ABSTRACT
Preterm labour, the most important single determinant of adverse infant outcome in terms of both survival and quality of life, is problematic because of the several neonatal complications and the long term sequelae. Preterm birth affects 12 – 18% of all births in India. Tocolytic therapy is the most commonly used strategy to arrest preterm labour. Isoxsuprine, a ß sympathomimetic agent is a drug that is currently used as a tocolytic but is associated with serious side effects. Magnesium sulphate is another Tocolytic which has also been the focus of recent research for its neuroprotective effects on preterm babies. We have compared the two in this study. Objectives: To compare the efficacy of Isoxsuprine with magnesium sulphate with respect to 1. Cessation of labour pains and prolongation of gestational age 2. Drug related side effects 3. The perinatal outcome Methodology : 50 patients who came to Jubilee Mission Medical College hospital with preterm labour from November 2012 to April 2014 were randomised into two groups of 25 each. Group I was given Isoxsuprine 90mg intravenously in 1000ml Ringer lactate solution at the rate of 0.05 – 0.20 mg/min. Group M was given magnesium sulphate, loading dose of 4gm diluted in 100ml normal saline intravenously, followed by a continuous infusion of 2gm/hr for at least 12 hours. The vitals, urine output and patellar reflex of the patients were monitored. Results: The mean number of days gained in utero in group I and group M were 30.88 ±21.24 and 27.26±18.79 days respectively. The percentage of NICU admissions in group I was 28% and group M was 28%. Maternal side effects were noted in 32% in group I and 20% in group M. Conclusion: Magnesium sulphate is comparable to Isoxsuprine in its efficacy in managing preterm labour with less maternal and neonatal side effect
ABSTRACT
El objetivo fue comparar la eficacia del clorhidrato de isoxuprina endovenoso o la progesterona vaginal en la amenaza de parto pretérmino en la Maternidad Dr. Nerio Belloso. Hospital Central Dr. Urquinaona, Maracaibo, Estado Zulia. Se Seleccionaron 82 embarazadas con edad gestacional entre 24 y 34 semanas y diagnóstico de amenaza de parto pretérmino para recibir progesterona vaginal (grupo A; n=41) o clorhidrato de isoxuprina endovenoso (grupo B; n=41). Se evaluaron tiempo de cese de las contracciones y los efectos adversos maternos. El promedio de edad gestacional de las pacientes al momento del inicio del tratamiento fue de 31.7 ± 2.1 semanas en el grupo A y 32.4 ± 2.4 semanas en el grupo B (P=ns). En las primeras 24 horas de tratamiento clorhidrato de isoxuprina fue más efectivo que la progesterona vaginal con una tocólisis efectiva (26,8% en el grupo A y en 61.0% en el grupo B, p<0.05). Sin embargo, después de 7 días de tratamiento, 73.2% de las pacientes del grupo A y 36.6% de las pacientes en el grupo B aún permanecían sin contracciones (P<0.05). El retraso del parto más allá de las 34 semanas se logro en 80.5% de las pacientes en el grupo A y 26.8% de las pacientes grupo B (P<0.05). La cefalea fue el efecto adverso más frecuente en el grupo de pacientes del grupo A. La progesterona vaginal es más efectiva que el clorhidrato de isoxuprina endovenoso en el tratamiento de la amenaza de parto pretérmino.
The objetive was to compare the efficacy of endovenous isoxuprine clorhidrate of vaginal progesterone in treathened preterm labor in the Maternidad Dr. Nerio Belloso. Hospital Central Dr. Urquinaona, Maracaibo. Estado Zulia. Eighty two patients with a gestational age between 24 and 34 weeks and treathened preterm labor were selected to receive vaginal progesterone (group A; n= 41) or endovenous isoxuprine clorhidrate (group B; n=41). Time of ceasing of uterine contractions and maternal adverse effects were evaluated. Mean gestational age of patients at beginning of treatment was 31.7 ± 2.1 weeks in group A and 32.4 ± 2.4 weeks in group B(P=ns). At the first 24 hours of treatment, isoxuprine clorhidrate was more effective than vaginal progesterone for effective tocolysis (26.8% in group A and 61.0% in group B, P<0.05). However, after 7 days of treatment, 73.2% of patients in group A and 36.6% of patients in group B still were without contractions (P<0.05). Delay of delivery beyond 34 weeks was achieved in 80.5% of patients in group A and 26.8% of patients in group B (P<0.05). Headache was the most frequent adverse effects in patients of group A. Vaginal progesterone is more effective than endovenous isoxuprine clorhidrate in the treatment of treathened preterm labor.
Subject(s)
Humans , Male , Female , Pregnancy , Adrenergic beta-Agonists/administration & dosage , Progesterone/therapeutic use , Obstetric Labor, Premature/therapy , Administration, Intravaginal , Pregnancy Complications/prevention & control , Infant Mortality , Premature Birth/etiology , Tocolytic Agents/therapeutic useABSTRACT
Comparar la eficacia del clorhidrato de isoxuprina o la nifedipina en la tocólisis de la amenaza de parto pretérmino. Se seleccionaron 82 pacientes con edad gestacional entre 24 y 34 semanas y diagnóstico de amenaza de parto pretérmino. Las pacientes se dividieron al azar en 2 grupos para recibir clorhidrato de isoxuprina (grupo A) o nifedipina (grupo B). Se determinaron el tiempo de cese de las contracciones, tensión arterial materna, concentraciones de glucosa y efectos adversos maternos. Maternidad "Dr. Nerio Belloso", Hospital Central "Dr. Urquinaona", Maracaibo. Estado Zulia. Se logró una tocólisis efectiva en las primeras 24 horas en 61,0 por ciento y 70,7 por ciento de las pacientes del grupo A y B, respectivamente (P = ns). Después de 7 días de tratamiento, 36,6 por ciento de las pacientes en el grupo A y 31,7 por ciento de las pacientes en el grupo B aun permanecían sin contracciones (P = ns). Se logró un retraso del parto hasta las 34 semanas o más en 26,8 por ciento y 29,3 por ciento de las pacientes de los grupos A y B, respectivamente. En el grupo de pacientes tratadas con clorhidrato de isoxuprina se observó un aumento significativo de las concentraciones séricas de glucosa (P < 0,001). Los efectos adversos maternos fueron significativamente más frecuentes en el grupo de clorhidrato de isoxuprina después de 2 y 24 horas de tratamiento (P < 0,05). La nifedipina es igual de efectiva que el clorhidrato de isoxuprina en la tocólisis de la amenaza de parto pretérmino y produce menos efectos adversos
To compare the efficacy of isoxuprine clorhidrate or nifedipine in tocolysis of threatened preterm labor. 82 patients with a gestational age between 24 and 34 weeks and threatened preterm labor diagnosis were selected. Patients were randomly divided in 2 groups to receive isoxuprine clorhidrate (group A) or nifedipine (group B). Time of cease of contractions, maternal blood pressure, glucose concentrations and maternal adverse effects were determined. Maternidad "Dr. Nerio Belloso", Hospital Central "Dr. Urquinaona", Maracaibo. Estado Zulia. An effective tocolysis was obtained within 24 hours in 61.0 percent and 70.7 percent for patients in group A and B, respectively (P = ns). After 7 days of treatment, 36.6 percent of patients in group A and 31,7 percent of patients in group B were still without contractions (P = ns). A delay in labor till 34 weeks or more was made in 26.8. percent and 29.3 percent of patients in group A and B, respectively. In the group of patients treated with isoxuprine clorhidrate a significant raise of glucose concentrations was observed (P < 0.001). Maternal adverse effects were significant more frequent in isoxuprine clorhidrate group after 2 and 24 hours of treatment (P < 0,05). Nifedipine has a similar effectivity than isoxuprine clorhidrate for tocolysis in threatened preterm labor and produces less adverse effects