Modern tocolysis and adverse effects of tocolytics

GYNECOLOGY ◽  
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.

Prospects of the treatment of preterm labor by the use of sublingual forms of micronized progesterone

2016 ◽  
pp. 28-32
Author(s):  
G.I. Reznichenko ◽  
◽  
N.Yu. Reznichenko ◽  
V.Yu. Potebnya ◽  
I.L. Antonyuk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Preterm Labor ◽  
Total Bilirubin ◽  
Antenatal Clinic ◽  
Premature Births ◽  
Complex Treatment ◽  
Delayed Treatment ◽  
Threatened Preterm Labor ◽  
Micronized Progesterone

The objective: to determine the efficacy of sublingual forms of micronized progesterone (Luteina) in treatment of women with preterm labor. Patients and methods. 45 women with preterm labor were examined in 24–35 weeks of gestation. 2 subgroups were formed. Subgroup Ia consisted of 23 women, who received micronized progesterone sublingually in complex treatment, subgroup IB consisted of 22 pregnant women, who didn’t receive progesterone. 56 case reports of premature births were analyzed retrospectively. The main group of pregnant women underwent general and biochemical examination, determination of ALT, AST, total bilirubin and progesterone. Results. Risk factors for preterm labor during observation in the antenatal clinic were established. They included the underestimation of anamnesis, incomplete examination, delayed treatment of threatened preterm labor, insufficient prevention of complications of pregnancy. It was established that the levels of both AST and ALT as well as total bilirubin in serum hadn’t change after the treatment in both subgroups of women from I group. The decrease in the serum level of progesterone was observed in both subgroups. Average concentration of progesterone in blood serum increased up to 1108±39 nmol/l on the third day of treatment in the subgroup Ia, and it reached 1260±42 nmol/l on the seventh day, whereas its dynamics practically didn’t chang in subgroup IB (882±33 nmol/l and 893±31 respectively). The use of sublingual form of micronized progesterone in the complex treatment of women with preterm labor gave the opportunity 2 times to decrease frequency of premature births, 1.5 times to decrease frequency of delivery complications, almost 2.5 to improve perinatal consequences compared to subgroup of women who hadn’t use progesterone. Conclusions. 1. Risk factors of preterm labor are delayed first prenatal visit of pregnant women to antenatal clinic, the underestimation of anamnesis and risk factors for the development of gestational complications, incomplete examination, delayed treatment of threatened preterm labor, incomplete prevention of pregnancy complications. 2. The use of sublingual forms of micronized progesterone in cases of signs of preterm labor permits to restore quickly the level of progesterone in blood serum to physiological parameters, 2 times to decrease the frequency of premature births and 2.5 times to decrease perinatal consequences in infants. 3. The use of sublingual form of micronized progesterone in pregnant women with preterm labor does not affect the function of the liver. 4. The obtained results allow to recommend the wide use of sublingval form of micronized progesterone to pregnant women with preterm labor. Key words: preterm labor, treatment, Luteina.

scholarly journals СРАВНЕНИЕ ТОКОЛИЗА ГЕКСОПРЕНАЛИНОМ И АТОЗИБАНОМ

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. 

Administration Rates of the Tdap Vaccine in Obstetric Patients

2018 ◽  
Vol 52 (7) ◽  
pp. 655-661 ◽  
Author(s):  
Jamie Koerner ◽  
Alicia B. Forinash ◽  
Abigail M. Yancey ◽  
Jessica Brinkmeyer ◽  
Spencer Dingman ◽  
...  
Keyword(s):  
Prenatal Care ◽  
Pregnant Women ◽  
Preterm Labor ◽  
Primary Outcome ◽  
Retrospective Chart Review ◽  
Further Education ◽  
Risk Level ◽  
Cross Sectional ◽  
Tdap Vaccine ◽  
To Receive

Background: Infants younger than 6 months of age are at high risk for contracting pertussis because of not being fully vaccinated. The Advisory Committee on Immunization Practices (ACIP) recommends vaccinating all pregnant women with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) between 27 and 36 weeks to offer passive immunity to the infant to help protect them until they are able to receive the full pertussis series. Objective: To assess and compare compliance with the 2013 ACIP recommendation of vaccinating pregnant women with Tdap at 27 to 36 weeks’ gestation in 2 obstetric clinics. Methods: This cross-sectional, retrospective chart review evaluated Tdap vaccine compliance in a random sample of obstetric patients from October 2013 to September 2014. The primary outcome evaluated the proportion of patients who received Tdap between 27 and 36 weeks’ gestation. Secondary outcomes included the proportion of patients who received Tdap at any point in pregnancy and within 30 days postpartum. Results: The charts of 573 patients were reviewed, and 237 met inclusion criteria. For the primary outcome, 142 patients (59.9%) received the Tdap vaccine. Overall, 156 patients (65.8%) received Tdap at some point during the pregnancy. Factors associated with receiving the Tdap vaccination were insurance status, prenatal care risk level and site of prenatal care, receipt of the influenza vaccine, and preterm labor in the current pregnancy. Conclusion: The Tdap vaccine rate was 65.8%, with 59.9% of patients receiving the vaccine within the recommended ACIP timeframe. Further education, improvements in documentation, and chart reminders are needed to enhance administration.

scholarly journals Short-Term Outcomes of Atosiban in the Treatmentof Preterm Labour at the Sultan Qaboos University Hospital, Muscat, Oman

2021 ◽  
Vol 21 (2) ◽  
pp. e260-265
Author(s):  
Nihal Al-Riyami ◽  
Hanin Al-Badri ◽  
Sanjay Jaju ◽  
Silja Pillai
Keyword(s):  
Side Effects ◽  
Pregnant Women ◽  
Preterm Labour ◽  
Patient Outcome Assessment ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
Sultan Qaboos University ◽  
Secondary Objective ◽  
The Relationship ◽  
Tocolytic Agents

Objectives: This study aimed to generate baseline evidence regarding the effectiveness of atosiban in delaying delivery by ≥48 hours among pregnant women presenting with threatened preterm labour (TPL). The secondary objective was to assess the relationship between atosiban success and various perinatal factors and neonatal outcomes. Methods: This retrospective study was conducted between June 2008 and May 2018 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all pregnant women who received atosiban between 24–34 gestational weeks for TPL during this period were reviewed. Results: A total of 159 women were included in the study. Atosiban was successful in delaying delivery by ≥48 hours in 130 cases (81.8%). Approximately half of the women (50.9%) achieved uterine quiescence in <12 hours. Failure to delay delivery by ≥48 hours was significantly lower among women with normal versus abnormal cervical findings (11.1% versus 25.6%; P = 0.023). Only 9.4% of women experienced minor side-effects. Mean birth weight (2,724.55 versus 1,707.59 g; P <0.001) and Apgar scores at 5 minutes (9.66 versus 8.28; P <0.001) were significantly higher among neonates delivered at ≥48 versus <48 hours post-atosiban, whereas the rate of neonatal respiratory distress syndrome was significantly lower (18.4% versus 81.6%; P <0.001). Conclusion: Atosiban was highly effective in delaying delivery by ≥48 hours and resulted in few adverse maternal side-effects and neonatal outcomes. To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the effectiveness of atosiban in preventing preterm labour. Keywords: Preterm Labor; Atosiban; Tocolytic Agents; Treatment Outcome; Patient Outcome Assessment; Oman.

scholarly journals Oral dydrogesterone as an adjunctive therapy in the management of preterm labor: a randomized, double blinded, placebo‐controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Suparudeewan Thongchan ◽  
Vorapong Phupong
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Pregnant Women ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Preterm Labor ◽  
Controlled Trial ◽  
Latency Period ◽  
Gestational Age At Delivery ◽  
Double Blinded

Abstract Background Preterm birth is a major challenge in obstetric and perinatal care. It is the leading cause of neonatal death. The primary aim of this study was to evaluate the efficacy of oral dydrogesterone on latency period in managing preterm labor. The secondary aims were to evaluate the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, time to recurrent uterine contraction, pregnancy outcomes, neonatal outcomes, compliance and side effects. Methods This was a randomized, double blinded, placebo-controlled trial. Forty-eight pregnant women with preterm labor, singleton pregnancy, and gestational age of 24–34 weeks were enrolled into the study. The study group received 10 mg of oral dydrogesterone three times per day and the control group received placebo. All pregnant women received standard treatment with tocolytic and antenatal corticosteroids. Results The median latency periods were not significantly different between the dydrogesterone group (27.5 days) and placebo group (34 days, p = 0.45). Additionally, there were no differences in the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, pregnancy outcomes, neonatal outcomes, compliance and side effects. However, the time to the recurrence of uterine contractions in participants that had recurrent preterm labor was longer in the dydrogesterone group than in the placebo group (30.6 ± 12.3 vs 13.7 ± 5.0 days, p = 0.01). Conclusions Adjunctive treatment with 30 mg of oral dydrogesterone could not prolong latency period in preterm labor when compared to placebo. Trial registration ClinicalTrials.gov (Clinical trials registration: NCT 03935152, registered on May 2,2019).

scholarly journals Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome

2015 ◽  
Vol 40 (2) ◽  
pp. 52-57 ◽  
Author(s):  
M Sharmeen ◽  
PA Shamsunnahar ◽  
TR Laita ◽  
SB Chowdhury
Keyword(s):  
Adverse Effects ◽  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Perinatal Outcomes ◽  
Fetal Outcome ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Adequate Treatment ◽  
In Pregnancy

Objectives: Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome.Methods: We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted.Results: Overt hypothyroidism was significantly (p<0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p<0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P=0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p<0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.Bangladesh Med Res Counc Bull 2014; 40 (2): 52-57

The Use of Methotrexate in Rheumatoid Arthritis

1985 ◽  
Vol 19 (5) ◽  
pp. 349-358 ◽  
Author(s):  
Peter W. Letendre ◽  
Douglas J. DeJong ◽  
Donald R. Miller
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
Folic Acid ◽  
Side Effects ◽  
Adverse Effects ◽  
Systemic Administration ◽  
Refractory Disease ◽  
Controlled Clinical Trials ◽  
Folic Acid Antagonist ◽  
Acid Antagonist

The use of methotrexate in rheumatoid arthritis is reviewed. Methotrexate, a folic acid antagonist, is sometimes employed in an attempt to symptomatically control patients whose disease does not respond adequately to conventional therapies. Systemic administration of 7.5–15 mg/wk in a “pulse” fashion appears to be effective without precipitating severe adverse effects. However, concern over potentially serious side effects and a lack of well-controlled clinical trials have limited its use to severe, refractory disease. Further studies are needed before its role in rheumatoid arthritis can justifiably be expanded.

scholarly journals Neutralizing Antibodies Titers and Side Effects in Response to BNT162b2 Vaccine in Healthcare Workers with and without Prior SARS-CoV-2 Infection

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 742
Author(s):  
José Javier Morales-Núñez ◽  
José Francisco Muñoz-Valle ◽  
Carlos Meza-López ◽  
Lin-Fa Wang ◽  
Andrea Carolina Machado Sulbarán ◽  
...  
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Adverse Effects ◽  
Antibody Production ◽  
Neutralizing Antibodies ◽  
Healthcare Workers ◽  
Vaccination Program ◽  
Expected Result ◽  
Neutralizing Capacity ◽  
The Usa

The main expected result of a vaccine against viruses is the ability to produce neutralizing antibodies. Currently, several vaccines against SARS-CoV-2 are being applied to prevent mortal complications, being Pfizer-BioNTech (BNT162b2) one of the first to be authorized in the USA and Mexico (11 December 2020). This study evaluated the efficacy of this vaccine on antibody production with neutralizing capacity and its side effects in healthcare workers with and without prior SARS-CoV-2 infection and in a group of unvaccinated individuals with prior COVID-19. The main findings are the production of 100% neutralizing antibodies in both groups after the second dose, well-tolerated adverse effects, the possible presence of immunosenescence, and finally, we support that a single dose of this vaccine in individuals with prior COVID-19 would be sufficient to achieve an immunization comparable to people without prior COVID-19 with a complete vaccination program (2 doses).

Short-term adverse effects of testosterone used for priming in prepubertal boys before growth hormone stimulation test

2018 ◽  
Vol 31 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Andrea Albrecht ◽  
Theresa Penger ◽  
Michaela Marx ◽  
Karin Hirsch ◽  
Helmuth G. Dörr
Keyword(s):  
Growth Hormone ◽  
Side Effects ◽  
Adverse Effects ◽  
Side Effect ◽  
Serum Testosterone ◽  
Low Flow ◽  
Effect Rate ◽  
Testosterone Levels ◽  
Testicular Pain ◽  
Prepubertal Boys

AbstractBackground:Despite the fact that priming with sex steroids in prepubertal children before growth hormone (GH) provocative tests is recommended, there is an ongoing controversial discussion about the appropriate age of the children, the drug used for priming, the dose and the period between priming and the GH test. Interestingly, there is no discussion on the safety of this procedure. To date, only little data have been available on the possible side effects of priming with testosterone.Methods:We analyzed the outcome in 188 short-statured prepubertal boys who had been primed with testosterone enanthate (n=136: 50 mg; n=51: 125 mg, and accidentally one boy with 250 mg) 7 days prior to the GH test. Serum testosterone levels were measured on the day of the GH test in 99 boys.Results:Overall, only five boys developed adverse side effects. Two boys (dose 125 mg) showed severe low-flow priapism and had to undergo decompression of the corpora cavernosa. One boy suffered from self-limiting priapism and testicular pain (dose 50 mg). Two patients reported testicular pain (each dose 50 mg). The single patient with 250 mg testosterone did not show any adverse effects. The total side effect rate was 2.7%. The serum testosterone levels of the boys with side effects were not different from the testosterone levels of the boys without any side effects.Conclusions:Parents and patients should be informed about the possible side effects of priming with testosterone such as priapism and testicular pain. However, the overall side effect rate is low. We found no correlation between the outcome and the testosterone dose used and/or the level of serum testosterone.

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