Fetal Scalp Blood Sampling During Second Stage of Labor—Analyzing Lactate or pH? A Secondary Analysis of a Randomized Controlled Trial

Abstract

However, because initial concerns were raised in the 1990s, the risks associated with indomethacin have appeared to be low, and the use of this tocolytic, given its effectiveness, has gradually increased.Use of any medication is a risk/benefit calculation, and with TTTS, even after laser therapy, the risks remain very high. Although minimally invasive in utero approaches are relatively safe, the uterus does not appreciate intrusions, and contractions, chorioamnion separation, premature rupture of the membranes, and PTB are common. Conclusions that can be drawn from this article are limited given that the treatment was used at one site and not the other, and there are undoubtedly other differences in the populations and in other aspects of care. However, the data are certainly thought provoking that long-term indomethacin should at least be considered after laser treatment for TTTS. Although the association of indomethacin with neonatal complications is likely to be real, the risks are relatively small, whereas the risks of TTTS are extremely high. If indomethacin truly prolongs pregnancy by a substantial length of time, this would appear to outweigh potential risks. Studies of indomethacin have generally focused on very high-risk infants whose pregnancies fail tocolysis; those in whom labor is successfully halted likely have a different outcome. Although a randomized trial would be ideal, that will require large numbers of patients treated for TTTS and is unlikely to happen. In the meantime, use of this postsurgical treatment for at least some extended period seems reasonable.-MEN)