Maintenance tocolysis: a reappraisal of clinical evidence

Stelzl, Patrick; Kehl, Sven; Rath, Werner

doi:10.1007/s00404-019-05313-7

Cited by 14 publications

(7 citation statements)

References 90 publications

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“…Prematurity is associated with higher morbidity and mortality rates; therefore, it seems obvious that prolongation of the pregnancy should improve the outcome. However, there are only a few studies which demonstrate that maintenance tocolysis improves maternal and neonatal (long-term) outcomes and does not merely prolong pregnancy 12 , 18 , 19 . Short-term tocolysis should be given for 48 h to allow the administration of antenatal corticosteroids to improve the neonatal outcome 20 , and it is often recommended that maintenance tocolysis should be avoided 8 , 21 , 22 , 23 .…”

Section: Discussionmentioning

confidence: 99%

Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Kirchhoff

Schneider

Pichler³

et al. 2022

Geburtshilfe Frauenheilkd

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Introduction Preterm birth is defined as a live birth before 37 weeks of gestation and is associated with increased neonatal morbidity and mortality. The aim of this study is to compare the efficacy of hexoprenaline and atosiban for short- and long-term tocolysis and their effects on neonatal and maternal outcomes. Methods This retrospective cohort study included women with threatened preterm labor between 24 + 0 and 34 + 0 weeks of gestation without premature rupture of membranes. The tocolytic efficacy of hexoprenaline and atosiban was compared in women receiving one of the two medications for short- and long-term tocolysis. Continuous variables were compared using t-test or Mann–Whitney U test, as appropriate. Comparison of categorical variables between the two groups was done with χ2 test after Pearsonʼs and Fisherʼs exact test. Results 761 women were enrolled in this study; 387 women received atosiban and 374 women received hexoprenaline as their primary tocolytic agent. Atosiban showed a higher efficacy as a primary tocolytic agent (p = 0.000) within 48 hours. As regards long-term tocolysis, there were no differences between the treatment groups (p = 0.466). Maternal side effects such as tachycardia (p = 0.018) or palpitations (p = 0.000) occurred more frequently after the administration of hexoprenaline, while there were no differences between the two drugs administered with regard to any other maternal or neonatal outcome parameter. Conclusion Our retrospective study shows a significantly higher efficacy of atosiban in the first 48 hours, especially when administered at an early gestational age. There were no significant differences in terms of neonatal outcome but significantly more maternal adverse effects during the administration of hexoprenaline.

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Section: Discussionmentioning

confidence: 99%

Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Kirchhoff

Schneider

Pichler³

et al. 2022

Geburtshilfe Frauenheilkd

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“…Allerdings wird in zahlreichen Industrieländern, auch in Deutschland, ausweislich von nationalen Umfragen die Erhaltungstokolyse von 30-60 % der Geburtshelfer weiterhin befürwortet (Übersicht bei [58]).…”

Section: Kombinationenunclassified

Tokolyse

Rath¹

2021

Frauenheilkunde up2date

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“…Although a meta-analysis from 2016 showed that there was no evidence for currently used tocolytics of prolonging pregnancy or reducing the rate of perinatal deaths [9], a more recent meta-analysis suggests that the assessed tocolytics were probably all effective in delaying birth for 48 hours [10]. When looking at clinical evidence for the effectiveness of tocolytic treatment, a distinction between acute tocolysis and long-term or maintenance tocolysis (continuation of therapy beyond the initial 48 hours) must be made [11]. Despite there being insufficient evidence for the benefit of maintenance tocolysis (resulting of omission of long-term treatment in current guidelines), it is frequently performed in clinical practice [12].…”

Section: Introductionmentioning

confidence: 99%

Bryophyllum pinnatum Inhibits Oxytocin and Vasopressin Signaling in Myometrial Cells

Zurfluh,

Duvaud,

Inci

et al. 2024

Planta Med

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The medicinal plant Bryophyllum pinnatum was previously shown to block oxytocin (OT)-induced signals in myometrial cells, consistent with its tocolytic effect observed in patients. OT activates not only OT receptors but also V1A receptors, two receptors with high receptor homology that are both expressed in the myometrium and play a crucial role in myometrial contraction signaling. We aimed to study the molecular pharmacology of B. pinnatum herbal preparations using specific receptor ligands, the human myometrial cell line hTERT-C3, and cell lines expressing recombinant human OT and V1A receptors. We found that press juice from B. pinnatum (BPJ) inhibits both OT- and vasopressin (AVP)-induced intracellular calcium increases in hTERT-C3 myometrial cells. In additional assays performed with cells expressing recombinant receptors, BPJ also inhibited OT and V1A receptor mediated signals with a similar potency (IC50 about 0.5 mg/mL). We further studied endogenous OT- and AVP-sensitive receptors in hTERT-C3 cells and found that OT and AVP stimulated those receptors with similar potency (EC50 of ~1 nM), suggesting expression of both receptor subtypes. This interpretation was corroborated by the antagonist potencies of atosiban and relcovaptan that we found. However, using qPCR, we almost exclusively found expression of OT receptors suggesting a pharmacological difference between recombinant OT receptors and native receptors expressed in hTERT-C3 cells. In conclusion, we show that B. pinnatum inhibits both, OT and AVP signaling, which may point beyond its tocolytic effects to other indications involving a disbalance in the vasopressinergic system.

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Maintenance tocolysis: a reappraisal of clinical evidence

Cited by 14 publications

References 90 publications

Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Tokolyse

Bryophyllum pinnatum Inhibits Oxytocin and Vasopressin Signaling in Myometrial Cells

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