Cyclo-oxygenase (COX) inhibitors for treating preterm labour

Reinebrant, Hanna E.; Pileggi-Castro, Cynthia; Romero, Carla Lionela Trigo; Santos, R. A. N.; Kumar, Sailesh; Souza, João Paulo; Flenady, Vicki

doi:10.1002/14651858.cd001992.pub3

Cited by 94 publications

(54 citation statements)

References 80 publications

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“…It is therefore important to inform pregnant women of the potential fetal and neonatal complications following maternal ingestion, and that these drugs should be avoided as self-medication especially in the third trimester. There is an ongoing debate whether NSAIDs should be reintroduced as tocolytic therapy since their effect on delaying preterm delivery is high 26 27. However, the potential negative side effects, most importantly premature closure of the ductus arteriosus and fetal renal impairment, have to be balanced, and treatment should only be introduced after thorough consideration and with caution.…”

Section: Discussionmentioning

confidence: 99%

Prenatal constriction of the ductus arteriosus following maternal diclofenac medication in the third trimester

2015

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SUMMARYWe describe a case of a 21-year-old primigravida at 36 weeks' gestation who was admitted to a local hospital because of abdominal pain. She was prescribed a total of six doses of diclofenac 50 mg over 2 days. One day later, there was difficulty registering the fetal heartbeats on cardiotocography. Ultrasound examination revealed a fetus with ascites and pathological flow over the tricuspid valve. The patient was referred to a tertiary centre for fetal medicine. Fetal echocardiography revealed, in addition to ascites and tricuspid regurgitation, a constricted ductus arteriosus, dilated right ventricle and reduced flow in the pulmonary artery. Immediate caesarean section resulted in an excellent neonatal outcome. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

Prenatal constriction of the ductus arteriosus following maternal diclofenac medication in the third trimester

2015

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“…Anti‐inflammatory agents like progesterone are also effective in reducing PTB risk in a limited subset of PTB (mostly beneficial in cases with prior history or short cervix of < 20 mm) . Similarly, the benefit of cyclooxygenase (COX) inhibitor, indomethacin in PTB reduction is also limited …”

Section: Heterogeneity Associated With Inflammationmentioning

confidence: 99%

Mechanistic Differences Leading to Infectious and Sterile Inflammation

Behnia

Sheller

Menon

2016

American J Rep Immunol

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Inflammation is a physiologic component of pregnancy and parturition. Overwhelming intrauterine inflammatory load promotes quiescent feto-maternal tissues into a contractile phenotype. Like inflammation, oxidative stress is an inevitable component of both pregnancy and parturition. Pathologic activation of host innate immune response to adverse pregnancy conditions can lead to premature activation of inflammatory and oxidative stress. Inflammation and oxidative stress markers seen with both sterile and infectious inflammation are often similar; therefore, it is difficult to understand causality of conditions like spontaneous preterm birth. This review demonstrates potential mechanistic pathways of activation of sterile and infectious inflammation. We demonstrate the activation of two unique pathways of inflammation by factors that are well-documented proxies for oxidative stress (cigarette smoke extract) and infection (lipopolysaccharide). Sterile inflammation seen after exposure to an oxidative stress inducer is due to cellular elemental damage resulting in p38 mitogen-activated protein kinase (MAPK) induced cellular senescence. Infectious inflammation is through activation of transcription factor NF-κB and independent of oxidative stress-associated damages and p38 MAPK-induced senescence. Understanding the differences in the inflammatory pathway activation by various risk factors is important to design better screening, diagnostic and intervention strategies to reduce the risks of adverse pregnancy outcomes.

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“…The research stated that COX-2 may be a predictor in determining the occurrence of preterm labor, an increase of COX-2 in 86% of labor may determine the risk of preterm labor 10 . Meta-analysis stated that the eISSN : 2579-8324 pISSN : 2579-8323 discovery of the effect of COX to the occurrence of preterm labor, it is necessary to treat with COX-2 inhibitors for the prevention and treatment of preterm labor 11 . Progesterone and COX-2 markers as a determinant of success in the prevention of preterm labor.…”

Section: Diagnostic Value Of Cyclooxygenase 2 Serum Levels In Predictmentioning

confidence: 99%