Tocolysis for acute preterm labor: does anything work

Haram, Kjell; Mortensen, Jan Helge Seglem; Morrison, John C.

doi:10.3109/14767058.2014.918095

Cited by 43 publications

(42 citation statements)

References 57 publications

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“…Although it is possible that preeclampsia itself affects uterine contractility, a more likely explanation is the inhibition of uterine contractility by magnesium. A frequently used tocolytic agent in the prevention of preterm labor [22], magnesium has been shown to decrease oxytocin induced contractions in vitro by blocking calcium channels [23, 24]. …”

Section: Discussionmentioning

confidence: 99%

Factors associated with higher oxytocin requirements in labor

Frey

Tuuli

England

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective To identify clinical characteristics associated with high maximum oxytocin doses in women who achieve complete cervical dilation. Methods A retrospective nested case-control study was performed within a cohort of all term women at a single center between 2004-2008 who reached the second stage of labor. Cases were defined as women who had a maximum oxytocin dose during labor >20 mu/min, while women in the control group had a maximum oxytocin dose during labor of ≤20 mu/min. Exclusion criteria included no oxytocin administration during labor, multiple gestations, major fetal anomalies, nonvertex presentation, and prior cesarean delivery. Multiple maternal, fetal, and labor factors were evaluated with univariable analysis and multivariable logistic regression. Results Maximum oxytocin doses >20 mu/min were administered to 108 women (3.6%), while 2864 women received doses ≤20 mu/min. Factors associated with higher maximum oxytocin dose after adjusting for relevant confounders included maternal diabetes, birth weight >4000 gm, intrapartum fever, administration of magnesium, and induction of labor. Conclusions Few women who achieve complete cervical dilation require high doses of oxytocin. We identified maternal, fetal and labor factors that characterize this group of parturients.

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Section: Discussionmentioning

confidence: 99%

Factors associated with higher oxytocin requirements in labor

Frey

Tuuli

England

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Betamimetics and calcium channel blockers reduce the number of preterm labor women who will give birth within 48 hours. Nevertheless, tocolysis does not appear to significantly lengthen the gestational age beyond 7 days 14. It is known that nifedipine is easy to administer and have fewer side effects relative to betamimetics 15.…”

Section: Discussionmentioning

confidence: 97%

Success rate in preterm uterine contraction inhibition with tocolytic agents in a tertiary care center

Kiatsuda

Thinkhamrop

Prasertcharoensuk

2016

IJWH

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ObjectiveThis study aims to assess the success rate of inhibiting preterm uterine contraction with tocolytic agents to delay delivery for at least 48 hours and risk factors of failure inhibition.Materials and methodsBetween January 2013 and July 2014, medical records of all singleton pregnant women between 24 0/7 and 33 6/7 weeks of gestation with the diagnosis of preterm labor (with cervical dilatation) or threatened preterm labor (without cervical dilatation) who received tocolytic agents were reviewed. The success rate of preterm uterine contraction inhibition was accounted in patients with 48 hours delayed delivery. The risk factors of the inhibition failure and neonatal outcomes were also investigated in this study.ResultsAmong 424 pregnant women diagnosed of preterm labor or threatened preterm labor, 103 singleton pregnant women met the study criteria. Overall success rate of preterm uterine contraction inhibition to prolong pregnancy for at least 48 hours was 86.4% (95% confidence interval [CI]: 78.3, 92.3). However, the success rate among the threatened preterm labor group was 93.8% (95% CI: 88.3, 99.1) while the preterm labor group was 60.9% (95% CI: 39.3, 82.4). The significant factor associated with inhibition failure was preterm labor (adjusted odds ratio 7.22; 95% CI: 1.99, 26.20).ConclusionThe success rate of preterm uterine contraction inhibition with tocolytic agents to delay delivery for at least 48 hours was high in threatened preterm labor and low in preterm labor. A significant risk factor for inhibition failure was the preterm uterine contraction with cervical change.

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“…In our case of an AV block III°, no additional drug interaction could be identified, but the electrolyte imbalance was considered to be the trigger as other arrhythmogenic causes were absent. As the best maternal safety profile was shown for atosiban when compared with magnesium sulfate, beta-mimetics, indomethacin, or calcium channel blockers [7,8], and based on our own experience reported here, we strongly recommend that magnesium sulfate should not be used as a short-term tocolytic anymore. Instead, atosiban seems to be the most appropriate choice.…”

Section: Discussionmentioning

confidence: 99%

“…The use of magnesium sulfate as a tocolytic agent is still controversial [7]. In a Cochrane analysis on giving birth within 48 h after trial entry, no significant differences were seen between women who received magnesium sulfate for tocolysis and women who did not [11].…”

Section: Discussionmentioning

confidence: 99%

Tocolysis for in utero Surgery: Atosiban Performs Distinctly Better than Magnesium Sulfate

et al. 2017

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Introduction: To compare tocolysis with magnesium sulfate versus atosiban regarding the occurrence of short-term preterm labor and maternal side effects during and after open fetal myelomeningocele (MMC) repair. Material and Methods: A prospective nonrandomized cohort study was performed including 30 fetal MMC cases. The first 15 cases (group 1) received magnesium sulfate according to the MOMS protocol. In the following 15 cases (group 2), magnesium sulfate was substituted by atosiban. Chorioamniotic membrane separation (CMS), premature prelabor rupture of the fetal membranes (PPROM), preterm delivery <3 weeks after fetal MMC repair, and maternal complications due to the tocolytic medication were the major endpoints. Results: In both groups, one CMS but no PPROM was diagnosed <3 weeks after fetal MMC repair. One patient of group 2 delivered <3 weeks after fetal MMC repair because of an intraoperative placental abruption at 25 weeks. All women of group 1 showed an electrolyte imbalance during magnesium sulfate administration. One woman of group 1 developed several episodes of a third-degree atrioventricular block within the first 3 days after fetal surgery. Lethargy was found in all women during magnesium sulfate therapy. No maternal side effects were found under atosiban. Discussion: The use of atosiban resulted in an almost identical short-term uterine outcome without any serious maternal complications as seen when magnesium sulfate was given. Thus, the authors suggest using atosiban instead of magnesium sulfate in the context of open fetal surgery.

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Tocolysis for acute preterm labor: does anything work

Cited by 43 publications

References 57 publications

Factors associated with higher oxytocin requirements in labor

Factors associated with higher oxytocin requirements in labor

Success rate in preterm uterine contraction inhibition with tocolytic agents in a tertiary care center

Tocolysis for in utero Surgery: Atosiban Performs Distinctly Better than Magnesium Sulfate

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