Should intravenous tocolysis be considered beyond 34 weeks' gestation?

Jones, Stephen C.; Brost, Brian C.; Brehm, Walter T.

doi:10.1067/mob.2000.107663

Cited by 14 publications

(7 citation statements)

References 5 publications

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“…We also do not know if any of these mothers received tocolytic agents in an effort to delay delivery. Although the appropriate end point for tocolysis is a subject of controversy among obstetricians, [10][11][12] we suspect that, for some of these mothers, efforts to delay delivery were discontinued once the gestational age of their infant reached 34 weeks. The association of birth defects with both latepreterm delivery and mortality suggests that, in some cases at least, the presence of a lethal birth defect may have resulted in preterm labor and delivery.…”

Section: Discussionmentioning

confidence: 98%

Mortality of Late-Preterm (Near-Term) Newborns in Utah

Young

Glasgow

Li³

et al. 2007

Pediatrics

104

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Section: Discussionmentioning

confidence: 98%

Mortality of Late-Preterm (Near-Term) Newborns in Utah

Young

Glasgow

Li³

et al. 2007

Pediatrics

104

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“…Our findings document a significantly increased morbidity in 34-week gestations versus 35-week gestations. This study and others [2][3][4][5] have reviewed the mortality and morbidity of infants born between 34 and 36 weeks' gestation. These 2 weeks of gestation are still considered to be premature, but near the upper level of prematurity.…”

Section: Discussionmentioning

confidence: 99%

“…Studies done over the past two decades [3][4][5]7 have focused on respiratory distress syndrome as the primary variable defining morbidity. This data was accumulated prior to newer treatment modes.…”

Section: Discussionmentioning

confidence: 99%

The Morbidity of the 34- to 35-Week Gestation: Should We Reexamine the Paradigm?

Gladstone

Katz²

2004

Am J Perinatol

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Algorithms for the management of preterm labor avoid the use of tocolysis beyond 34 weeks' gestation, based in large part on low respiratory morbidity found at this gestational age. We sought to delineate the morbidities, not just respiratory, of this age group in a modern neonatal intensive care unit setting. We prospectively looked at hospital resource use and general morbidity in a consecutive 2-year cohort of 34-weekers at our hospital. The concurrent consecutive 35-week cohort was used as a control. Data were prospectively collected from obstetricians and bedside records. Compared with 35-weekers, the 34-week group had similar obstetric characteristics. Significant differences were seen in use of oxygen, nasal continuous positive airway pressure, methylxanthines, home apnea monitoring, antibiotics, and phototherapy. The 34-week group took longer to come off intravenous lines and were discharged later. Overall, they used approximately twice the resources of the 35-week group. To stop or not use tocolysis at 34 weeks' gestation based mainly on low respiratory morbidity ignores the significant other morbidities. These findings suggest a reconsideration of the paradigm regarding 34-week gestation as a cutoff point in decision making.

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“…Berücksichtigt wurden die Berichte ab dem Stichdatum der Klinikeinweisung vom 1.1.1991 bis zum 31. 12 term. Delivery occurred within 48 hours after stopping tocolysis in 140 cases, predominantly in the premature birth group; in 105 of these cases the duration of tocolysis exceeded 48 hours.…”

Section: Materials Und Methodikunclassified

Ist die Dauertokolyse sinnvoll?

Mandach¹,

Hermer²,

Huch³

et al. 2002

Geburtsh u Frauenheilk

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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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Should intravenous tocolysis be considered beyond 34 weeks' gestation?

Cited by 14 publications

References 5 publications

Mortality of Late-Preterm (Near-Term) Newborns in Utah

Mortality of Late-Preterm (Near-Term) Newborns in Utah

The Morbidity of the 34- to 35-Week Gestation: Should We Reexamine the Paradigm?

Ist die Dauertokolyse sinnvoll?

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