Case report Anhydramnios and maternal thrombocytopenia after prolonged use of nimesulide Delia M. Paternoster * , Deborah Snijders, Francesca Manganelli, Angela Torrisi, Roberto Bracciante Department of Gynaecology and Human Reproduction, V Giustiniani 3, 35128 Padova, Italy Received in revised form 24 May 2002; accepted 1 August 2002 Abstract Prostaglandin synthesis inhibition have been proposed as an effective alternative to prevent preterm labour. This case report shows a pregnancy with anhydramnios and maternal thrombocytopenia, as side effects of the nimesulide therapy. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Anhydramnios; Nimesulide; Preterm delivery 1. Introduction Prostaglandin synthesis inhibitors have been proposed as an effective alternative to prevent preterm labour and is often used in cases in which either ritodrine or magnesium sulphate has failed [1]. However, adverse effects in the mother and in the newborn have limited their use. We present a case of anhydramnios and maternal thrombocy- topenia in which a non-steroidal anti-inflammatory drug (NSAID), nimesulide, had been administered at a dosage of 200 mg per day for 25 days continuously. 2. Case report A 33-year-old woman, gravida 1, para 0, had been admitted to another hospital at 28 weeks of gestation with uterine contractions. The ultrasound showed normal anat- omy, growth and amniotic fluid and Doppler velocimetry in the umbilical cord artery was normal. Transvaginal ultra- sound revealed a 2.5 cm long cervix. She was treated with ritodrine i.v. This did not stop the uterine contractions, so a new tocolytic, nimesulide 200 mg per day for 25 days, was established. She presented at our hospital at 32 weeks’ gestation with anhydramnios and a suspicion of premature labour. We stopped her treatment with nimesulide and administered betamethasone 12 mg i.m. for 2 days to induce the pulmonary maturation. On arrival, the platelet count was 82  10 9 l 1 , Hb 9.9 g/l, erythrocytes 3:19  10 6 l 1 and leucocytes were 3:5  10 6 l 1 . Ultrasonographic foetal growth and the flow velocity waveforms in the umbilical and renal arteries were normal. The cervical length was 2.0 cm and uterine contractions were occurring at a frequency of three in 10 min. The patient underwent caesarean section of a female infant. The mother’s haematological values post delivery are shown in Fig. 1. The rise in platelets may be a compensatory mechanism after the surgery rather than a pharmacological affect of stopping the nimesulide. The baby weighed 1830 g. Venous cord pH was 7.27, P CO 2 45.2 mmHg, P O 2 30.9 mmHg, and potassium 6.3 mmol/l (n, 3.5–5.3). Apgar scores after 1 and 5 min were both 7/10. The child was vasoconstricted, with reduced tone, and respiratory difficulties. The infant was ventilated for 5 days. Surfactant and xantines were administered and antibiotics given for 6–8 days. The child is now in normal health. 3. Conclusion Non-steroidal anti-inflammatory drugs inhibit both iso- forms of the cyclooxygenase enzyme that catalyses the conversion of arachidonic acid to prostanoids. Agents such as nimesulide were originally developed to selectively inhibit the cyclooxygenase-2 isoform in order to reduce gastrointestinal side effects. A tocolytic effect might result by preventing synthesis of prostaglandins and related inflammatory mediators. European Journal of Obstetrics & Gynecology and Reproductive Biology 108 (2003) 97–98 * Corresponding author. Tel.: þ39-49-8213410; fax þ39-49-8750860. E-mail address: paternod@unipd.it (D.M. Paternoster). 0301-2115/02/$ – see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-2115(02)00343-3