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PubMed1987

[Comparison of the effectiveness of Partusisten and ethanol tocolysis. III: Comparison of long-term and short-term tocolysis with Partusisten and ethanol].

The effectivity of Partusisten or ethanol long term respectively short term tocolysis by combination of a retrospective and a prospective-randomised study has been compared. Long term tocolysis was better than short term tocolysis. Partusisten was more effective than ethanol. Partusisten long term tocolysis was different to other forms or treatment with a high significance. 70% of newborns after Partusisten long term tocolysis had a birth weight of 2500 g or more.

Birth Weight↗
PubMed1987

[Comparison of the effectiveness of Partusisten and ethanol tocolysis. I: long-term tocolysis with Partusisten or ethanol].

Effectiveness of long term tocolysis with fenoterol (Partusisten) (n = 124) or ethanol (n = 117) has been compared in a retrospective study of the years 1978 to 1980. Situation of starting therapy has been estimated by Bishop-Score, tocolysis index and gestational week. Criterias of success were duration of gestation (reaching greater than or equal to 37th gestational week), neonatal parameters (weight greater than or equal to 2500 g, RDS morbidity, neonatal mortality) and prolongation index by Richter and success score by Weidinger. Fenoterol (Partusisten) is the better drug for treatment of premature labor. In cases of contraindications or incompatibility ethanol tocolysis is justified.

Adult↗
PubMed1987

[Comparison of the effectiveness of Partusisten and ethanol tocolysis. II. Short-term tocolysis with Partusisten or ethanol].

A prospectively randomised study for treatment of premature labor either by Partusisten or ethanol short term tocolysis was done in the years 1981 to 1983. The tocolysis was successful in 54 per cent (Partusisten) respectively 50 per cent (ethanol) by reaching a birth weight 2,500 g. 36 per cent respectively 37 per cent pregnant women reached 37th gestational week. Prolongation index 21 or more allows to predict a birth weight of 2,500 g or more. Success score 12 is not identical with corresponding birth weight. Ethanol tocolysis is an alternative to Partusisten treatment.

Adult↗
PubMed1987

A study of maternal ECG characteristics before and during intravenous tocolysis with beta-sympathicomimetics. Effects of i.v. tocolysis on maternal ECG characteristics.

Severe maternal complications during beta-mimetic therapy have been reported. In a study of maternal complications related to intravenous tocolysis, which covering a period of 2 years, we paid special attention to the maternal ECG before and during treatment. There was a high prevalence of pretreatment ECG changes: tachycardia (23.6%), disorders of impulse conduction (43.6%), ST-depression (14.5%) and disorders of repolarization (43.6%). During intravenous beta-mimetic therapy there was an increase in the prevalence of tachycardia, prolonged QT-time and disorders of repolarization. We also studied the course in time of the different ECG characteristics during treatment. With regard to the ST-depression, a possible physiological adaptation to the beta-mimetic drug is described. We could not find this possible adaptation with regard to the other ECG characteristics. None of the women in the studied group showed clinical signs of myocardial ischemia, notwithstanding the high prevalence of ECG changes. We conclude that the ECG criteria for discontinuation of tocolytic therapy need re-evaluation.

Adult↗
PubMed1989

A prospective randomised controlled trial of external cephalic version comparing two methods of uterine tocolysis with a non-tocolysis group.

The use of tocolvtic agents to enhance uterine relaxation and facilitate external cephalic version (ECV) has come under recent debate. We studied 90 breech presentations in late pregnancy who did not have contra-indications to ECV. The patients were randomised into 3 groups of 30 patients each: one was administered oral salbutamol 4 mg t.d.s.; another had intravenous salbutamol infused until the maternal heart rate rose above 100 bpm for 30 mins; and the last served as a control group. All patients in each group were matched for parity and gestation, and each had an intravenous line, thereby masking the treatment group from the 2 doctors who performed half the number of ECVs each. There was no significant difference in the success of ECV between the treatment and control groups (46.6% vs 50.0% vs 46.6%). The gestational age, the placental site, the attitude of the breech, the abdominal girth, and the maternal weight and fetal birth weights did not seem to influence results. On the other hand, there was a significant difference in successful ECV between nullipara (26%) and multipara (75%) (p less than 0.001). There were no cases of abruptio placenta or foetal distress, and one patient entered labour one day after the ECV at 39 weeks gestation. There were 2 cases of spontaneous version after failed ECV, and one case of spontaneous reversion to breech after successful ECV. We conclude that the use of salbutamol does not increase the incidence of successful ECV, but multiparity predicts for a successful outcome.

Adult↗
PubMed2004

Aggressive tocolysis does not prolong pregnancy or reduce neonatal morbidity after preterm premature rupture of the membranes.

OBJECTIVE: This study was undertaken to evaluate whether aggressive tocolysis improves pregnancy outcome after preterm premature rupture of the membranes (PPROM). STUDY DESIGN: Retrospective case-control study of patients with PPROM before 34 weeks of gestation, followed by a prospective cohort study with historical controls. The retrospective phase covered 1995 through 1999 when we used tocolysis aggressively. With the use of survival analysis, we compared latency in our cases with 4 published control series in which tocolysis was never used. On the basis of the results, we adopted a new protocol in mid-2000 limiting tocolysis to 48 hours after betamethasone dosing and we conducted a 2-year prospective evaluation of this new protocol. RESULTS: In the retrospective phase, tocolysis was used in 94% of 130 cases and maintained during 84% of 1162 total antenatal patient-days. There was no difference in latency between our cases and the published controls. One or more complications of tocolysis occurred in 18%. In the prospective study, 43% of 63 patients received tocolytics, but these were used at lower doses and were given during only 7% of 770 patient-days. Latency with this very limited tocolytic regimen (median 4.5 days, interquartile range 2.3 to 14.0) was not significantly different than during the last 24 months of aggressive tocolysis (median 3.8 days, 1.8 to 14 days, P=.16) and there were no differences in neonatal morbidity. CONCLUSION: Aggressive tocolysis after PPROM causes significant maternal morbidity, but does not increase latency or decrease neonatal morbidity compared with either very limited tocolysis or no tocolysis at all.

Adult↗
PubMed1999

Pulsatile vs. continuous parenteral tocolysis: comparison of side effects.

Bolus tocolysis has been developed to reduce the dose of fenoterol compared to continuous tocolysis. Whereas the high efficacy of pulsatile application of fenoterol has been shown, the proof of reduced side effects is still lacking. A total of 59 patients with preterm labor were divided in three groups: (1) continuous tocolysis and oral application of magnesium (n=19), (2) continuous tocolysis and parenteral application of magnesium (n=20), (3) pulsatile tocolysis (bolus tocolysis) and oral application of magnesium (n=20). Heart rate, systolic and diastolic blood pressure, serum K+ and serum Mg++ were quantified before tocolysis and after 2, 8 and 24 h. Beta-blockers and water balance were recorded over 24 h. Subjective side effects were quantified using a questionnaire with scales graduated covering palpitations, tremor, diaphoresis, thirst, precardialgia and nausea/vomiting. The analysis of the data revealed significantly fewer side effects concerning heart rate, plasma K+ level and the subjective side effects among patients treated with bolus tocolysis than among those treated with continuous tocolysis. Between the latter two groups, no significant difference was found. Concerning blood pressure and need for beta-blockers, no significant differences were found between the three groups. The results of the present study show that especially the side effects subjectively found to be disagreeable by the patients are reduced by pulsatile tocolysis, whereas other side effects show only slight differences between the study groups.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Cerebral hemorrhage and periventricular leucomalacia in preterm neonates after intravenous tocolysis with fenoterol: results of postnatal ultrasound examination].

BACKGROUND: This study tested whether tocolysis with beta-adrenergic agonists (Fenoterol) had an effect on the frequency of cerebral lesions in preterm neonates. PATIENTS AND METHODS: Head ultrasound scans of preterm neonates who were born after long-term (> 24 h) tocolysis were compared with scans of preterm neonates without preceding tocolysis. The gestational and neonatal data were analyzed retrospectively. RESULTS: Preterm neonates after (n = 102) and without (n = 101) tocolysis were subdivided into three groups according to their gestational age (23 - 28 wk: n = 41; 29 - 33 wk: n = 66; 34 - 36 wk: n = 96). Within these groups, no significant differences were found with respect to birth weight, rate of cesarean section, or pulmonary morbidity. Preterm babies < 28 weeks of gestation from the control group had lower Apgar scores (after 1 and 5 minutes, respectively) and arterial umbilical cord pH values. Intravenous tocolysis did not lead to an increase in pseudocystic periventricular leucomalacia (PVL) or intracerebral hemorrhage (ICH) in any of the subgroups studies. However, cerebral lesions were found in preterm neonates after tocolysis who exhibited signs of infection (29 - 33 wk: PVL n = 2; 23 - 28 wk: ICH n = 1) and in preterm neonates without tocolysis who had undergone fetal hypoxia or abruptio placentae (29 - 33 wk: PVL n = 4; antenatal terminal vein bleeding n = 1; 23 - 28 wk: PVL n = 2; terminal vein bleeding n = 5; posterior cerebral artery bleeding n = 1). When compared to preterm neonates of 34 - 36 weeks of gestation, the risk of infection was increased 4-fold in neonates of 29 - 33 weeks of gestation (odds ratio 5.43, 1.10 - 26.83) and 10-fold in neonates of 23 - 28 weeks of gestation (odds ratio 20.50, 3.65 - 115.03). Chorioamnionitis also was a more common finding in preterm neonates < 28 weeks of gestation. CONCLUSION: Preterm neonates who were born after intravenous long-term (> 24 h) tocolysis with Fenoterol do not exhibit an increase in periventricular leucomalacia or intracranial hemorrhage. The occurrence of cerebral lesions in these patients merely depends on their degree of immaturity and on the presence or absence of perinatal infection. In preterm neonates without tocolysis, brain lesions are mainly associated with hypoxic events.

Cerebral Hemorrhage↗
PubMedDate not supplied

Amniotic fluid interleukin-6 and interleukin-8 levels predict the success of tocolysis in patients with preterm labor.

OBJECTIVE: To determine whether the levels of the cytokines interleukin-6 (IL-6) and IL-8 in amniotic fluid identify patients with preterm labor who are resistant to tocolysis. METHODS: Amniocenteses were performed in 23 women with documented preterm labor at 20-32 weeks' gestational age who were treated subsequently with tocolytics. The concentrations of IL-6 and IL-8 in amniotic fluid were determined by double-antibody radioimmunoassay methods using recombinant human IL standards. RESULTS: Of the 23 patients, five failed to respond to tocolysis (four delivered within 48 hours), and of the remaining 18, all delivered more than 9 days after tocolysis was initiated (mean 31 +/- 10 days; range 9-61). In women who had failed tocolysis, discriminatory concentrations of IL-6 and IL-8 were 20 and 15 ng/mL, respectively. Of the patients who had amniotic fluid concentrations higher than these thresholds, all failed tocolysis (100% positive predictive value) and delivered within 6 days. The patients with levels below these discriminatory concentrations had successful tocolysis, and 17 of 18 delivered more than 2 weeks after treatment (95% negative predictive value). CONCLUSION: The success of tocolysis and thus delivery remote from an episode of preterm labor is associated with discriminatory amniotic fluid IL-6 and IL-8 levels of less than 20 and less than 15 ng/mL, respectively. If the immunologic response that causes the release of IL-6 and IL-8 has not occurred, the likelihood of successful tocolysis is extremely high. However, if both IL-6 and IL-8 are elevated, tocolysis is likely to fail and delivery may occur within 48 hours.

Adult↗
PubMedDate not supplied

[Tocolysis with nifedipine: its use in current practice].

OBJECTIVES: To assess tocolysis with nifedipine in preterm labour during actual clinical practice in terms of efficacy and safety. PATIENTS AND METHODS: Retrospective observational study during two years including preterm labour between 26 and 33+6 weeks of amenorrhea. Preterm labour was defined by the presence of three or more uterine contractions in 10 minutes associated to cervical modifications diagnosed by vaginal sonography (length<or=25 mm). Patients were excluded if they had more than two fetuses or other gestational pathologies. Tocolysis resulted in oral taking of 30 mg of nifedipine (3x10 mg) with continuous follow-up of blood pressure. Tocolysis was modified when contractions did not disappear. Success was defined when delivery was delayed more than 48 hours. Failure was defined either by a delivery occurring in the first two days of tocolysis or when a modification of treatment was required. RESULTS: Fifty-eight patients were included, 10 of whom having a twin pregnancy. Success was obtained in 84% of patients (49/58). All of these women did not deliver during the first seven days after introduction of tocolysis. Five patients delivered in the first two days after tocolysis and four others required a change in tocolysis. Mean gestational age at delivery was 37+5 weeks and 35 weeks for single and twin pregnancies, respectively. No maternal or fetal side effects were described. DISCUSSION AND CONCLUSION: Nifedipine could be prescribed for tocolysis in actual clinical practice because it seems to have safety and excellent tolerance.

Adolescent↗
PubMed1988

The therapeutic efficacy and cost-effectiveness of aggressive tocolysis for premature labor associated with premature rupture of the membranes.

We conducted a randomized trial comparing bed rest with tocolysis to determine the therapeutic efficacy, safety, and cost-effectiveness of tocolysis for the treatment of preterm labor after membrane rupture. One hundred nine women participated over a 26-month interval. Treatment groups did not differ significantly in terms of gestational age at membrane rupture, gestational age at delivery, birth weight, maternal or fetal infectious morbidity, respiratory distress syndrome, necrotizing enterocolitis, or perinatal mortality. Prolongation of intrauterine time after the onset of uterine contractions was seen in women receiving tocolysis (105.2 +/- 157 hours versus 62.1 +/- 77 hours, p = 0.06). This prolongation was not associated with a significant reduction in the total cost per surviving infant (tocolysis, $38,593 +/- $40,887 versus bed rest, $43,158 +/- $37,116; p = 0.445). The cost difference was artifactual. The number of very premature infants born (less than 28 weeks' gestation) was unequal in the two groups (12 in the bed rest group and 5 in the tocolysis group) and skewed the results. Before 28 weeks' gestation tocolysis was associated with a significant increase in intrauterine time after the onset of regular contractions (p = 0.05). However, there was no identifiable perinatal benefit garnered from the additional 5 days. After 28 weeks there were no significant differences between treatment groups in terms of intrauterine time after the onset of regular contractions and total cost per surviving infant. Because tocolysis does not improve perinatal outcome and can itself be associated with major maternal morbidity, it should be avoided after 28 weeks' gestation. Before 28 weeks' gestation tocolysis may greatly increase intrauterine time, but the benefit of this prolongation is not clear.

Adult↗
PubMed1989

Bolus tocolysis: treatment of preterm labor with pulsatile administration of a beta-adrenergic agonist.

The treatment of premature labor with beta-adrenergic substances is complicated by side effects. Although most human control mechanisms are pulsatile, therapy is usually administered continuously. We designed a microprocessor-controlled pump to allow pulsatile tocolytic infusion, hoping to reduce the total dose and thus the side effects. In 33 patients pulsatile bolus tocolysis was compared with continuous tocolysis in a control group of 38 patients. Bolus tocolysis required considerably less beta-sympathomimetic agent for comparable therapeutic success (median dosage 3.0 versus 15.9 mg, p less than 0.001). Duration of therapy under bolus tocolysis was also significantly shorter (p less than 0.05). Birth weight was higher after bolus tocolysis (median 3070 versus 2580 gm, p = 0.05). Additional indicators favored bolus tocolysis but were not statistically significant: a longer gestational period, fewer infants weighing less than 2500 gm, and a lower incidence of respiratory distress syndrome. Pulmonary edema occurred in one patient during continuous tocolysis.

Adrenergic beta-Agonists↗
PubMed2004

Severe cardiotocographic pathology at labor: effect of acute intravenous tocolysis.

The purpose of this study was to evaluate the effect of acute tocolysis on severely pathological cardiotocographic (CTG) readings during the first stage of labor. Seventy-three consecutive parturients with full-term pregnancy were treated by acute tocolysis with a beta-mimetic agent after recognition of severe CTG abnormality in the first stage of labor. The main outcome measures were normalization or persistence of the CTG pattern after tocolysis. Risk factors with regard to CTG effect of tocolysis were also evaluated. In 67% of cases the CTG pattern normalized at a mean of 4 minutes after the beginning of intravenous tocolysis. No characteristic feature of the parturient, labor course, CTG abnormality, or the parameters of uterine contractive activity was found to be a predictive factor with regard to the CTG effect of tocolysis. No adverse effects of tocolytic therapy were found. Tocolysis with a beta-mimetic agent is an effective method to normalize the CTG pattern during the first stage of labor, even in cases without uterine hypertonicity.

Adult↗
PubMed2004

Repeat measurement of cervical length after successful tocolysis.

OBJECTIVE: To measure the ultrasonographic cervical length in undelivered women after successful tocolysis for preterm labor, and to determine whether this could improve the predictive value of cervical length measured before initiation of tocolysis on the risk of preterm delivery. METHODS: This was a prospective study of patients admitted and treated for uterine contractions at 24(+0) to 33(+6) weeks of gestation with a cervical length of 26 mm or less by transvaginal ultrasonography on admission. Intravenous tocolysis was stopped when delivery was delayed by 48 hours, and cervical length was remeasured before discharge. The primary outcome was preterm delivery, defined by a delivery before 37 weeks. Predictive analysis was based on logistic models, with estimated odds ratios and 95% confidence interval. RESULTS: One hundred and nine patients were included in the study. The median (first, third quartile) cervical length on admission was 18 (13, 22) mm. The median (first, third quartile) variation in cervical length after tocolysis was stopped was 3 (0, 8) mm, and ranged from -13 to 26 mm. The median (first, third quartile) time interval from tocolysis to delivery was 53.0 (35.0, 70.0) days, with 45 (41.3%) patients delivered before 37 weeks. After adjustment for cervical length before admission and parity and gestational age on admission, the assessment of the variation in cervical length after successful tocolysis did not improve the predictive value of transvaginal sonography for the risk of preterm delivery (odds ratio 0.97; 95% confidence interval 0.90-1.03; P = .27). CONCLUSION: To repeat ultrasonographic cervical length measurement after successful tocolysis for preterm labor is useless.

Adult↗
PubMed2006

Neonatal mortality and morbidity after aggressive long-term tocolysis for preterm premature rupture of the membranes.

OBJECTIVE: To test the hypothesis that predischarge morbidity and mortality are not increased for infants admitted to our neonatal intensive care unit and whose mothers had tocolysis for >48 h plus antibiotics and steroids (aggressive long-term tocolysis) after preterm premature rupture of the membranes (PPROM) as compared with gestational age-matched infants born to mothers not treated for PPROM. METHODS: A retrospective cohort study was conducted on live preterm births ( 48 h (n=137, group 1) with singletons born to all other mothers matched for group-1 gestational age at delivery (n=628, group 2), excluding severe maternal complications such as insulin-dependent diabetes and preeclampsia in both groups. Primary outcome was the predischarge mortality and morbidity of the neonates. RESULTS: In the group with post-PPROM tocolysis which lasted for 14.4+/-14.0 days with a latency of 15.3+/-15.3 days (time from PPROM to delivery) and 14.4+/-14.0 days (time from the start of tocolysis to delivery), the predischarge mortality and morbidity was not increased compared to the non-treated group. The 1- and 10-min Apgar scores of between 1 and 7 were less frequent with tocolysis (p<0.05), and oxygen use was less frequent (26.3 vs. 36.3%, p=0.03) and shorter (8.7 vs. 19.6 days, p=0.03). However, amniotic fluid infection syndrome and latency (i.e. >1 week) are the most potential predictors of the respiratory distress syndrome in addition to gestational age at delivery in pregnancies with post-PPROM tocolysis. CONCLUSIONS: Amniotic fluid infection syndrome and a latency of >1 week achieved by aggressive post-PPROM tocolysis lessens the advantages of extended gestational age and decreased predischarge neonatal morbidity. These findings may have important implications for the clinical management of PPROM.

Adult↗
PubMed1997

Successful tocolysis: does cervical change affect time to delivery?

Generally, it is preferable to tocolyze patients with idiopathic preterm labor (PTL). Little information is available about ultimate outcomes after successful tocolysis. Our objective is to evaluate the relationship between cervical change after the initiation of tocolysis and the delay in time to delivery in patients with preterm labor. A historical analysis of all patients with successful tocolysis after PTL between January 1992 and December 1993 was undertaken. The patients were then placed in one of three categories (regression, unchanged, or progression) based on cervical change after the initiation of tocolysis. Various demographic pregnancy characteristics and pregnancy outcome data were analyzed. One hundred and twenty-six patients had successful tocolysis and met the admission criteria. Patients who had cervical progression had shorter delay to delivery, delivered at an earlier gestational age (31.7 weeks compared to 34.0 and 34.1 weeks, respectively, p < 0.05), and were more likely to deliver before 35 weeks (88% compared to 50.0 and 55.0%, respectively, p < 0.05). Also, neonates remained in the hospital longer and were more likely to have respiratory distress syndrome when compared to the other two groups. Patients who had cervical progression after the initiation of tocolysis are more likely to deliver prematurely, had a shorter delay to delivery, and delivered lower birth weight infants than did patients whose cervix regressed or remained unchanged. In our population, patients who had successful tocolysis had a preterm delivery rate of 59.5% before the 35th week of gestation.

Adolescent↗
PubMed2005

Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double-blinded, placebo-controlled trial.

BACKGROUND: External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. OBJECTIVE: To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. DESIGN: Randomised, double-blinded, placebo-controlled trial. SETTING: UK teaching hospital. POPULATION: One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV. METHODS: Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat. MAIN OUTCOME MEASURES: Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity. RESULTS: The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23-8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14-0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64-53.62). Maternal and neonatal morbidity remain unchanged. CONCLUSIONS: The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis.

Adult↗
PubMed2006

[Study of stress and coping behaviors in families of hospitalized pregnant woman undergoing tocolysis].

Because of tocolysis intervention, families of pregnant woman undergoing tocolysis face stresses beyond the physical and psychological challenges of normal pregnancy. The lifestyle of the family and the relationship between family members will change significantly. The purpose of this study was to explore the stresses and coping behaviors of families of pregnant woman undergoing tocolysis in the hospital. A clinical field method was used and the subjects were recruited from one medical center in Taipei. Data, collected from participant observations and interviews, was subject to content analysis. Results showed that the family stress could be segmented into the four realms of (1) uncertainty about tocolysis; (2) worrying about infant's health; (3) role conflicts between relatives; and (4) changes in family life patterns. The study classified family coping behavior into the following four activity categories: (1) searching for information about tocolysis; (2) adjusting family member roles; (3) changing family member interactions; (4) streamlining the use of family resources. These conclusions are helpful to promote nursing quality in relation to caring for families of pregnant woman with tocolysis by fully understanding the related sources of stress and patterns of coping behaviors.

Adaptation, Psychological↗