Use of m-cholinolytics for management of threatened miscarriage
The objective. Assessment of the effectiveness of using Methacin as a tocolytic in women with threatened miscarriage. Patients and methods. Methacin was used in 50 patients with single-foetus pregnancy in the 1 st and 2 nd trimesters of gestation. The drug Methacin (metocinium iodide) was administered orally 2 mg 3 times daily. In 24 pregnant women Methacin was used as the only tocolytic. In 26 pregnant women Methacin was used in combination with other tocolytics due to the presence of marked pain and tonic symptoms, and evident structural changes of the birth canal. We assessed the objective tocolytic effectiveness of the drug by the end of the first and 7th day of the drug intake by the number of uterine tensions a day, and the subjective one - by the intensity of the increased uterine tone as reported by pregnant women, from «+» to «++++», and also birth outcomes for mother and foetus. Results. As has been found, in cases of threatened miscarriage, when patients have mild manifestations of the structural changes of the birth canal but also have symptoms of the increased contractility of the uterus, tocolytic monotherapy with Methacin has proven to be the most effective. In the Methacin monotherapy group, 17 (70.8%) pregnant women subjectively reported of the effectiveness of tocolytic therapy with Methacin by the end of the first day, and 20 (83.3%) women by the 7 th day. Against the background of the intake of Methacin, only 2 secundiparas reported of a persisting periodical increase of the uterine tone with a decrease of its intensity, the other patients noted complete absence of the increased uterine tone against the background of therapy. 14 patients noted the disappearance of periodical uterine tensions, 10 - decrease of the number of tensions. In pregnant women with marked threatened miscarriage accompanied by structural changes of the uterine cervix, complex tocolytic therapy has shown a less but still sufficient effectiveness, permitting to prolong pregnancy until the terms safe for newborns: preterm labour occurred in 10 of 26 patients (38.5%), but they all took place at 35-36 wks of pregnancy. Conclusion. Taking into consideration the absence of side effects and cost-efficiency, Methacin is a widely available drug and might be successfully employed in threatened miscarriage, first of all, in women with the increased uterine contractility.