Administration of Tocolytic Agents is not Only un useful but also Culprit to Prevent Preterm Labor

The article presents modern views on the pathogenesis of preterm labor, their relevance and classification. From the perspective of evidence-based medicine methods of prevention are considered. A comparison of the main tocolytic agents, their advantages and disadvantages is presented. Key words: premature birth, perinatal and infantile mortality, tocolysis, magnesium sulfate, gestational age.

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Improvement in perinatal mortality rate attributed to spontaneous preterm labor without use of tocolytic agents

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(83)90678-6 ◽

1983 ◽

Vol 145 (7) ◽

pp. 781-783 ◽

Cited By ~ 16

Author(s):

Peter Boylan ◽

Kieran O'Driscoll

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Preterm Labor ◽

Perinatal Mortality Rate ◽

Tocolytic Agents

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Do tocolytic agents stop preterm labor? A critical and comprehensive review of efficacy and safety

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(93)90376-t ◽

1993 ◽

Vol 168 (4) ◽

pp. 1247-1259 ◽

Cited By ~ 169

Author(s):

Kenneth Higby ◽

Elly M-J. Xenakis ◽

Carl J. Pauerstein

Keyword(s):

Preterm Labor ◽

Efficacy And Safety ◽

Comprehensive Review ◽

Tocolytic Agents

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The Oxytocin-Oxytocin Receptor System and Its Antagonists as Tocolytic Agents

International Journal of Endocrinology ◽

10.1155/2011/350546 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 45

Author(s):

Nikolaos Vrachnis ◽

Fotodotis M. Malamas ◽

Stavros Sifakis ◽

Efthymios Deligeoroglou ◽

Zoe Iliodromiti

Keyword(s):

Preterm Labor ◽

Oxytocin Receptor ◽

Uterine Contractility ◽

Receptor Antagonists ◽

Receptor System ◽

Main Pathway ◽

Intracellular Ca ◽

Oxytocin Antagonists ◽

Tocolytic Agents ◽

G Protein Coupled

Oxytocin, a hormone involved in numerous physiologic processes, plays a central role in the mechanisms of parturition and lactation. It acts through its receptor, which belongs to the G-protein-coupled receptor superfamily, while Gq/phospholipase C (PLC)/inositol 1,4,5-triphosphate (InsP3) is the main pathway via which it exerts its action in the myometrium. Changes in receptor levels, receptor desensitization, and locally produced oxytocin are factors that influence the effect of oxytocin on uterine contractility in labor. Activation of oxytocin receptor causes myometrial contractions by increasing intracellular Ca+2and production of prostaglandins. Since oxytocin induces contractions, the inhibition of its action has been a target in the management of preterm labor. Atosiban is today the only oxytocin receptor antagonist that is available as a tocolytic. However, the quest for oxytocin receptor antagonists with a better pharmacological profile has led to the synthesis of peptide and nonpeptide molecules such as barusiban, retosiban, L-368,899, and SSR-126768A. Many of these oxytocin receptor antagonists are used only as pharmacological tools, while others have tocolytic action. In this paper, we summarize the action of oxytocin and its receptor and we present an overview of the clinical and experimental data of oxytocin antagonists and their tocolytic action.

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СРАВНЕНИЕ ТОКОЛИЗА ГЕКСОПРЕНАЛИНОМ И АТОЗИБАНОМ

Medical Council ◽

10.21518/2079-701x-2017-2-57-61 ◽

2017 ◽

pp. 57-61

Author(s):

О. Р. Баев ◽

О. Н. Васильченко ◽

А. О. Карапетян ◽

Н. К. Тетруашвили ◽

З. С. Ходжаева

Keyword(s):

Pregnant Women ◽

Clinical Condition ◽

Preterm Labor ◽

Preterm Labour ◽

Premature Labour ◽

Loading Dose ◽

Efficacy And Safety ◽

Treatment Start ◽

Tocolytic Agents ◽

In Pregnancy

The aim of the study was to compare the efficacy and safety of tocolytic agents - atosiban and hexoprenaline.Patients and methods: The study included 119 pregnant women with threatening preterm labour between 28 to 34 weeks of gestation. Sixty two pregnant received 62 tocolysis by hexoprenaline and fifty seven - atosiban. There were no differences in the clinical condition of pregnant women and features of preterm labour among groups before start of the tocolysis.The degree of effectiveness is determined by the duration of the pregnancy prolongation (48 hours, 7 days, more than 14 days).Results: 9 women of 62 that received hexoprenaline tocolysis (22,6%), and 2 – atosiban (3.5%) failed to prolong the pregnancy for more than 48 hours (p < 0,05). Additionally, 5 women of the hexoprenaline group had premature labour within the first week from the treatment start and eight within 7-14 days. In the group of women with an effective atosiban tocolysis all births took place in a range of more than 7 days from the beginning of tocolysis. Four woman in hexoprenaline group received one repeated course of therapy with this drug (without a loading dose) for 24 hours. In atosiban group full repeated course was conducted in the two cases. Full-term gestation births occurred in 14 women (22.6%) after hexoprenaline tocolysis and in 19 (33.3%) – atosiban (p > 0,05%). On average, atosiban tocolysis allowed to prolong pregnancy by 6.5 days longer than hexoprenaline (p < 0,05).Conclusion: The results of study has shown that atosiban is more effective than hexoprenaline in pregnancy prolongation for more than 48 hours in threatening preterm labor.

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Modern tocolysis and adverse effects of tocolytics

GYNECOLOGY ◽

10.26442/2079-5696_2018.2.46-50 ◽

2018 ◽

Vol 20 (2) ◽

pp. 46-50

Author(s):

O R Baev ◽

O N Vasilchenko ◽

A O Karapetyan

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Pregnant Women ◽

Preterm Labor ◽

Primary Outcome ◽

Comparable Efficacy ◽

Premature Births ◽

Instrumental Methods ◽

Tocolytic Agents ◽

Methods Of Control

Relevance. Toсolytic therapy is the only method that is used in the treatment of pregnant women with preterm labor. However, the effectiveness and safety of this therapy is still a matter of debate. One of the least studied issues of this problem is the safety of therapy, which is primarily manifested by the frequency of side effects. The aim is to carry out a comparative study of the safety of the most common tocolytic agents - atosiban, nifedipine and hexoprenaline sulfate. Material and methods. The study included 173 pregnant women with threatening premature births in a period of 28 to 34 weeks. In 54 cases, tocolysis with nifedipinum, 57 with atosiban, 62 with hexoprenaline was performed. To assess the effectiveness of tocolysis, clinical and instrumental methods of control (ultrasound with cervicometry) were used. The primary outcome points were the frequency of prolongation of pregnancy at 48 h and the incidence of side effects, including those requiring the termination of tocolysis. Results. Prolongation of pregnancy at 48 h was achieved in groups of nifedipine, atosiban and hexoprenaline sulfate, respectively in 46 (85.19%), 55 (96.49%) and 53 (77.40%) pregnant. Atosiban showed significantly higher efficacy. In 8 cases of tocolysis with nifedipine and 3 - hexoprenaline, the tocolysis protocol was not performed due to intolerance of treatment. In these observations, the highest frequency of preterm labor occurred. After excluding these observations from the analysis of differences in the frequency of prolongation of pregnancy was not. The overall frequency of adverse events in the groups was 38.9, 12.3 and 82.3%, and was significantly lower in the atosiban group than nifedipine and hexoprenaline sulfate. Conclusions. The effectiveness of tocolysis is affected by the tolerability of the drugs. Atosiban showed the best of the three drug safety profile. With comparable efficacy, atosiban has proven to be a drug that, to a greater extent than nifedipine and hexoprenaline sulfate, meets the current requirements for tocolytic drugs.

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