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D'Ambrosio V, Vena F, Scopelliti A, D'Aniello D, Savastano G, Brunelli R, Giancotti A. Use of non-steroidal anti-inflammatory drugs in pregnancy and oligohydramnios: a review. J Matern Fetal Neonatal Med 2023; 36:2253956. [PMID: 38092425 DOI: 10.1080/14767058.2023.2253956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/26/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid. METHODS Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI). RESULTS Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment. CONCLUSIONS The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.
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Affiliation(s)
- Valentina D'Ambrosio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Annalisa Scopelliti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Debora D'Aniello
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Giovanna Savastano
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
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Grincevičienė Š, Volochovič J, Grincevičius J. Lack of pharmacist-physician communication associated with nimesulide-induced oligohydramnios during pregnancy. Int J Clin Pharm 2016; 38:196-8. [PMID: 26951121 DOI: 10.1007/s11096-016-0267-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Abstract
CASE The consequences of medication errors can be serious, especially in pregnant women. When decision-making is critical, physician-pharmacist communication has the potential to improve patient safety. In this report, we describe the case of a pregnant woman who developed oligohydramnios after taking nimesulide for neuropathic pain. The drug was improperly prescribed by a family physician and mistakenly dispensed by a community pharmacist. Oligohydramnios was observed during ultrasound examination and an iatrogenic cause was suspected. This case is presented to raise awareness that patient safety is threatened because of a lack of physician-pharmacist communication, especially for pregnant patients. CONCLUSION Healthcare professionals are continually at-risk for making errors at work. Effective inter-professional communication should be an organisational tool to prevent adverse events for pregnant women.
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Affiliation(s)
- Švitrigailė Grincevičienė
- Department of Biothermodynamics and Drug Design, Institute of Biotechnology, Vilnius University, V. Graičiūno 8, 02241, Vilnius, Lithuania.
| | - Jelena Volochovič
- Centre of Obstetrics and Gynaecology, Hospital "Santariškių Klinikos", Vilnius University, Santariškių st. 2, 08661, Vilnius, Lithuania
| | - Jonas Grincevičius
- Department of Drug Technology and Social Pharmacy, Faculty of Pharmacy, Lithuanian University of Health Sciences, Sukilėlių ave. 13, 50161, Kaunas, Lithuania
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Evangelinakis NE, Polyzou EN, Salamalekis GE, Kotsaki AJ, Chrelias CG, Giamarellos-Bourboulis EJ, Kassanos DP. Alterations in the cellular component of the maternal immune system in a murine preterm delivery model. J Matern Fetal Neonatal Med 2013; 26:1024-9. [DOI: 10.3109/14767058.2013.765848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maternal ingestion of diclofenac leading to renal failure in newborns. Pediatr Nephrol 2012; 27:1033-6. [PMID: 22331206 DOI: 10.1007/s00467-012-2114-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of non-steroidal anti-inflammatory drugs, such as indomethacin, ibuprofen, and nimesulide, during pregnancy has been reported to cause nephrotoxicity in the fetus. However, neonatal renal failure following antenatal exposure to diclofenac has not been reported in the literature. We report three cases of neonatal renal failure, including a pair of twins, following ingestion of diclofenac by the mother during pregnancy. CASE-DIAGNOSIS/TREATMENT Cases 1 and 2 involved a pair of twins born to a mother with oligohydramnios. The first twin had nonoliguric renal failure with incomplete recovery at day 17 of life. The second twin developed anuria and hyperkalemia on day 2 of life, for which peritoneal dialysis was initiated. After 20 days of peritoneal dialysis, the second twin remained oligo-anuric, developed peritonitis, and died. Case 3 involved a female infant born to a primigravida with severe oligohydramnios. The baby developed oliguria and renal failure after birth, which was managed conservatively. Creatinine normalized by day 15 of life and remained normal at 1 year of age. Ultrasonography in the first week of life showed that all three infants had normal-sized kidneys. Both mothers had been administered diclofenac during pregnancy. CONCLUSIONS In utero exposure to diclofenac may be associated with neonatal renal failure that may be transient or irreversible. We recommend that the use of diclofenac during pregnancy be avoided.
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Equils O, Nambiar P, Hobel CJ, Smith R, Simmons CF, Vali S. A computer simulation of progesterone and Cox2 inhibitor treatment for preterm labor. PLoS One 2010; 5:e8502. [PMID: 20111699 PMCID: PMC2811723 DOI: 10.1371/journal.pone.0008502] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 11/11/2009] [Indexed: 12/05/2022] Open
Abstract
Background Sufficient information from in vitro and in vivo studies has become available to permit computer modeling of the processes that occur in the myometrium during labor. This development allows the in silico investigation of pathological mechanisms and the trialing of potential treatments. Methods/Results Based on the human literature, we developed a computer model of the immune-endocrine environment of the myometrial cell. The interactions between molecules are represented by differential equations. The model is designed to simulate the estrogen and progesterone receptor changes during pregnancy and particularly the changes in the progesterone receptor (PR) isoforms A and B that are thought to mediate functional progesterone withdrawal in the human at labor. Parturition is represented by an increase in the PRA to PRB ratio to levels seen in women in labor. Infection is shown by inducing inflammation in the system by increasing phospho-IkB kinase concentration (IKK) levels; which lead to increased NF-κB activation, causing an increase in the PRA/PRB ratio. We examined the effects of progesterone or cyclo-oxygenase 2 (Cox2) inhibitor treatments on the PRA/PRB ratio in silico. The model predicted that high doses of progesterone and Cox2 inhibition would be effective in preventing an NF-κB-induced PRA/PRB ratio increase to the levels found during labor. Conclusions Our data illustrate the use of dynamic biological computer simulations to test the effectiveness of therapeutic interventions. This may allow the early rejection of ineffective therapies prior to expensive field trials.
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Affiliation(s)
- Ozlem Equils
- Department of Pediatrics, Burns and Allen Research Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America.
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Vercauteren M, Palit S, Soetens F, Jacquemyn Y, Alahuhta S. Anaesthesiological considerations on tocolytic and uterotonic therapy in obstetrics. Acta Anaesthesiol Scand 2009; 53:701-9. [PMID: 19397506 DOI: 10.1111/j.1399-6576.2009.01922.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Significant side effects of tocolytic and uterotonic substances may be of concern to the anaesthesiologist. Recently, new drugs have been introduced having less side effects for both the mother and the neonate. METHODS A literature search was undertaken mainly focusing on meta-analyses, to review the possible side effects that might affect the course of anaesthesia and to suggest which precautions should be considered to prevent the occurrence of significant interactions with anaesthetic manipulations and drugs. RESULTS Magnesium sulphate has a proven benefit in lowering systolic blood pressure and preventing the occurrence of eclampsia, but not as a tocolytic. beta-adrenergic agonists are being abandoned due to the availability of tocolytic agents causing less side effects. Calcium channel blockers (CCB) are frequently used but can cause major maternal cardiovascular complications. Nitroglycerin seems to be appreciated as an acute tocolytic rather than a routine substance during pre-term labour. Cyclo-oxygenase-2 inhibitors are still under investigation but their tocolytic benefit is questionable mainly due to foetal side effects. Atosiban is considered the first-choice tocolytic. With respect to oxytocic drugs, oxytocine, prostaglandines and methylergometrine may all cause serious side effects especially when combined. The cardiovascular side effects of prostaglandins and methylergometrine can be life-threatening. Both oxytocin and carbetocin have a rather low risk for maternal complications. CONCLUSION Atosiban and CCB are at least as effective tocolytic agents as beta-mimetics but have significantly less side effects. Magnesium sulphate can cause neuromuscular blockade, especially when combined with CCB. Concerning oxytocic agents, short-acting oxyctocin and long-acting carbetocin have the least side effects as compared with prostaglandins and methylergometrine.
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Affiliation(s)
- M Vercauteren
- Department of Anaesthesia, Antwerp University and University Hospital, Antwerp, Belgium.
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Bizargity P, Del Rio R, Phillippe M, Teuscher C, Bonney EA. Resistance to lipopolysaccharide-induced preterm delivery mediated by regulatory T cell function in mice. Biol Reprod 2009; 80:874-81. [PMID: 19144956 PMCID: PMC2804837 DOI: 10.1095/biolreprod.108.074294] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 11/19/2008] [Accepted: 12/30/2008] [Indexed: 01/21/2023] Open
Abstract
Intrauterine or intraperitoneal administration of lipopolysaccharide (LPS) into normal mice at midgestation induces preterm delivery (PTD) within 24 h through a mechanism dependent on Toll-like receptor signaling and expression of inflammatory cytokines. The exact participants in the cellular network involved in PTD are not known. Although the activities of innate immune cells are thought to be important, the extent to which this process depends on T and B cells has yet to be examined. Mice deficient in T and B cells due to genetic deficiency in the recombination activating gene 1 (Rag1(-/-)) were given LPS intraperitoneally on Day 15 of gestation and found to be susceptible to LPS-induced PTD. This was found to involve many of the inflammatory mediators reported as important in normal mice. Moreover, at a low dose (3 microg), pregnant Rag1(-/-) mice were found to be more susceptible to PTD than a cohort of normal mice on the same genetic background. This increased susceptibility was partially reversed by transfer, on Day 10 of gestation, of whole lymphocytes or purified CD4(+) T cells. Transfer of purified CD4(+) T cells to Rag1(-/-) mice resulted in a uterine draining node population of FOXP3(+) cells, suggesting that these cells may contribute to resistance to LPS-induced PTD. Overall, the data suggest that, although T and B lymphocytes are not critical positive regulators of LPS-induced PTD, CD4(+) T cells play a protective and regulatory role, and thus could be a target for preventive or therapeutic manipulation.
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Affiliation(s)
- Peyman Bizargity
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Roxana Del Rio
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Mark Phillippe
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Cory Teuscher
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Elizabeth A. Bonney
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Medicine, University of Vermont College of Medicine, Burlington, Vermont
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Kothari TH, Maner WL, Shi S, Garfield R, Chen J. Inhibitory effects of electrical stimulation on delivery in pregnant rats. Eur J Obstet Gynecol Reprod Biol 2008; 141:18-22. [DOI: 10.1016/j.ejogrb.2008.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 03/28/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
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Prefumo F, Marasini M, De Biasio P, Venturini PL. Acute Premature Constriction of the Ductus Arteriosus after Maternal Self-Medication with Nimesulide. Fetal Diagn Ther 2008; 24:35-8. [DOI: 10.1159/000132403] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 03/05/2007] [Indexed: 11/19/2022]
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Abstract
The acute treatment of premature labour is successful for delaying delivery for short periods of time. Acute tocolysis does not have a significant impact on perinatal outcome. This is likely to be because the process leading to labour occurs over a longer timeframe and therefore therapies instigated as preventative measures are more likely to be successful in delaying delivery. Identification of women at risk of preterm birth is essential to ensure therapies are targeted appropriately. Risk assessments for prediction include previous obstetric history, previous episode of threatened preterm labour, fetal fibronectin status and cervical length. Several groups of pharmacological agents have been studied for the prophylactic treatment of preterm labour. There is no evidence to support the use of tocolytics such as beta-mimetics and oxytocin receptor antagonists. Current studies of calcium channel blockers are too small to draw final conclusions. Non-steroidal anti-inflammatory drugs are associated with side effects on the fetal renal system and ductus arteriosus, making them suitable only for long term use in pregnancy with close ultrasound surveillance. Antibiotics used early in pregnancy in women with abnormal vaginal flora may reduce the risk of preterm birth; however, in women with other risk factors for preterm birth, metronidazole may be associated with an increased risk. The use of progesterone in women with a history of very early preterm labour is likely to be beneficial for preventing preterm labour.
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Affiliation(s)
- Katie M Groom
- Department of Obstetrics and Gynaecology, University of Auckland, School of Population Health, University of Auckland Tamaki Campus, Private Bag 92019, Auckland, New Zealand.
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Østensen M, Raio L. A woman with rheumatoid arthritis whose condition did not improve during pregnancy. ACTA ACUST UNITED AC 2006; 1:111-4; quiz 1 p. following 114. [PMID: 16932640 DOI: 10.1038/ncprheum0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 10/06/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND A 25-year-old woman with a 3-year history of rheumatoid arthritis presented 6 months before her first planned pregnancy. At the time of presentation, she was being successfully treated with infliximab and methotrexate. During her pregnancy, the patient discontinued infliximab and methotrexate and her arthritis relapsed. She was treated with low-dose prednisone, sulfasalazine, nimesulide, and intra-articular corticosteroid injections. Oligohydramnios developed at gestational week 18. INVESTIGATIONS Laboratory testing, ultrasonography of the fetus and of the patient's affected joints. DIAGNOSIS Active arthritis during pregnancy and oligohydramnios suspected to be caused by nimesulide. MANAGEMENT Low-dose oral prednisone, sulfasalazine, repeated intra-articular corticosteroid injections. Infliximab and methotrexate were restarted immediately after delivery.
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Affiliation(s)
- Monika Østensen
- Department of Rheumatology and Clinical Immunology and Allergology, University of Berne, Switzerland.
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Abstract
PURPOSE OF REVIEW Few drugs are licensed in pregnancy, and data on drug use in pregnancy are mainly retrospective and uncontrolled. Pregnancy exposure has increased recently to new classes of drugs, as they have been shown to be effective and well tolerated outside of pregnancy. RECENT FINDINGS Anti-nausea therapies, H2-receptor and proton pump inhibitors appear to be safe. Metformin is being trialed for treatment in gestational diabetes and initial reports appear encouraging. Concern has been raised about statins in early pregnancy and should be avoided. New antiepileptic medication appears effective with low risk of abnormality. However, when combined with valproate, risks are still high. Selective serotonin reuptake inhibitors for depression appear to be effective, with likely low risk for teratogenesis, although neonatal behavioural syndrome following their use in the third trimester is a concern. Angiotensin II inhibitors should be avoided in the second and third trimesters of pregnancy. Smoking cessation programmes need to be reevaluated. SUMMARY Information about safety of drugs and caution about prescribing in pregnancy should continue. Until large clinical trials are performed, the risk/benefit ratio of drugs during pregnancy will remain uncertain.
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Affiliation(s)
- Phillipa M Kyle
- Obstetrics and Gynaecology, Christchurch School of Medicine and Health Sciences, University of Otago, New Zealand.
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Slater DM, Astle S, Woodcock N, Chivers JE, de Wit NCJ, Thornton S, Vatish M, Newton R. Anti-inflammatory and relaxatory effects of prostaglandin E2 in myometrial smooth muscle. Mol Hum Reprod 2006; 12:89-97. [PMID: 16455619 DOI: 10.1093/molehr/gal005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The onset of human labour is complex and involves multiple mediators, prostaglandins, cytokines and chemokines. However, whilst prostaglandins are routinely used for labour induction and inhibitors of prostaglandin synthesis are used to prevent pre-term labour, these practices are not invariably successful, and the rationale for their use is equivocal. As COX-2 and prostaglandin E(2) (PGE(2)) production is increased towards term, we have investigated the effect of PGE(2) and other cAMP-elevating agents on events associated with labour induction. Time-dependent increases in granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-8 (IL-8) release were observed following treatment of primary human myometrial smooth muscle (HMSM) cells with IL-1beta, via mechanisms that required de novo transcription and translation. Prior treatment with PGE(2) (1 microM) produced 86 and 80% decreases in GM-CSF and IL-8 release, respectively. Similarly, the cAMP analogue, 8-bromo-cAMP (8Br-cAMP) and the phosphodiesterase-4 (PDE(4)) inhibitor, rolipram, also repressed GM-CSF and IL-8 release. In addition, PGE(2), 8Br-cAMP, rolipram and salbutamol all had a dose-dependent inhibitory effect on spontaneous myometrial contractions in vitro. In this study, PGE(2) reduced the release of factors associated with cervical ripening and attenuated force development in myometrial smooth muscle, raising the possibility that in myometrium, PGE(2) may act to down-regulate some of the processes that contribute to the onset of human labour and may be beneficial in helping to maintain pregnancy towards term.
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Affiliation(s)
- Donna M Slater
- Department of Biological Sciences, Biomedical Research Institute, University of Warwick, Coventry, UK
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIVERORDNUNG IN SCHWANGERSCHAFT UND STILLZEIT 2006. [PMCID: PMC7271219 DOI: 10.1016/b978-343721332-8.50004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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