Reports on the clinical effectiveness of oral treatment with beta-sympathomimetic fenoterol are quite divergent in their conclusions. The aim of this study was to determine the plasma levels of fenoterol in steady state during tocolytic treatment with high oral doses. Nine pregnant women with clinically indicated tocolysis were given a 5 mg dose of fenoterol in tablet form eight times per day at prescribed hours. During the first four days, in the late afternoon just before and again one hour after the intake, a blood sample was taken to determine the fenoterol concentration by radioimmunoassay. In addition, uterine activity, blood pressure, heart rate, and tremor were periodically checked while the patient was under observation. The fenoterol levels in the plasma ranged from 130 to 200 pg/ml; the steady state concentration remained relatively constant throughout the observation period. It is not certain, that by taking the blood sample one hour after the tablet was swallowed, the maximal concentration was found. However, with the given doses, nearly the same fenoterol levels were measured in the blood as with low doses of intravenously administered fenoterol.
Bisherige Daten zeigen den kurzzeitigen Erfolg einer Tokolyse mit Betamimetika. Langfristige Erfolge gemessen an einer Schwangerschaftsverlängerung von über 48 h sind zwar durch einzelne Studien ebenfalls belegt, konnten aber v. a. durch neuere Metaanalysen nicht bestätigt werden. Dies führte in den letzten Jahren zunehmend zu einer ablehnenden Haltung gegenüber einer langzeitigen i.v. Dauerinfusion. Viele Geburtshilfliche Kliniken im deutschsprachigen Raum verwenden daher im Sinne einer Alternative zur kontinuierlichen i.v. Langzeittokolyse eine Infusion während maximal 48 h. Das Ziel der vorliegenden Untersuchung war es, den Stellenwert einer langzeitigen i.v. Dauertokolyse mit Betamimetika anhand von objektiven Befunden vor, während und nach der Behandlung zu charakterisieren. Material und Methodik: Aus den Entlassungsberichten der Pränatalstation der Geburtshilflichen Klinik am Universitätsspital Zürich wurden primär diejenigen schwangeren Patientinnen einbezogen, die im Verlaufe ihrer vorgeburtlichen Hospitalisation eine i.v. Tokolyse mit Betamimetika erhielten. Berücksichtigt wurden die Berichte ab dem Stichdatum der Klinikeinweisung vom 1.1.1991 bis zum 31.12.1995. Diese Jahrgänge wurden deshalb ausgewählt, weil bis Ende 1995 ein konservatives Vorgehen bei der Tokolyse überwog, d. h. üblicherweise eine i.v. Dauertokolyse angewendet wurde. Von den primär einbezogenen Patientinnen wurden die Krankengeschichten herausgesucht, um die definitive Aufnahme in die Studie gemäû strengen Einschlusskriterien (therapeutische i.v. Tokolyse mit Betamimetika bei Ein-Abstract Objective: There are few data on the efficacy of beta-mimetic tocolysis for prolonging pregnancy by more than 48 hours and these data have not been confirmed by meta-analyses. We reviewed the results of long-term intravenous tocolysis with betamimetic agents. Methods: A total of 277 women received intravenous betamimetic tocolysis between 1991 and 1995. We analyzed 203 cases with singleton pregnancies, documented preterm labor, and a complete obstetric medical record. Results: The mean age of the 203 women was 30.0 5.7 years and the mean gestational age was 29.4 3.8 weeks. Fifty-seven women (36.1 %) had irregular premature contractions (23 with premature rupture of the membranes (PROM), 11 with bleeding, 10 with cervical dilatation > 1 cm). Sixty-two women (39.2 %) had regular premature contractions (16 with PROM, 14 with bleeding, 13 with cervical dilatation > 1 cm). Overall, 88 women (43.3 %) had PROM (16 with bleeding, mean cervical dilatation 1.1 1.4 cm). The mean duration of tocolysis was just under 14 days (£ 48 hours in 40 women (19.7 %), > 1 week in 105 cases (51.7%)). PROM and cervical dilatation > 1 cm were each associated with significantly shorter duration of tocolysis. The rate of patients receiving tocolysis for ³ 7 days was lower in patients with PROM than in those with intact membranes. The mean interval between the initiation of tocolysis and delivery was 26 days. Gestational age exceeded 32.0 weeks in 133 cases (65.5 %) and 34.0 wee...
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