Subcutaneous terbutaline and oral nifedipine for intrapartum fetal resuscitation: a prospective randomized controlled study / 中华围产医学杂志

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.

A comparative study between nifedipine and isoxsuprine in the suppression of preterm labor pain

Background: A prospective study was conducted to compare the effectiveness of Nifedipine and Isoxsuprine in suppression of preterm labour pain as tocolytics drug. As preterm labour pain is major contributor for perinatal morbidity and mortality. The aims of this study were to assess the effect of nifedipine and isoxsuprine in threatened preterm labour with the aim of preventing preterm birth and its sequelae.Methods: This study was conducted on 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical College, Udaipur and attending OPD and IPD with complain of uterine contractions between 28-36 weeks of gestation.Results: Nifedipine was more effective than isoxsuprine hydrochloride as tocolytic agent.Conclusions: There is high incidence of preterm labour in India which leads to neonatal morbidity and mortality. Nifedipine is a better tocolytic drug compared to isoxsuprine hydrochloride.

Role of magnesium sulphate in preterm labour

Introduction: Magnesium sulphate has been the drug of choice for the prophylaxis of convulsions in women with preeclampsia for many years. The use of this drug for the treatment of preterm labour originated in the observation that it causes a decrease in frequency and intensity of contractions in preeclampsia women in labour. The present study is conducted to study the effectiveness of intravenous magnesium sulphate in arrest of preterm labour. Materials and methods: The present study was conducted among 50 patients admitted in labor wards of obstetrics and gynecology department. Study was conducted at Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam. Study duration was from February 2016 to March 2017. Fifty patients with a diagnosis of preterm labor between 28 to 36 weeks period of gestation were included. A loading dose of intravenous magnesium sulfate 4 gm bolus over 20mins followed by 2g/hour infusion was administered until uterine quiescence was achieved. Results: The mean time taken for uterine quiescence was 74 mins after starting treatment. The magnesium sulfate dosage requirement for uterine quiescence was 1-2 gm/hour in 87.5% cases. Majority of the mothers experienced mild side effects but none were as serious as to discontinue the drug. Toxicity features were observed in 4% of cases, which need to discontinue the drug. Conclusion: Intravenous magnesium sulphate is effective in postponement of preterm labour at least for 48 hours. This is the minimum time considered sufficient to allow benefit if corticosteroids are administered to decrease the possibility of respiratory distress syndrome in premature infants. Thus magnesium sulphate plays a vital role in preterm labour

Magnesium sulphate as a tocolytic agent in preterm labour.

Background: Prematurity and its prevention continue to be a major challenge for both the obstetrician and neonatologist. Preterm labour is the most common obstetrical complication associated with perinatal deaths. Despite all advances in neonatology, the delivery of a preterm neonate is a clinical crisis that threatens the life and health of an infant. The obstetrician thus faces the challenge of affecting the delivery in such a way as to optimize the status of fetus-infant at birth. It is far more preferable to prevent the intiation of preterm labour than once the cascade of events has already been established. Objective: To assess the efficacy of magnesium sulphate as a tocolytic agent in preterm labour. Material and Methods: 50 pregnant patients with gestational age 28- 37 weeks with cervical dilatation not more than 3cm and cervical effacement not more than 50 % with intact membranes with regular uterine contractions with a frequency of 2 or more per 10 minutes lasting for at least 30 seconds were put on magnesium sulphate. Results: Magnesium sulphate was successful in attaining tocolysis in majority of patients and had no adverse effects on immediate neonatal out come. Conclusion: Magnesium sulphate is effective, safe and well tolerated tocolytic agent with no adverse effects on the fetus-infant.

Efecto de la aplicación de oxitocina en variables críticas sanguíneas de cerdas distócicas / Effects of oxytocin on critical blood variables from dystocic sows

The aim of the study was to monitor the sow maternal response to a low oxitocin dose in an advanced parturition stage in eutocic and maternal-foetal dystocia. Sixty York x Landrace sows, 30 with eutocic farrowing and 30 with maternal-foetal dystocia were assigned into two different groups: 15 received 0.083 IU/kg of oxytocin after the expulsion of the fifth piglet, and 15 received no treatment at all. Blood samples from every sow in trial were taken from the ear vein at three different times: immediately after membrane rupture, after the fifth piglet was born, and at the end of the farrowing. A third generation blood gas analyzer was used. Results show that when parturition was resumed, sows with maternal-foetal dystocia had significantly greater lactate, pCO2 and ear temperature (P < 0.001), compared with the eutocic sow group. Results from physiological variables and neonatal traits monitored in this experiment show evidence that oxytocin should not be used in normal parturition without stillbirths, since oxytocin in this case had adverse effects on sow performance. Oxytocin administered at the beginning of the second half of parturition decreased 50% the number of born alive with asphyxia in eutocic and dystocic sows, and on the other hand, decreased 50% the number of intra-partum stillbirths in the dystocic group. This is the first study describing the critical blood variables in dystocic sows (pH, pCO2, pO2, glucose, lactate and HCO3), using a third generation gasometry device.

Con el propósito de evaluar las respuestas maternas a dosis baja de oxitocina en estado avanzado del parto en cerdas con eutocia y distocia materno-fetal, se seleccionaron 60 cerdas de la cruza Yorkshire x Landrace, 30 eutócicas y 30 con distocia materno-fetal. Las cerdas de cada grupo fueron divididas en subgrupos: 15 recibieron 0.083 UI/kg de oxitocina después de la expulsión del quinto lechón, las otras 15 no fueron tratadas. Se obtuvieron muestras sanguíneas en cada una de las cerdas mediante punción de vena auricular después de la rotura de la fuente, al quinto lechón y al finalizar el parto; las muestras fueron evaluadas con un analizador de gases sanguíneos. Al finalizar el parto, las cerdas que presentaron partos con distocia materno-fetal incrementaron significativamente (P < 0.001) los niveles de lactato, pCO2 y temperatura, respecto de las hembras que presentaron partos eutócicos. Los resultados de las variables fisiológicas y los indicadores neonatales evaluados en este experimento son evidencia de que la oxitocina no debe aplicarse en partos con evolución normal sin nacidos muertos, ya que posee efectos adversos sobre el desempeño de la cerda. La oxitocina en cerdas, administrada al inicio de la segunda mitad del parto, disminuyó en 50% los nacidos con asfixia en cerdas eutócicas y distócicas; asimismo, redujo en 50% el número de muertes intraparto en las hembras distócicas. Los resultados del presente experimento determinan por primera vez la evolución de los parámetros críticos sanguíneos de la cerda con partos distócicos (pH, pCO2, pO2, glucosa, lactato y HCO3) utilizando equipo de gasometría de tercera generación.

Tratamento do trabalho de parto prematuro / Management of preterm labor

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.

Maternal serum highly sensitive C-reactive protein as a predictive marker of tocolytic success in preterm labor patient / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate whether maternal serum highly sensitive C-reactive protein (hsCRP) could be use as a marker of prediction of tocolytic success in preterm labor pregnancy, and was more useful in comparison with other inflammatory factors. METHODS: Maternal serum white blood cell (WBC) count, C-reactive protein (CRP), and hsCRP were determined in 87 patients in preterm labor and 68 controls. Preterm labor group was divided into tocolytic success group (n=44) and failure group (n=43). The levels of maternal serum WBC count, CRP, and hsCRP were evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC) to evaluate the relative value as prediction marker of tocolytic success in two preterm labor groups. The data were analyzed using student t-test. RESULTS: There was no significant difference for maternal age, body mass index (BMI), gestational age, and parity between normal group and preterm labor group. But, WBC count and hsCRP were significantly higher in preterm labor group in comparison to normal group (p<0.001). In preterm labor group, there was no significant difference in maternal age, BMI, gestational age, and parity between tocolytic success group and failure group. But, WBC count, CRP, and hsCRP were significantly lower in tocolytic success group. In the prediction of tocolytic success, the AUCs of WBC count, CRP, and hsCRP were 0.65, 0.77, and 0.82, respectively. CONCLUSION: This study showed that serum levels of hsCRP may be used as a marker of prediction of tocolytic success in preterm labor pregnancy.

Usefulness of Maternal Serum Amyloid A as a Predictor of Tocolytic Failure in Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: This study is directed to determine whether the concentrations of serum amyloid A (SAA) in maternal serum could be used to predict a tocolytic failure in preterm delivery, by comparing with other factors associated with inflammation. METHODS: A total of 100 pregnant women from September, 2000 to August, 2001 received continuous prenatal care and underwent delivery in our hospital was enrolled in the study. Gestational age was ranged between 20 and 37 weeks. Subjects were divided into four groups (group I, no preterm labor and no premature rupture of membranes [n=38]; group II, premature rupture of membranes and no preterm labor [n=12]; group III, preterm labor and no premature rupture of membranes [n=34]; Group IV, preterm labor and premature rupture of membranes [n=16]). The levels of SAA, CRP, ESR, and WBC count were measured in maternal serum. RESULTS: SAA levles, CRP levels, and WBC count in patients with tocolytic failure were significantly higher than those in patients without tocolytic failure. SAA and CRP appeared to be significant factors by logistic regression analysis. From the ROC curve analysis of maternal SAA for the prediction of tocolytic failure, we set 6 mg/L as a cut-off value in this study. Sensitivity, specificity, positive predictive value, and negative predictive value were 76%, 72%, 47.5%, and 90%, respectively. As for CRP, 0.59 mg/dL was set as a cut-off value, and sensitivity, specificity, positive predictive value, and negative predictive value were 72%, 81.3%, 56.3%, and 89.7%, respectively. When cut-off values for both SAA and CRP were applied at the same time, sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 92%, 71.4%, and 87.3%, respectively. CONCLUSION: This study showed that the measurement of maternal serum amyloid A may be a fast, non-invasive diagnostic method in the prediction of tocolytic failure in preterm delivery.

Pharmacologic models of drugs against premature delivery / 中国药理学通报

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.

Pharmacologic models of drugs against premature delivery / 中国药理学通报

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.