants and small children, whose mothers required tocolysis with hexoprenaline sulfate (Gynipral)]. / Untersuchungen der Herzfunktion an Säuglingen und Kleinkindern, deren Mütter in der Schwangerschaft mit Hexoprenalinsulfat (Gynipral) tokolysiert worden waren.

Cardiac function was investigated in 23 retrospectively selected children (mean age 15 months, range 2/12-3 4/12), whose mothers had undergone a successful course of tocolysis around the 31st week of pregnancy. Hexoprenaline sulfate (Gynipral) had been given at a mean cumulative dose of 51,103 micrograms over an average period of 13.8 days. The infants were born at term; cases with marked birth asphyxia, low birth weight or other perinatal problems possibly influencing cardiac performance were not included. The examination included a chest X-ray, ECG (all standard leads) and ultrasonography. There was no evidence of myocardial dysfunction which might have been the late result of untoward effects of the beta 2-mimetics given during the last trimester of pregnancy. All probands were normally developed: on cardiological examination an incidental systolic murmur was found in 2 infants and border-line cardiomegaly in another proband. ECG revealed a wandering pace-maker and occasional ventricular extrasystoles in one 3 month-old boy, which is not necessarily abnormal at this age. Two-dimensional echocardiography showed normal cardiac anatomy in all 23 probands. One-dimensional M-mode showed normal left ventricular function parameters. The slightly elevated myocardial contractility demonstrated by means of the M-mode was attributed to increased sympathetic tone in the non-sedated children.

[Hexoprenaline tocolysis--side effects in the child?]. / Hexoprenalintokolyse--Nebenwirkungen beim Kind?

There were examined two groups of children, whose mother were treated with the uterine relaxant Hexoprenalin. 21 children were examined when they were three years of age, 28 children during their first week of live (internistic and neurological findings, EKG and blood-analyses). There were no signes of pathological development; all the findings were within the norm.

[Hexoprenaline--a new tocolytic for treatment of premature labor]. / Hexoprenalin--ein neues Tokolytikum zur Behandlung der vorzeitigen Wehentätigkeit.

Hexoprenaline is a selective beta 2-mimetic drug used in tocology for the prevention of premature labor and immature birth. From clinical application of the drug in bronchospasm therapy its selectivity, which is due to the elongated nitrogen substituent, is well-known. Because of the relatively small stimulation of cardiac beta 1-receptors the side-effects related therewith are less pronounced than with other beta-mimetics. The extent of tachycardia depends on the initial sympathomimetic condition of the patients. The success rate for hexoprenaline tocolyses is 34-78%, dependent on the initial tocological condition. The advantage of hexoprenaline compared with other tocolytics on the basis of experience made so far seems to relate to the smaller increase in chronotropy and the better tolerability.

[Tocolysis with hexoprenalin and salbutamol in a clinical comparison]. / Tokolyse mit Hexoprenalin und Salbutamol im klinischen Vergleich.

140 patients with a threatening premature birth at the greater than or equal to 24-less than 37 week of gestation were in this study randomly treated with hexoprenalin or salbutamol. In 77% in the hexoprenalin and in 74% in the salbutamol group the weight of the newborn was greater than or equal to 2500 g. In 66% in both study groups the birth occurred after the completed 37 weeks of gestation. During infusion of hexoprenalin tachycardia in mothers occurred statistically highly significantly less than during salbutamol. 11% of the mothers in the hexoprenalin group had side-effects during infusion compared to 30% in the salbutamol group. The correlation between the tocolysis-index (Baumgarten) and the prolongation-index (Richter) given by the regression lines facilitates in some measure the comparison of different tocolytic drugs concerning its tocolytic effect.

[The effect of tokolysis by means if beta- mimetics on fetuses and neonates (author's transl)]. / Uber die Wirkung der Tokolyse durch beta-Mimetika auf fet und das Neugeborene.

The influence of beta mimetic substances, given to stop premature labor, on the metabolism of the fetus and the newborn was investigated in 32 women. There was a definite rise in Insulin and in the amniotic fluid as well in cord blood, with a tendency to hypoglycemia in the newborn (4 out of 18 babies). No influence on acid base level, blood count. Electrolyts, but a marked increase in Bilirubin levels could be observed. Changes in the ECG could be brought in connection with influences of beta mimetic drugs on the myocardium.

Clinical evaluation of intravenous hexoprenaline in bronchial asthma.

5 ug of hexoprenaline given intravenously resulted in a significant relief of airway obstruction in 12 out of 16 patients with acute attack of bronchial asthma. It produced a 40% increase in peak expiratory flow rate (PEFR) with a peak at 5 minutes and a 12% increase was still present at 2 hours. It produced only minimal cardiovascular side effects. As a bronchodilator, it was as effective as 0.5 mg of addrenaline given subcutaneously though the latter suffered from considerable cardiovascular side effects as shown by a 12% elevation of systolic blood pressure and a 16% reduction in the diastolic blood pressure.

Hexoprenaline: a review of its pharmacological properties and therapeutic efficacy with particular reference to asthma.

Hexoprenaline1, N,N-[2-(3,4-dihydroxyphenyl)-2-hydroxyethyl] hexamethyl-enediamine, sulphate is a selective beta2-adrenoreceptor agonist which is active in man as a bronchodilator by the oral or intravenous routes and by inhalation. It is indicated for use in the treatment of bronchospasm associated with obstructive airways diseases, including asthma, bronchitis and emphysema. Clinical experience and double-blind studies have established that hexoprenaline is an effective bronchodilator. It major advantage over many other many other brochodilators of equal efficacy is its generally low production of side-effects, particularly tremor, palptitations, and tachycardia. In comparative trials, it has generally been rated as superior to orciprenaline or trimetoquinol, but comparisons with salbutamol have provided equivocal results. Oral hexoprenaline was superior to fenoterol as long-term maintenance therapy is asthma, principally because its somewhat lesser bronchodilatory effects were more than compensated for by a lesser incidence of side-effects.