Chimura T

Abortifacient effect and uterine cervix-dilating action of 16,16-dimethyl trans Δ2 PGE1 methyl ester (ONO 802) in the form of a vaginal suppository (a randomized, double-blind, controlled study in the second trimester of pregnancy)

A newly synthesized 16, 16-dimethyl trans delta 2 PGE1 methyl ester (ONO 802) was clinically applied in the form of a vaginal suppository for therapeutic abortion of second trimester pregnancies. Its effects were studied in a double-blind test comparing it with an inactive placebo suppository. The study was conducted at 12 Japanese university hospitals. The number of patients was 125 in total, i.e. 63 receiving ONO 802 vaginal suppository (containing 1.0 mg ONO 802) and 62 receiving inactive placebo suppository. ONO 802 was more effective than placebo with a success rate of 87% (complete (71%) and incomplete (16%) abortions). The onset of uterine contractions was observed in 154.3+/-18.1 min. and the onset of uterine bleeding in 323.6+/-41.0 min. The expulsion of the fetus and placenta was observed in 955.4+/-97.0 and 961.6+/-97.0 min., respectively. The cervix dilating effect of ONO 802 was observed in 63.5% of the patients at 3 hours after the start of administration. Nausea, vomiting, abdominal cramps, diarrhea and pyrexia were noticed. However, all these side effects were transient and mild, requiring no treatment. No abnormality was observed in the puerperal course, duration of uterine bleeding or onset of subsequent menstruation following the therapeutic abortion. Therefore, the present study demonstrated that ONO 802 vaginal suppository was an effective and valuable drug for therapeutic abortion of second trimester pregnancies.

Placental transfer of lidocaine hydrochloride after prolonged continuous maternal intravenous administration

We treated a patient with arrhythmia during pregnancy with prolonged intravenous administration of lidocaine hydrochloride. This was a case of twin-to-twin transfusion syndrome and the arrhythmia was caused by ritodrine therapy. In total, 14.1 g lidocaine (50 mg · hr−1 for 282 hr) were used. Since there are no descriptions of human placental transfer of lidocaine after such a prolonged continuous intravenous administration, we measured lidocaine concentrations in maternal and fetal serum, and in the amniotic fluid (AF) at delivery. Fetal serum lidocaine concentrations (donor: 0.83 μg · ml−1; recipient: 0.82 μg · ml−1) were lower than in the maternal serum (1.6 μg · ml−1), while the AF lidocaine concentrations (donor: 1.05 μg · ml−1; recipient: 1.04 μg · ml−1) were higher than those of the fetal sera. The fetal/maternal concentration ratios of lidocaine were 0.52 for the donor and 0.51 for the recipient, which were similar to those described previously after administration of lidocaine in labour.RésuméNous avons traité l’arythmie d’une parturiente porteuse de jumeaux avec de l’hydrochlorure lidocaline iv. Il s’agissait d’un syndrome de gémellité perfuseur-perfusé et l’arythmie était consécutive au traitement à la ritodrine. En tout, 14,1 g (50 mg · h−1 pour 282 h) de lidocaine ont été administrées. Comme on n’a jamais rapporté de données sur le transfert placentaire de la lidocaïne après une administration iv aussi prolongée, nous avons mesuré à l’accouchement les concentrations sériques maternelles et foetales de lidocaïne, et la concentration sérique de liquide amniotique (LA) de lidocaïne. Les concentrations sériques (perjuseur: 0,83 μg · ml−1; perfusé: 0,82 μg · ml−1) étaient moins élevées que dans le sérum matemel (1,6 μg · ml−1), alors que dans le LA (perfuseur: 1,05 μg · ml−1; perfusé; 1.04 μg · ml−1) les concentrations étaient plus élevées que dans le sérum foetal. Les rapports concentration foetus/ mère de lidocaïne étaient de 0,52 pour le perfuseur et de 0,51 pour le perfusé et identiques à ceux trouvés après l’administration de lidocaïne pendant le travail.