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The constitutive and cytokine-inducible expression of interleukins from uterine smooth muscle cells suggests that the myometrium may contribute to the overall production of inflammatory mediators in the uterus that are thought to govern term- or infection-induced preterm labor. Down-regulation of the oxytocin receptor under IL-1beta in myometrial cells may indicate that initiation and maintenance of labor could be partially limited under severe inflammatory conditions such as chorioamnionitis.

The purpose of this retrospective study is to evaluate the effects of atosiban (Tractocile available in Austria since February 2000) for routine treatment of women with threatened preterm delivery. The advantage of this drug compared to other tocolytic agents is its specific action on reproductive tissues without the accompanying severe side effects. Women (n ¼ 208) were retrospectively evaluated. Diagnoses at admission were preterm labour (n ¼ 117), preterm rupture of membranes (n ¼ 65), incompetent cervix (n ¼ 19) and vaginal bleeding (n ¼ 7). Gestational age was between weeks 21 and 33 of pregnancy. Preterm labour was defined as 4 uterine contractions/30 min and cervical length <30 mm examined by vaginal ultrasound and/or detection of vaginal fetal fibronectin. Tocolytic effectiveness was determined as the number of women having a diagnosis of preterm labour who were still pregnant after 48 hours and after 7 days. The influence on the frequency of contractions before and 3-12 hours after the start of treatment was assessed. Maternal side effects, perinatal and neonatal morbidity and transfers to the NICU were also evaluated. The proportion of women who remained undelivered was 78.7% after 48 hours, and 64.3% after 7 days. Atosiban decreased the frequency of contractions from 5.4/30 min before treatment to 1.6 contractions/30 min after the start of treatment. At the initial bolus application, 20.2% of women presented drug-related side effects, such as nausea, vertigo and flush over a short period of 1 -2 minutes. During infusion, side effects possibly related to atosiban could be detected in 6% of women. Mean length of stay was 11.8 days in the NICU and 30.9 days in intermediate care.Twenty-three children developed intraventricular haemorrhage (I -IV). In conclusion, atosiban is an effective tocolytic drug in the treatment of preterm labour and preterm rupture of the membranes. It has significantly less side effects due to its lack of cardiovascular activity.

The purpose of this retrospective study is to evaluate the effects of atosiban (Tractocile available in Austria since February 2000) for routine treatment of women with threatened preterm delivery. The advantage of this drug compared to other tocolytic agents is its specific action on reproductive tissues without the accompanying severe side effects. Women (n = 208) were retrospectively evaluated. Diagnoses at admission were preterm labour (n = 117), preterm rupture of membranes (n = 65), incompetent cervix (n = 19) and vaginal bleeding (n = 7). Gestational age was between weeks 21 and 33 of pregnancy. Preterm labour was defined as >/=4 uterine contractions/30 min and cervical length <30 mm examined by vaginal ultrasound and/or detection of vaginal fetal fibronectin. Tocolytic effectiveness was determined as the number of women having a diagnosis of preterm labour who were still pregnant after 48 hours and after 7 days. The influence on the frequency of contractions before and 3-12 hours after the start of treatment was assessed. Maternal side effects, perinatal and neonatal morbidity and transfers to the NICU were also evaluated. The proportion of women who remained undelivered was 78.7% after 48 hours, and 64.3% after 7 days. Atosiban decreased the frequency of contractions from 5.4/30 min before treatment to 1.6 contractions/30 min after the start of treatment. At the initial bolus application, 20.2% of women presented drug-related side effects, such as nausea, vertigo and flush over a short period of 1-2 minutes. During infusion, side effects possibly related to atosiban could be detected in 6% of women. Mean length of stay was 11.8 days in the NICU and 30.9 days in intermediate care. Twenty-three children developed intraventricular haemorrhage (I-IV). In conclusion, atosiban is an effective tocolytic drug in the treatment of preterm labour and preterm rupture of the membranes. It has significantly less side effects due to its lack of cardiovascular activity.

Zusammenfassung Fragestellung: Durch die Entwicklung und Freigabe von Atosiban, einem selektiven Oxytocin-Rezeptor-Antagonisten, steht ein Medikament mit einer neuartigen, besonders auf die Physiologie der Schwangerschaft bezogenen Wirkung zur Tokolyse zur Verfügung. Diese Studie berichtet in Form einer Anwendungsbeobachtung über Erfahrungen beim Einsatz von Atosiban zur Tokolyse bei Patientinnen mit drohender Frühgeburt. Material und Methodik: 79 Patientinnen mit Diagnosestellung einer drohenden Frühgeburt wurden in die Studie inkludiert. Aufnahmediagnosen waren vorzeitige Wehentätigkeit (50), vorzeitiger Blasensprung (21), vaginale Blutung (6) und Zervixinsuffizienz (6), 4 Patientinnen wurden nach Entlassung neuerlich aufgenommen. Das Gestationsalter lag zwischen 21. und 33. Schwangerschaftswoche. Vorzeitige Wehentätigkeit wurde bei einem tokographischen Nachweis von mindestens 4 Kontraktionen/30 min und mindestens einem positiven Ergebnis der beiden Untersuchungen: 1. sonographisch nachgewiesener Zervixverkürzung unter 30 mm oder 2. positiver Nachweis von fetalem Fibronectin im Vaginalsekret, diagnostiziert. Die Wirksamkeit der Tokolyse wurde bei Diagnose einer vorzeitigen Wehentätigkeit anhand der Anzahl bestehender Schwangerschaften nach 48 Stunden und 7 Tagen ermittelt. Die Kontraktionsfrequenz wurde vor und 3 ± 12 h nach Applikation gemessen. Das peri-und neonatale, kindliche Outcome der geborenen Kinder wurde ermittelt. AbstractPurpose: To evaluate the effects of Atosiban which has been recently made available for routine treatment of patients with threatening pre-term delivery. Advantage of this tocolytic drug is its specific action on reproductive tissues. Material and Methods: 79 Patients were retrospectively evaluated, diagnoses at admission were pre-term labor (50), preterm rupture of membranes (21), vaginal bleeding (6) and incompetent cervix (6). Gestational age lied between 21st and 33rd week of pregnancy. Pre-term labor was defined as ³ 4 uterine contractions/30 min and at least one of these 2 examinations positive: 1. cervical length < 30 mm examined by vaginal ultrasound, 2. detection of vaginal fetal fibronectin. Tocolytic effectiveness was determined as the number of women having a diagnose of pre-term labor who were still pregnant after 48 hours and after 7 days. The influence on the frequency of contractions before and 3 ± 12 hours after start of treatment was assessed. Maternal side effects, perinatal and neonatal morbidity was evaluated Results: After 48 hours 86.0 % of patients with threatening preterm delivery and after 7 days 80.0 % of these patients had not been delivered. Atosiban decreased the frequency of contractions from 8.0 4.9 (mean sed) before treatment to 2.4 3.2 contractions/30 min after start of treatment. At the initial bolus application 33% of patients presented drug related side effects as nausea, vertigo and flush over a short period of 1 ± 2 minutes. During infusion in 6% of patients side effects possibly related to Atosiban Originalarbeit 755 Institutsangaben