Efficacy and safety of transdermal glycerytrinitrate verus intravenous ritodrine for tocolysis in preterm labor

Preterm delivery is a common obstetric problem. It accounts for three quarters of the mortality and morbidity among newborns without congenital anomalies. The goal of tocolytic therapy is to reduce neonatal morbidity and mortality by delaying delivery until 34 weeks of gestation or at least for 48 hours to allow time for the therapeutic effects of corticosteroid. The aim of this study was to compare the efficacy and safety of tocolysis with glyceryl trinitrate [GTN] patch and intravenous ritodrine with respect to maternal side effects and neonatal outcome. Fifty-seven singleton pregnancies with preterm labor and intact membrane between 28 and 34 weeks gestation were assigned randomly to receive either GTN patch [n = 27] or ritodrine hydrochloride infusion [n = 30]. The principal outcomes assessed were prolongation of pregnancy for 48 hours, 7 days and until 34 weeks of pregnancy and maternal side effects and neonatal outcome. Both GTN and ritodrine treated women were comparable in entry variable including age, parity, gestational age, contraction frequency and cervical dilatation and effacement. Delivery of woman was delayed for 48 h, 7 days and until 34 weeks gestation in 77.8%, 59.2% and 44.4% of women respectively treated with GTN compared with 73.3%, 56.7% ancf 43.3% respectively among women received ritodrine [no significant difference]. Average number of the side effects per patient was significantly [P<0.01] lower with GTN treatment than ritodrine therapy. The neonatal outcome was similar in the two treatment regimens. We found no overall difference between glyceryl trinitrate and ritodrine in the acute tocolysis of preterm labor but a suggested advantage of glyceryl trinitrate over ritodrine in reducing preterm delivery rate. The maternal side effect profile and treatment discontinuation rates were fewer for glyceryl trinitrate, suggesting it was a safer alternative to ritodrine

Urinary hyperglycosylated hCG As a predictive non-invasive new marker for gestational down syndrome screening

Hyperglycosylated human ehorionic gonadotrophin [HhCG] also known as invasive trophoblast antigen [ITA] is a new test. It specifically detects a unique oligosaccharide variant of hCG associated with Down syndrome pregnancies. We evaluated this test diagnosis through confirmatory studies. HhCG was measured by ELISA technique using commercial kit of Nunc-Immunolab-l Fisher Scientific [Larry 2001].In urine samples from women undergoing amniocentesis for advanced maternal age concerns at 6-12 weeks of gestation. 908 with normal karyotyping and 30 Down syndrome fetuses [28-45 years old]. As confirmation 36 pregnant women over 45 years old non karyotyped. 33 delivered normal babies and 3 delivered Down babies. The mean HhCG value was 7.3-7.7 folds higher in Down syndrome at 6-8 weeks gestation and 7.8-9.5 folds at 9-12 weeks gestation for women 28-45 years old. While it was 6.7 folds higher at 6-8 weeks gestation and 9.8 folds higher at 9-12 weeks gestation for women over 45 years old with Down syndrome babies. Urinary HhCG could be a new predictive non invasive marker for Down syndrome screening in the 1[st] trimester when 8-9 folds higher than normal on adding the advanced maternal-age risk factor. It can be an alternative to amniocentesis, this was a small study, thus the best clinical value of test can be established in large trials