ABSTRACT
Objective:To compare the safety and efficacy of terbutaline and nifedipine for acute intrapartum fetal resuscitation (IUFR).Methods:This was a prospective randomized controlled study involving 110 pregnant women with non-reassuring fetal heart rate tracings (NRFHT) during delivery at Guangzhou Women and Children's Medical Center between January and April 2021. These women were randomly allocated to receive subcutaneous terbutaline sulphate (0.25 mg, terbutaline group) or oral nifedipine (10 mg, nifedipine group), with 55 subjects in each group. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation before and 5, 15 and 30 min after treatment as well as the success rate of intrapartum resuscitation, the onset time of medication, and the incidence of postpartum hemorrhage were analyzed using t test, Chi-square test or Fisher's exact test. Results:Two groups both showed no significant difference in the mean arterial pressure or oxygen saturation before or after treatment (all P>0.05). The heart rate was not affected in nifedipine group at any time points ( P>0.05). While the patients treated with terbutaline showed accelerated maternal heart rate 5, 15 and 30 min after administration as compared with the baseline[(97.0±20.2), (99.2±13.8), (91.8±12.6) vs (81.7±11.3) bpm, all P<0.001], but it began to decrease at 30 min, with a drop of 6.4 bpm compared with that at 15 min (95% CI: 1.5-11.2, P<0.05). None of the pregnant women had adverse reactions requiring medical intervention. The rates of successful acute resuscitation were similar in the two groups [terbutaline: 78.2% (43/55) vs nifedipine: 70.9% (39/55), χ 2= 0.77, P=0.381]. Terbutaline had a shorter onset time than nifedipine in slowing the frequency of contractions and returning fetal heart rate to class Ⅰ category [2(1-6) vs 6(1-10) min, U=2 348.50, P<0.001]. No significant difference was found between the two groups in terms of NRFHT-indicated cesarean section, assisted vaginal delivery, or second dose of tocolysis within 1 h (all P>0.05) nor in blood loss volume, postpartum hemorrhage rate, low Apgar score, low umbilical artery pH value (pH<7.2), neonatal asphyxia rate, or neonatal intensive care admission rate (all P>0.05). Conclusion:Terbutaline spends less time than nifedipine to take effect and may be an alternative for acute IUFR without significant adverse outcomes.
ABSTRACT
O objetivo principal para o uso de uterolíticos no trabalho de parto prematuro é prolongar suficientemente a gestação para a administração materna de glicocorticoides e/ou realizar a transferência materna para um centro hospitalar terciário. As decisões sobre o uso e a escolha de uterolítico requerem o diagnóstico correto do trabalho de parto prematuro, o conhecimento da idade gestacional, das condições médicas materno-fetais, da eficácia, dos efeitos colaterais e do custo do medicamento. Todos os uterolíticos possuem efeitos colaterais e alguns deles são potencialmente letais. Os estudos sugerem que os agonistas de receptores beta-adrenérgicos, os bloqueadores de cálcio e os antagonistas de receptor de ocitocina são eficazes para prolongar a gestação por pelo menos 48 horas. Dos três agentes, o atosiban (antagonista de receptor de ocitocina) possui maior segurança, embora o custo seja elevado. O sulfato de magnésio não é eficaz para prolongar a gestação e apresenta efeitos colaterais importantes. Os inibidores da ciclooxigenase também apresentam efeitos colaterais significativos. Até o momento, não há evidências suficientes para se recomendar o uso de doadores de óxido nítrico para inibir o trabalho de parto prematuro. Não existem fundamentos para o emprego de antibióticos para evitar a prematuridade diante do trabalho de parto prematuro.
The main purpose of using uterulytic in preterm delivery is to prolong gestation in order to allow the administration of glucocorticoid to the mother and/or to accomplish the mother's transference to a tertiary hospital center. Decisions on uterolytic use and choice require correct diagnosis of preterm delivery, as well as the knowledge of gestational age, maternal-fetal medical condition, and medicine's efficacy, side-effects and cost. All the uterolytics have side-effects, and some of them are potentially lethal. Studies suggest that beta-adrenergic receptor agonists, calcium blockers and cytokine receptor antagonists are effective to prolong gestation for at least 48 hours. Among these three agents, atosiban (a cytokine receptor antagonist) is safer, though it presents a high cost. Magnesium sulfate is not efficient to prolong gestation and presents significant side-effects. Cyclooxygenase inhibitors also present significant side-effects. Up till now, there is not enough evidence to recommend the use of nitric oxid donors to inhibit preterm delivery. There is no basis for the use of antibiotics to avoid prematurity in face of preterm labor.
Subject(s)
Female , Humans , Pregnancy , Obstetric Labor, Premature/diagnosis , Obstetric Labor, Premature/therapyABSTRACT
The animal models for pharmacologic assessment of drugs against premature delivery are reviewed, which include the measure of spontaneous delivery time between the first and the second pups in term pregnancy rats, the delay in the onset of labor in rats and premature delivery artificially induced by lipopolysaccharide, interleukin-1 α and prostaglandin F2α in mice.
ABSTRACT
The animal models for pharmacologic assessment of drugs against premature delivery arereviewed, which include the measure of spontaneous delivery time between the first and the second pups in term pregnancy rats, the delay in the onset of labor in rats and premature delivery artificially induced by lipopolysaccharide, interleukin 1 ? and prostaglandin F 2? in mice.