Efficacy of oral nifedipine as a tocolytic agent

Background: Preterm birth is defined as birth at less than 37 weeks period of gestation, is the most important single determinant of adverse infant outcome in terms of both survival and quality of life. The need for tocolysis in terms of safety and efficacy is necessary to decrease perinatal mortality and morbidity in preterm labour. This study was aimed to evaluate the effectiveness of nifedipine as a tocolytic for inhibiting uterine contraction in threatened preterm labour.Methods: It was a prospective, nonblinded, single centred, randomized control trial. This study included 100 cases of preterm labour admitted in department of obstetrics and gynaecology, KIMSH, Bangalore, who satisfied the inclusion and exclusion criteria and were administered with nifedipine tocolysis.Results: 100 cases of preterm were evaluated for the prolongation of pregnancy for more than 48 hours. Prolongation of pregnancy till term was observed in 88% of the cases administered with nifedipine tocolysis. The mean gestational age in each group was 32.58±1.95 weeks. Nifedipine had very few side effects, namely tachycardia and headache and no changes in fetal heart rate.Conclusions: In this study oral nifedipine was found to be efficacious in prolongation of pregnancy for more than 48 hours with the ease of oral administration and with minimal dose tocolytic effect was achieved. It had minimal maternal and neonatal side effects and eliminate the need for intensive maternal monitoring.

Comparative study of efficacy of nifedipine, nitroglycerin dermal patches and isoxsuprine as tocolytic agents in suppression of preterm labour 1-year study at navodaya medical college hospital and research centre Raichur

Background: Tocolytic agents are used to reduce preterm deliveries. Very few studies documenting the comparison of tocolytic agents viz. nifedipine, nitroglycerin dermal patches and isoxsuprine. Other drugs are not used due to their adverse effects. Objective was to study and compare the safety efficacy of nifedipine, nitroglycerin dermal patches and isoxsuprine as tocolytic agents in suppression of preterm labour 1 year study.Methods: This was a prospective case control study was conducted for a period of 1 year. Total 90 cases selected to study were randomly distribute in to three treatment groups viz. A, B, and C nifedipine, nitroglycerin and isoxsuprine respectively. Subjects in all three groups were evaluated for maternal pulse rate, palpitation uterine contractions and fetal heart rate in order to assess efficacy of each drug under investigation.Results: There was no statistically significant difference in age of woman’s in three different groups. Among (100%) subjects, majority of the cases i.e. (27.8%) primi gravida followed by multi (72.2%). Side effects of nifedipine was less when compared to nitroglycerine dermal patch and isoxsuprine i/v/o of headache (8.9%), nausea (1.1%), vomiting (1.1%), tachycardia (3.3%), palpitation (3.3%), hypotension (1.1%). side effects were statistically significant different between the treatment groups. There was no statistically significant difference with respect to APGAR score at 1 minute and 5 minutes.Conclusions: Oral nifedipine was found to be superior and efficacious as tocolytic agent as compared to transdermal nitroglycerin and intravenous isoxsuprine.

RISK FACTOR FOR UNSUCCESSFUL RATE OF PRETERM LABOR INHIBITION WITH TOCOLYTIC AGENT IN PREGNANT WOMEN 240/7-336/7 WEEKS OF GESTATION AT MAHARAT NAKHON RATCHASIMA HOSPITAL

The objective is aimed to Assessing risk factors for unsuccessful rate of uterus contraction inhibition in pregnant women 240/7-336/7 weeks of gestation in Maharat Nakhon Ratchasima Hospital The retrospective cohort study approved by the Research Ethics committee of, Maharat Hospital, Nokhon Ratchasima Province Thailand studying pregnant women who were diagnosed with preterm labor pain with gestrational age of 240/7-336/7 weeks at the delivery ward of Maharat Nakhon Ratchasima Hospital and received Dexamethasone(corticosteroid) for the first time in every case between 1 January 2016 – 31 December 2018. From 361 pregnant women with preterm labor pain, 169 women were successful inhibition which was 54.29%. The group with failure inhibition were 165 women which was 45.71%. The factors relating to unsuccessful inhibition of uterus contraction were ANC less than 5 times, Adjusted odd ratios(AORs) 1.74; 95%CI 1.01-3.03, multiple pregnancy AORs 4.42 ; 95%CI 1.96-9.97 Cervical dilatation ≥3 cm AORs 5.93; 95%CI 3.44-10.22, the Effacement ≥ 80%, AORs 3.39; 95%CI 2.07-5.55, transfer from another hospital AORs 13.96; 95%CI 5.24-37.19. The research concludes that the factors relating to unsuccessful inhibition of uterus contraction were ANC less than 5 times, multiple pregnancy, Cervical dilatation ≥3 centimeters, Effacement ≥ 80%,and pregnant women referred from Secondary care center

Evaluation of Atosiban Therapy in the Management of Preterm Labour in Indian Patients

Aims: To assess the efficacy and fetomaternal safety of atosiban among Indian pregnant women presenting with preterm labor. Study Design: Prospective, open-label, multicentric, non-comparative, phase-IV clinical study. Place and Duration of Study: Department of Obstetrics and Gynaecology at nine hospitals across India from October 2016 to December 2019. Methodology: A total of 212 pregnant women admitted with preterm labour between 24 and 36 weeks of gestation were administered intravenous atosiban up to 48 hours. Efficacy was defined as the successful delay of delivery without the need of an additional or alternative tocolytic agent for 72 hours. Safety was evaluated by recording the occurrence of adverse events in the mother, fetus and neonate. Results: Tocolytic efficacy of Atosiban was 84.88% at 48 hours and 74.15% at day 7 without additional tocolytic agent or retreatment after 48 hours. The mean number of days gained after the start of atosiban tocolysis were 29.15 ± 1.82 days with mean gestational age at delivery of 35.1 ± 3.33 weeks. Atosiban reduced the frequency of contractions from 4.3 ± 1.47 to 0.67 ± 1.13 contractions/30 min at 72 hours. The proportion of neonates with birth weights more than 2,500 gm was 41.67%. A total of 205 neonates out of 216 (94.95%) had APGAR score more than 7 after 5 minute. Atosiban successfully delayed the labour in 92.31% (n=13) of “Twin pregnancy” patients for 48 hours and beyond 7 days in 9 patients (69.2%). There were no serious adverse events reported. Conclusions: In patients with threatened preterm birth, 48 hour tocolysis with atosiban was found to be safe and effective in preventing imminent preterm birth even when it was a twin pregnancy or associated with co-morbidities. Atosiban showed favorable side effects profile and improved the perinatal outcomes. Clinical Trial Registry of India Number: CTRI/2017/03/008065;

Effect of Magnesium Sulfate on Prevention of Preterm Labour and Perinatal Outcome

Background: Preterm labour is a major cause of maternal mortality in our country. Hypomagnesaemia during pregnancy could be an indirect cause of preterm labour. Magnesium has a role on uterine smooth muscle relaxation, which is the basis for the use of magnesium sulphate as a tocolytic agent. Objective: This study was done to see the effect of magnesium sulfate to prevent preterm labour and perinatal outcome. Materials and Methods: This study was carried out in Comilla Medical College & Hospital, from December 2011 to May 2012. Fifty pregnant women, both primi and multi with preterm labour were selected for the study. Results: Study showed labour delayed >24 hours in 86% cases. And the majority of newborn (96%) had Apgar score in 5 minute was 8-10, 4% had Apgar score 7-8. The mode of delivery was vaginal in 70% cases and by c/s in 16% cases; among subject whose labour delayed more than 24 hours. Conclusion: Intravenously administration of magnesium sulfate is safe, well tolerated and effective tocolytic agent for prolongation of pregnancy in preterm labour. It produces minimal harmful effects on mother and fetus. KYAMC Journal Vol. 11, No.-3, October 2020, Page 145-149

COMPARATIVE STUDY OF NIFEPIDINE AND ISOXSUPRINE IN SUPPRESSION OF PRETERM LABOUR IN THIRD TRIMESTER

Background: A prospective study was conducted to compare the efficacy of nifedipine against isoxsuprine in preventing preterm labour in third trimester and also to evaluate maternal side effects and neonatal outcome. Methods: This prospective comparative study was conducted at JLNMCH, Bhagalpur, Bihar. 75 antenatal women with gestational age between 28 to 36 weeks wereselected who fulfilled the inclusion criteria for the study, were given nifedipine and were monitored throughout thecourse of treatment. Results: Groups were compared with mean prolongation of delivery, side effects, neonatal outcome, parity, cervicaleffacements. Nifedipine was twice more effective than isoxsuprine hydrochloride as a uterine tocolytic agent whileside effects were comparable with fewer side effects in nifedipine group. Neonatal outcome was better with nifedipinein comparison to isoxsuprine. Conclusions: There is a high incidence of preterm labour in India. The present study found that nifedipine has bettertocolytic efficacy, less side effects and better tolerability as compared to isoxsuprine in third trimester.

The Impact of Nifedipine on Maternal and Fetal Blood Stream on the Threat of Preterm Labor: an Experimental Study

Background: Preterm birth is a significant cause of perinatal morbidity and mortality and that becomes a major challenge in perinatal health care. Various pharmacological agents that inhibit uterine contractions are used in clinical practice to prevent preterm delivery. The maternal and fetal side-effect profiles of tocolytic agents are becoming an important consideration in selecting the drug of choice. Nifedipine, a dihydropyridine calcium entry blocker, is an effective tocolytic agent with low toxicity and teratogenicity, while carrying potential maternal as well as fetal vascular side effects due to its action on vascular smooth muscle. This study was performed to asses nifedipine use as tocolytic agent in preventing preterm birth, and assesing maternal as well as fetal vascular side effects.Methods: This experimental study with one-group pretest-posttest design was performed in 30 pregnant women undergoing nifedipine as tocolytic. Doppler assessment of uterine, umbilical and fetal middle cerebral arteries, ductus venosus, and cerebroplacental ratio was performed before and 48 hours after nifedipine therapy. Wilcoxon's signed ranks test was used to analyze the difference between the two variables. A P-value of < 0.05 was considered significant.Results: The result of the study showed nifedipine was associated with a significant decreased of pulsatility index uterine artery (p = 0.016; p-value<0.05) and umbilical artery (p = 0.037; p-value<0.05) after 48 hours therapy, while pulsatility index of fetal middle cerebral arteries, ductus venosus, and cerebroplacental ratio did not change significantly.Conclusion: The study concluded that nifedipine as tocolytic increased blood flow of uterine artery and umbilical artery after 48 hours therapy.

Study on Effect of Magnesium Sulfate as Tocolytic Agent

We face many problems in diagnosis, monitoring and adopting treatment policy.There are very limited studies about preterm labour prevention in our country and few national data are available about the incidence of preterm labour. Acute tocolysis prevents preterm labor for 48 hours, which is the critical period for antenatal steroid administration or maternal transfer to perinatal centers to improve neonatal outcomes. This prospective study was conducted. To determine the effectiveness of magnesium sulfate as tocolytic agent in preterm labour to arrest the premature onset of labour. A total of 90 primigravid and multigravid with preterm labour was included in this study at 250 Beded General Hospital Tangail from January 2012 to December 2015. The mean age of the respondents was 24.13±4.67 year. The mean systolic and diastolic blood pressure were 122.47±12.64 and 71.67±12.67 mm of Hg respectively. Gestational age did not influence on the outcome of treatment with Tocolytic regime. Out of 90 pregnant women, 70% were anemic, 53.3% had vaginal bleeding and 76.7% had abdominal pain. Among 90 respondents only 6 women had premature rupture of membrane and about 40% had inadequate amniotic fluid. The three treatment regime (Antibiotic+ Tocolytic+ steroid) was found indifferent in terms of affectivity. Preterm labour is not a very uncommon pregnancy-related complication. This study evaluates, the effect of magnesium sulphate as tocolytic agent. Bangladesh Med J. 2020 May; 49(2) : 25-29

PERBEDAAN RERATA KADAR IL-6 SERUM MATERNAL BERDASARKAN KEBERHASILAN PEMBERIAN TOKOLITIK PADA PARTUS PREMATURUS IMMINENS

Preterm labor needs to be prevented, one of the prevention methods is by tocolytic administration which could prevent labor thus providing a chance for lung maturation. Preterm Pregnancy is associated with increased concentrations of cytokines such as Interleukin (IL). The increasing concentration of maternal serum IL-6 can be used to predict preterm labor. This research uses the design Cross-Sectional Comparative to determine differences in means of maternal serum levels of IL-6 based on the success of the administration of a tocolytic agent on preterm labor. This study was performed on pregnant women who come to the obstetric emergency room of DR. MA. Hanafiah Batusangkar Hospital within August-November 2015. The total number which was included in statistical analysis was 34 pregnant women which were divided into 2 groups, 17 people in the group of patients who failed in tocolytic agent administration, and 17 people in the group who success in managed with a tocolytic agent. Statistical analysis was performed to analyze the validity using the T-test. There are significant differences in the average rate of maternal serum IL-6 in patients who failed to treat with a tocolytic agent and successful to treat with a tocolytic agent. Seen from the p-value 0.000. Levels of maternal serum IL-6 in patients who failed to treat with a tocolytic agent were higher than successful to treat with a tocolytic agent.Keywords: IL-6, Tocolytic, Preterm labor

The use of atosiban prolongs pregnancy in patients treated with fetoscopic endotracheal occlusion (FETO)

Objective To evaluate the impact of atosiban as a tocolytic agent in patients treated with the fetoscopic endotracheal occlusion (FETO) procedure due to congenital diaphragmatic hernia (CDH). As premature birth after fetoscopy remains a serious concern, an effort to reduce prematurity is required. Methods A total of 43 patients with severe CDH treated with FETO were enrolled in this study. The study group consisted of 22 patients who received atosiban during the FETO procedure and a control group of 21 patients who did not receive atosiban during the FETO procedure. Demographic data, gestational age (GA) at delivery, cervical length and GA at premature rupture of membranes (PROM) were evaluated. Results The GA at delivery was significantly different between the two groups studied. The median GA at delivery was 32.6 and 34.5 weeks in the no-atosiban vs. atosiban groups, respectively (P = 0.013). The median cervical length was 29.9 and 31.2 mm for the no-atosiban and atosiban groups, respectively, and was not statistically significant (P = 0.28). There were no significant correlations between groups for the occurrence of PROM, GA at the time of PROM, duration of the procedures, parity, maternal body mass index (BMI) or age. In the univariate linear regression model, the only factor independently associated with GA at delivery was the use of atosiban during FETO procedures (β = 0.375; P < 0.013). Conclusion In cases of severe CDH treated with FETO, the use of atosiban as a tocolytic agent during the procedure prolonged pregnancy by 2 weeks. Cervical length, duration of FETO or maternal characteristics were not associated with GA at delivery.