Terbutaline versus salbutamol for suppression of preterm labor: a randomized clinical trial

Preterm labor [PTL] is a common medical problem during pregnancies and is associated with neonatal mortality and morbidity. Beta-adrenergic agonists are among the most commonly used tocolytic agents. The aim of this study was to compare the effectiveness, safety and adverse effects of terbutaline with those of salbutamol in the prolongation of pregnancy beyond 48 hours and until 37 weeks of gestation. Two hundred women with PTL were randomly assigned to receive subcutaneous terbutaline [250 micro g] or intravenous salbutamol [0.1 mg] followed by oral terbutaline [20 mg/d] or oral salbutamol [24 mg/d] as maintenance. The efficacy, side effects and complications after 48 hours and until 37 weeks of gestation were analyzed and compared. There was no significant difference between the two groups in success rate within 48 hours [P= .091]. Gestational age at delivery [P=.031] and the number of days for which the gestation was prolonged [P=.024] were significantly higher in those receiving terbutaline. Adverse effects, including tachycardia [P=.007] and anxiety [P=.006], were experienced more in the salbutamol group. Birth weight was significantly lower in the salbutamol group [P=.001]. Terbutaline provided more effective tocolysis with fewer adverse effects and a better neonatal outcome. However, terbutaline and salbutamol are equally effective in the first 48 hours

O atosibano como agente tocolítico: uma nova proposta de esquema terapêutico / Atosiban as a tocolytic agent: a new proposal of a therapeutic approach

OBJETIVO: avaliar um novo esquema terapêutico de emprego do atosibano quanto ao efeito tocolítico, eficácia e efeitos colaterais maternos e fetais. MÉTODOS: Estudo prospectivo com 80 gestantes em trabalho de parto prematuro admitidas para tocólise. Critérios de inclusão: gestação única, presença de contrações uterinas regulares, dilatação cervical >1 cm e <3 cm, esvaecimento cervical >50 por cento, idade gestacional entre 23 e 33 semanas e seis dias, membranas ovulares íntegras, índice de líquido amniótico >5 e <25 e ausência de doenças maternas, patologias feto-anexiais, restrição do crescimento fetal, sofrimento fetal e incompetência cervical. Critérios de exclusão: corioamnionite ou febre na vigência de tocólise. No grupo de estudo, utilizou-se atosibano com dose de ataque de 6,75 mg iv em bolus. Em seguida, infusão por três horas de 300 mcg/min e, após, 100 mcg/min durante três horas e 30 minutos. Se as contrações persistissem, mantinha-se infusão iv de 100 mcg/min durante 12 horas e 30 minutos e fazia-se nova avaliação, sucessivamente até completar 45 horas. No Grupo Controle, foi utilizado terbutalina; diluíram-se cinco ampolas de 2,5 mg de terbutalina em 500 mL de soro glicosado a 5 por cento e foi iniciada a infusão intravenosa contínua, 20 mL/h. Na persistência de contrações uterinas, aumentava-se a velocidade de infusão da solução em 20 mL/h até que se conseguisse a parada das contrações uterinas. Quando foi atingida a dose na qual a paciente não apresentava atividade uterina, esta foi mantida por 24 horas. RESULTADOS: a idade gestacional no parto variou de 29 semanas e cinco dias a 40 semanas e seis dias. Em 97,5 por cento dos casos foi possível postergar o parto em pelo menos 48 horas, com intervalo médio entre o início da tocólise e o parto de 28,2 dias. No Grupo Controle, em nove casos, o parto ocorreu em intervalo inferior a 48 horas após o início da tocólise (22,5 por cento); o intervalo médio entre o início da tocólise...

PURPOSE: to test a therapeutic approach using atosiban for tocolysis, evaluating its safety and maternal and fetal side effects. METHODS: prospective study with 80 pregnant women with preterm labor admitted for tocolysis. Inclusion criteria: singleton pregnancy, regular uterine activity, cervical dilatation between 1 to 3 cm, cervical enfacement greater than 50 percent, 23 to 33 weeks and six days of gestational age, intact membranes, amniotic fluid index between 5 and 25, no maternal, fetal or placental diseases, no fetal growth restriction, no cervical incompetence, no fever. Exclusion criteria: chorioamnionitis or fever during tocolysis. Atosiban group: women received 6.75 mg atosiban iv in bolus, 300 mcg/min for three hours, then 100 mcg/min for three hours and thirty minutes. If uterine activity persisted, it was maintained iv infusion of 100 mcg/min for 12.5 hand that so for as long as 45 hours. Control group: women received terbutaline (five ampoules, 500 mL crystalloid solution) iv infusion, 20 mL/h. If uterine activity persisted, infusion velocity was raised (20 mL/h) until uterine contractions were absent. The dose was maintained for 24 hours. RESULTS: gestational age at birth was 29 weeks and five days to 40 weeks and six days. In atosiban group, the proportion of women who had not delivered at 48 hours was 97.5 percent, mean interval between tocolysis and birth of 28.2 days. In control group, birth occurred before 48 hours in 22.5 percent of the cases; mean interval between tocolysis and birth of 5.3 days. Maternal side effects were observed in 27.5 percent of cases of the atosiban group, none with tachycardia, dyspnea or tachypnea. In the control group, 75 percent of the cases referred palpitations, tachycardia, tachypnea or headache (drug infusion was interrupted in four cases). Fetal tachycardia was observed in 22.5 percent of the cases (n=9). No early neonatal death was observed. CONCLUSIONS: the therapeutic approach used...

Oral salbutamol for treatment of preterm labor.

OBJECTIVE: The aim of this study was to assess the value of oral salbutamol for the inhibition of preterm labor. MATERIAL AND METHOD: Medical records of the department from January 1, 1991 to December 31, 1999 were reviewed for all idiopathic preterm labors that were inhibited by oral salbutamol and statistically analyzed. RESULTS: Of 132 pregnancies, 81.1% (95%CI, 74.4, 87.7) were prolonged for more than 24 hours, 59.8% (95%CI, 51.5, 68.2) for more than 2 days, 32.6% (95%CI, 24.6, 40.6) for more than 1 week, and 8.3% (95%CI, 4.2, 14.4) for more than 4 weeks. Tachycardia (pulse rate > 100 beats/min) occurred in 85.6% of the patients, but those with a pulse rate higher than 140 beats/min occurred in only 3%. Hypotension occurred in only 0.8%. Neonatal complications occurred in 28%, while respiratory distress syndrome occurred in 22.7% of the babies. Perinatal mortality in the present study was 7.6 per 1,000 births. When comparing the pregnancy outcome between groups regarding the prolongation time, the pregnancy outcome was significantly better in the group that had a prolongation time of at least 48 hours. CONCLUSION: Oral salbutamol proved to be another effective method that inhibits preterm labor and consequently prolongs pregnancy. Because it requires no intensive medical nursing care and observations, and no discomfort of an intravenous line, oral salbutamol may be an alternative drug in the management of preterm labor.

Edema agudo de pulmón secundario a tocolíticos (Reporte de un caso) / Acute pulmonary edema associated with tocolytics (It reports a case)

Justificación: Desde hace más de 30 años se han utilizado los beta-agonistas con el fin de inhibir la actividad uterina prematura, disminuyendo la mortalidad perinatal. Sin embargo, desde entonces se ha descrito el edema agudo de pulmón como efecto adverso potencialmente fatal. Objetivo: En este artículo, se discutirá un caso clínico y se revisarán los factores predisponentes y los posibles mecanismos fisiopatológicos en la génesis del edema pulmonar secundario a tocolíticos, así como, el diagnóstico y manejo más adecuado del mismo según diferentes revisiones. Conclusión: se resalta la posibilidad etiológica de los tocolíticos como causantes del edema pulmonar.

A comparative study between nifedipine and isoxsuprine in the suppression of preterm labour.

Preterm labour and delivery remains a major cause of perinatal morbidity and mortality. Numerous drugs and interventions have been used to prevent and inhibit preterm labour but none have been found to be completely effective with the choice being further limited by troublesome side effects. This study compares in a prospective and randomised design the efficacy and safety of the calcium antagonist Nifedipine with the beta mimetic Isoxsuprine. 81.25% of patients receiving Nifedipine and 70% of those receiving Isoxsuprine achieved successful tocolysis. The mean prolongation of pregnancy with Nifedipine was 25+/-19.85 days and with Isoxsuprine it was 19.18+/-17.82 days. Maternal side effects were similar in both groups with hypotension and tachycardia being the commonest. Discontinuation rates were also similar with pulmonary oedema and severe hypotension being the reasons for foregoing tocolysis. It can be concluded that Nifedipine is a safe and effective alternative to Isoxsuprine for suppressing preterm labour.