Systematic review and meta‐analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor

Ali, Aya; Sayed, Ahmed Kamal; El-Sherif, Loalo'a; Loutfi, Gihan Ossam; Ahmed, Abdullah Mahmoud Mohamed; Mohamed, Hajer; Anwar, Ahmad; Taha, Abdullah Salah; Yahia, Reem Mohamed; Elgebaly, Ahmed; Abdel-Daim, Mohamed M.

doi:10.1002/ijgo.12793

Cited by 20 publications

(17 citation statements)

References 43 publications

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“…1 In our institute, Atosiban is the primary tocolytic agent mainly to give time for steroids administration, especially in the case of very early and early preterm labour, providing no contraindication. In a recent systematic review, Ali et al, 13 showed that there is no significant difference between Atosiban and nifedipine regarding prolongation of pregnancy for 48 hours or more or 7 days of more. However, Atosiban resulted in fewer maternal side-effects than did nifedipine.…”

Section: Discussionmentioning

confidence: 99%

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Gestation age at the diagnosis of threatened preterm labour and the success of atosiban

2020

IPCB

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Objective: To assess the effect of gestational age at diagnosis or threatened preterm labour (TPL) on the success of Tocolytic using Atosiban (i.e. prolongation of pregnancy). Methodology: A retrospective observational study the pregnant women admitted to the hospital with threatened preterm labour, and who received Atosiban as a tocolytic in the period 1st January 2015 till 31st December 2015 and the follow up till the timing of their delivery. Data were using an online data collecting system [Cerner; version 12.4.0 (441592)-2016 Citrix Systems, Inc]. After defining inclusion criteria; we created two groups Very Early Preterm (24 to <32 weeks) and Early Preterm (32-34 weeks) and Deferent variables were studied among the two groups. The data were kept anonymously in an Excel sheet [(Microsoft Office-2016]. Statistical analysis was done using Wizard Pro (version 1.9.26). A P-value of less than 0.05 was considered statistically significant. Results: Total of 84 cases was included during the study period. 47.6% and 52.4% belong to the Very Early Preterm (VEPT) and the Early Preterm (EPT)group, respectively. Mean maternal age (27.8±1.4 weeks and 27.0±1.6 week for VEPT and EPT respectively (p-value 0.43), same for gravidity (p-value 0.88) with a median of 2 each. Median gestation age at diagnosis of PTL was 29.2 and 33 weeks, respectively (p-value <0.001). Median cervical dilation at diagnosis was 2 cm for each (p-value 0.53). Median Duration Atosiban Administration was 48 and 39.5 hours for VEPT and EPT, respectively (p-value 0.53). The Median Interval between Atosiban Discontinuation & Delivery was 16 and 16.5 days (p-value 0.71). The median gestation age at delivery was 32 and 36 weeks respectively (p-value <0.001) Conclusion: Our study revealed that indifference that gestational age can do to influence the success of the Atusiban in prolonging the pregnancy. Preventing Preterm labour shall be an outmost goal to achieve.

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Section: Discussionmentioning

confidence: 99%

“…The limitations include; the retrospective nature of the research, the small number of the cases to compare, and the limited information about patients variables (comorbidities, the presence of infection (e.g.Group B Strept) as well as neonatal complications details. [10][11][12][13][14]…”

Section: Discussionmentioning

confidence: 99%

Gestation age at the diagnosis of threatened preterm labour and the success of atosiban

2020

IPCB

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“…Then, 300 µg/min − 1 as loading dose for 3 hours and 100 µg/min − 1 as maintenance dose for 48 hours was administered. Alternatively, nifedipine 20 mg, followed by 10 mg each 20 minutes until 40 mg for 1 hour, was administered [44]. Thus, all women received atosiban or nifedipine for < 24 hours.…”

Section: Participantsmentioning

confidence: 99%

Cumulative Life Stressors and Stress Response to Threatened Preterm Labor as Birth Date Predictors

Vento¹,

Moreno-Giménez²,

Campos-Berga³

et al. 2021

Preprint

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Purpose: Preterm birth represents one of the main causes of neonatal morbimortality and a risk factor for neurodevelopmental disorders. Appropriate predictive methods for preterm birth outcome, which consequently would facilitate preventing programs, are needed. We aim to predict delivery date in women with a threatened preterm labor (TPL) based on stress response to TPL diagnosis, cumulative life stressors, and relevant obstetric variables. Methods: A prospective cohort of 157 pregnant women with TPL diagnosis between 24 and 31weeks gestation formed the study sample. To estimate the stress response to TPL, maternal salivary cortisol, α-amylase levels, along with anxiety and depression symptoms were measured. To determine cumulative life stressors, previous traumas, social support, and family functioning were registered. Then, linear regression models were used to examine the effect of potential predictors of birth date. Results: The main predictors were lower family adaptation, higher Body Mass Index (BMI), higher cortisol levels and TPL diagnosis week, which showed a non-linear interaction with cortisol levels: TPL women with middle- and high-cortisol levels before 29 weeks of gestation presented an imminent labor.Conclusion: A combination of stress response to TPL diagnosis (salivary cortisol) and cumulative stressors (family adaptation) together with obstetric factors (TPL week and BMI) was the best birth date predictor. Therefore, a psychosocial therapeutic intervention program aimed to increase family adaptation and decrease cortisol levels at TPL diagnosis as well as losing weight, may prevent preterm birth in symptomatic women.

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“…Using tocolytics in women as labor-inhibiting agents could postpone delivery by inducing myometrium relaxation [ 11 ]. It has been shown that survival rate increases by 3% for every 24 h of labor delay, which allows for further neonatal rescue intervention and the administration of alternative treatments, such as antenatal corticosteroids, during the extended period until delivery [ 12 , 13 ]. Several tocolytic classes are commonly used, including ritodrine hydrochloride, prostaglandin antagonists indomethacin and ketorolac, the β-adrenoceptor agonist ritodrine, magnesium sulfate, the oxytocin receptor antagonist atosiban, the calcium channel-blocking agent nifedipine, and others.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of nifedipine/indomethacin combination therapy and nifedipine monotherapy for postponing preterm birth (25–34 weeks of gestation) in Sudanese women: a randomized clinical trial study protocol

Ibrahim

Elfaki

Elhassan

et al. 2021

BMC Pregnancy Childbirth

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Background Preterm birth is the most common cause of neonatal morbidity and mortality. Tocolytics are considered a standard treatment for women with threatened preterm delivery to allow time for maternal steroid administration and transfer to referral centers with neonatal intensive care units. However, there is controversy about the best tocolytic therapy to be considered as the first choice. The aim of this study is to compare the tocolytic effectiveness and tolerability of combination therapy with nifedipine and indomethacin versus nifedipine monotherapy among Sudanese women with preterm labor (PTL) as well as to compare the possible neonatal outcomes associated with each drug. Methods/design This is a randomized controlled clinical trial to be conducted in the Medani Maternity Hospital, Sudan. Women aged 18–40 years that are diagnosed with preterm labor and have a gestational age between 25 and 34 weeks will be eligible to participate in this trial. The diagnosis of threatened PTL is defined as persistent uterine contractions “(four contractions every 20 min or eight contractions every 60 min)” with cervical changes “(cervical effacement ≤80% or cervical dilatation >two cm)”. Patients will be eligible regardless of the presentation of the fetus. It will be randomly decided whether participants receive nifedipine/indomethacin combination therapy or nifedipine monotherapy. The primary outcome is the number of women who do not deliver and do not need alternative tocolytic drug (terbutaline). The secondary outcome is an estimated association with neonatal morbidity and mortality. The sample size will be 117 subjects in each arm of the study, according to a type I error of 0.05 and a study power of 80%. Discussion We expect higher effectiveness of the combination indomethacin/nifedipine tocolytic therapy compared with nifedipine monotherapy. We plan to suggest this combination therapy as the best option for postponing PTL. Trial registration Clinical trial registration: PACTR202004681537890, date of registration: March 8, 2020.

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Systematic review and meta‐analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor

Cited by 20 publications

References 43 publications

Gestation age at the diagnosis of threatened preterm labour and the success of atosiban

Gestation age at the diagnosis of threatened preterm labour and the success of atosiban

Cumulative Life Stressors and Stress Response to Threatened Preterm Labor as Birth Date Predictors

The effectiveness of nifedipine/indomethacin combination therapy and nifedipine monotherapy for postponing preterm birth (25–34 weeks of gestation) in Sudanese women: a randomized clinical trial study protocol

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