Drug-induced rhabdomyolysis during pregnancy is extremely rare. We report here a rare case of ritodrine-hydrochloride-induced rhabdomyolysis in a pregnant patient with myotonic dystrophy. A 32-year-old primigravida was admitted because of premature labor at 31 weeks of gestation. She had been diagnosed as having myotonic dystrophy by electromyographic investigations and abnormal serum creatinine phosphokinase (CPK) levels. Tocolysis was initiated with oral ritodrine hydrochloride (15 mg/day) alone. There was a prompt response to the ritodrine hydrochloride. Three days after administration began, serum CPK levels had become markedly elevated to 10,897 mg/dl and myoglobinuria was detected (1,800 ng/dl), suggesting the presence of rhabdomyolysis. There was no evidence of worsening of the myotonic symptoms. Tocolysis was stopped immediately, and the laboratory data improved gradually. At 37 weeks of gestation, she spontaneously delivered a healthy male baby. Rhabdomyolysis has been recognized as a complication of tocolytic therapy with ritodrine hydrochloride. Therefore, β-adrenergic agents should be used with great care, especially for patients with myotonic dystrophy, because of these agents’ tendency to aggravate or precipitate myotonia and to induce rhabdomyolysis.

Poisonous snakebite is a rare complication of pregnancy. It has been suggested that snakebite poisoning during pregnancy may cause fetal loss. We report a case of intrauterine fetal death after a poisonous snakebite in the first trimester of pregnancy. A 29-year-old pregnant Japanese woman was admitted to hospital after being bitten by a pit viper on her right heel. The patient was at 10 weeks of gestation. In response to the bite, her right leg became extremely swollen, and paralysis of the right oculomotor nerve was observed. Intravenous administration of cepharanthine, ulinastatin, hydrocortisone sodium succinate, gabexate mesylate and antibiotics was started. Laboratory data suggested the presence of rhabdomyolysis. One week after admission, although she improved clinically and symptomatically, transvaginal ultrasonography revealed intrauterine fetal death. No vaginal bleeding was observed. A dilatation and curettage was performed. The patient made an uneventful recovery and was discharged from hospital 17 days after the snakebite. Consistent with other reports, in the first trimester intrauterine fetal death may especially occur when the mother has systemic symptoms, although its mechanism remains unclear.

Acute renal failure is a serious complication of preeclampsia that usually requires the termination of pregnancy. We present a case of acute renal failure due to severe preeclampsia successfully treated with the infusion of a low dose of dopamine. This 25-year-old Japanese primigravida was admitted at 31 weeks of gestation for the treatment of preeclampsia. Urine output was decreased to 380 ml/day; 24-hour creatinine clearance was decreased to 13.7 liters/day. Blood urea nitogen was elevated to 31.9 mg/dl; serum creatinine was elevated to 3.34 mg/dl. The diagnosis was acute renal failure related to preeclampsia. A low dose of dopamine, 1 µg/kg/min, was infused daily for 7 days at 32 weeks of gestation to maintain urine output. Renal function improved markedly without any adverse effect on the patient’s blood pressure which was controlled on hydralazine. Fetal distress developed 4 days later and emergency cesarean section was performed. A healthy female was delivered. The infusion of a low dose of dopamine appeared to be highly effective in managing acute renal failure caused by preeclampsia with no serious side effects.