Dergiler / GORM:Gynecology Obstetrics & Reproductive Medicine / 2002 / Cilt: 8 - Sayı: 3
Does ritodrine infusion have any effects on umbilical and uterine arteries' blood flows during the treatment of preterm labor
- Sayfa
- 189–193
- DOI
- —
Özet
Bu çalışmada preterm eylem tanısı alan gebelerde tokolitik amaçla uygulanan intravenöz ritodrin infüzyonunun umbilikal ve uterin arter kan akımına etkileri olup olmadığını araştırdık. Kan akımı değerlendirmesinde Doppler ultrasonografi ile ölçülen sistolik/diastolik oran kullanılmıştır. Ayrıca maternal ve fetal kalp atım hızları da kaydedilmiştir. Datalar infüzyon öncesi (T0), infüzyon sırasında(T1) ve infüzyon sonrası(T2) olarak gruplandırılmış, istatistiksel olarak karşılaştırılmıştır. Umbilikal arter sistolik/diastolik oranları arasında her 3 dönemde anlamlı farklılık bulunmuştur (T0: 3.22±0.72, T1: 2.47±0.60, ve T2: 2.89±0.56). Uterin arter Doppler incelemesinde ise anlamlı farklılık T0-T1 ve T2-T1 dönemleri arasında saptanmıştır (sağ uterin arter T0: 2.56±0.59, T1: 2.21±0.56, T2: 2.52±0.60; T0-T1, p<0.001 ve T1-T2, p<0.007). İnfüzyon öncesi ve sonrası dönemler arasında maternal ve fetal kalp atım hızları yönünden analamlı fark gözlenmemiştir. Sonuç olarak ritodrin infüzyonu uygulama dozundan bağımsız olarak uteroplasental vasküler direnci azaltmaktadır. Bu etkinliği literatürde tartışılan ve henüz netlik kazanmamış mekanizmalara bağlı olarak gelişiyor olabilir. Kanımızca ritodrinin uteroplasental ve fetal dolaşıma etkinlğinin ortaya çıkarılmasında daha geniş çalışmalara gereksinim vardır.
Abstract
OBJECTIVES: In this study we sought to evaluate the effects of tocolytic treatment using intravenous ritodrine on umbilical and uterine arteries by measuring systolic-to-diastolic ratios in pregnant patients being followed for preterm labor. STUDY DESING: One hundred twenty-three singleton pregnancies were included in the study between September 1999 and October 2000. The umbilical and uterine arteries velocimetries were performed by continous-wave Doppler ultrasonography. The systolic-to-diastolic ratios of umbilical and uterine arteries and maternal - fetal heart rates were recorded in three periods: pre-infusion, during infusion and post-infusion of ritodrine. For statistical analysis, statistical package for social sciences for Windows 7.0 was used. The quantitative results were compared with Friedman test, Wilcoxon signed ranks and correlation rates. A statistical significance was expressed as p value<0.05, (95% confidence interval). RESULTS: The pre-therapy (T0), during therapy (T1) and post-therapy (T2) findings were recorded and compared with each other to determine the effects of ritodrine infusion on right and left uterine arteries, and umbilical artery systolic-to-diastolic ratios. Regarding to the systolic-to-diastolic ratio, while statistically significant differences were detected between each period at the umbilical artery (T0: 3.22±0.72, T1: 2.47±0.60, and T2: 2.89±0.56), in both uterine arteries, the only significant difference was found by comparing the therapy scores with the pre-therapy and post-therapy ones (right uterine artery T0: 2.56±0.59, T1: 2.21±0.56, T2: 2.52±0.60; T0-T1, p<0.001 and T1-T2, p<0.007). We found no statistically significant difference in maternal and fetal heart rates between pre and post-therapy; but, a statistically significant difference was observed between therapy period and both of these periods. CONCLUSİONS: This study shows that ritodrine infusion decreases the uteroplacental vascular resistance by a mechanism which is not yet clarified. However, this effect was not dose related, and the decrease observed in systolic-to-diastolic ratio of umbilical and uterine arteries could be the result of any one or a combination of the mechanisms mentioned in the literature. Further studies including greater numbers of patients need to be performed to reveal exactly the effects of ritodrine on uteroplacental and fetoplacental circulation.