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Introduction: Preterm labour and delivery have a major contribution to perinatal mortality and morbidity. Tocolytic therapy reduces neonatal mortality and morbidity by prolonging gestation, allowing for corticosteroid administration and inutero transfer to a tertiary care centre. There is a need to find out better tocolytic agent that is most effective and with the least side-effects. Aim: To compare oral Nifedipine and transdermal Nitroglycerine patch to achieve tocolysis in preterm labour. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, from January 2020 to June 2021. A total of 100 women presenting with signs and symptoms of preterm labour with live singleton pregnancy and intact membranes were included. All the women were divided into Group-A (n=50) and Group-B (n=50). Group-A received oral Nifedipine 20 mg of oral initially and 10 mg Nifedipine repeated after 30 minutes if the contractions persisted. Oral Nifedipine 10 mg was repeated every six hours till contractions subsided, and a transdermal Nitroglycerin patch (25 mg) was directly applied to the skin of the abdomen in Group-B. Demographic profile, the number of patients in which tocolysis was successful, improvement in Bishop score, prolongation in gestational age, maternal sideeffects, and foetal outcomes in the form of birth weight, APGAR score, and NICU admission were recorded in both the groups on Excel sheet. Chi-square test and t-test were used to test the significance of the difference between categorical and continuous variables respectively. A p-value less than 0.05 were taken as significant. Results: In Group-A 94% (47 out of 50) achieved tocolysis while in Group-B 86% (43 out of 50) achieved tocolysis (p value-0.182). The mean prolongation of pregnancy was 17.70±13.04 and 13.14±11.03 in Groups A and B, respectively. The maternal complication was significantly higher in Group-B as compared to Group-A (22% Vs 6%, p-value-0.0097). In Group-A mean birth weight was 2.422 kg ±0.34 whereas in Group-B mean birth weight was 2.204±0.38 Kg (p-value-0.0032). Conclusion: Both drugs oral Nifedipine and transdermal Nitroglycerine were found to be effective in the treatment of preterm labour. [ABSTRACT FROM AUTHOR]

Background/Objectives: Fetal spina bifida (fSB) is the most common neural tube defect, and intrauterine repair has become a valid treatment option for selected cases. If fSB repair is offered, the ideal time for surgery is from 24 to 26 gestational weeks (GWs). The preoperative steroids for lung maturation and preoperative tocolytics that are administered are known to increase the prevalence of gestational diabetes (GD), which normally occurs in about 10–15% of all pregnant women. This study assessed the prevalence, possible influencing factors, and consequences on the course of pregnancy regarding GD in this cohort. Methods: Between 2010 and 2022, 184 fSB cases were operated. Those patients operated on after 24 0/7 GWs received steroids before surgery. All the patients received tocolysis, and an oral glucose tolerance test was performed between 26 and 28 GWs at least 7 days after steroid administration. In 2020, we established an early postoperative mobilization protocol. The perioperative management procedures of those patients with and without GD were compared to each other, and also, the patients treated according to the early mobilization protocol were compared to the remaining cohort. Results: Nineteen percent were diagnosed with GD. Corticosteroids were administered in 92%. Neither the corticoid administration nor the interval between the administration and glucose tolerance test was different in patients with or without GD. Further, 99.5% received postoperative tocolytics for at least 48 h. The women with GD had significantly longer administration of tocolytics. The length of stay (LOS) was higher in those patients with GD. The gestational age (GA) at delivery was significantly lower in the cohort with GD. In the early mobilized group, we found a significantly higher GA at delivery (37.1 GWs vs. 36.2 GWs, p = 0.009) and shorter LOS (p < 0.001), and their GD rate was lower (10% vs. 20%), although not statistically significant. Conclusions: The GD incidence in the women after fSB repair was higher than in the usual pregnant population. Early mobilization, rapid tocolytics decrease, and shorter LOS could benefit the pregnancy course after fSB repair and may decrease the risk for GD in this already high-risk cohort without increasing the risk for preterm delivery. [ABSTRACT FROM AUTHOR]

• Any suspicion of placental tumour, requires assessment with feto-maternal specialist. • Placental chorioangioma classified into small and large. • Large placental chorioangioma causes significant maternal and perinatal morbidity. • Combined care between a feto-maternal specialist, anaesthetic and neonatologist. Placental chorioangioma is a benign placenta tumour. Majority of cases, the placental chorioangioma are small and no maternal and fetal complications. We highlight a case diagnosed with large placental chorioangioma with an intrapartum event associated with significant maternal and perinatal morbidity. A 38-year-old woman, Gravida 3 Para 1, with one previous miscarriage, presented with preterm labour at 33 weeks gestation. Antenatally, she was referred to a feto-maternal specialist for finding a placental tumour size 12 × 10 cm. Features are consistent with placental chorioangioma with polyhydramnios. The anomaly scan was normal. Antenatal fetal surveillance with Doppler studies were normal. During this admission, corticosteroid was given together with a tocolytic agent and opioid analgesia. Unfortunately, the labour progressed, and the patient felt reduced in fetal movement. The cardiotograph showed suspicious tracing. We proceed with emergency caesarean delivery. The placenta was sent for histopathology assessment which confirmed a large placental chorioangioma. The baby was born with Apgar's score of 9 at 1 min, pH of 7.28 and lactate of 7.28 with anaemia and thrombocytopenia. The uterus developed intermittent uterine atony, and the uterotonic agent was given. She recovered well post-delivery. The baby was admitted to the neonatal intensive care unit (NICU) and received a blood product transfusion and discharged from NICU on day 15 of life. Large placental chorioangioma is associated with polyhydramnios, preterm labour, postpartum haemorrhage, fetal anaemia, fetal distress, fetal hydrops and possible perinatal death. Multidisciplinary team involvement with feto-maternal specialists, anaesthetic and neonatologists would improve the outcome of both mother and fetus. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate differences in maternal characteristics and obstetric and offspring childhood outcomes between births at and after 37 weeks of gestation (referred to as term and post-term births) according to the use of tocolytic treatment. Methods: Data for 63,409 women with singleton births at and after 37 weeks of gestation were analyzed using data from the Japan Environment and Children's Study (JECS). We compared maternal characteristics, obstetric outcomes, and offspring childhood outcomes between term and post-term births exposed and not exposed to tocolytic treatment. Additionally, multivariable logistic regression models were used to calculate adjusted odds ratios for offspring childhood outcomes with significant between-group differences in the univariable analysis, with term and post-term births without tocolytic agents as the reference group. Results: We observed differences in maternal characteristics and obstetric outcomes between term and post-term births exposed and not exposed to tocolytic treatment. The incidence of offspring childhood developmental disorders showed no significant between-group differences. However, participants exposed to tocolytic agents had higher incidence of offspring childhood allergic disorders. The adjusted odds ratio for any of the offspring childhood allergic disorders in term and post-term births with tocolytic agents was 1.08 (95% confidence interval, 1.03–1.13). Conclusion: This study found no significant difference in the incidence of offspring developmental disorders between term and post-term births exposed and not exposed to tocolytic treatment. However, tocolytic treatment was associated with differences in maternal characteristics and obstetric outcomes, along with a marginal increase in the incidence of childhood allergic disorders in offspring. [ABSTRACT FROM AUTHOR]

Aim: In Japan, unlike Western countries, tocolytic agents are administered in long‐term protocols to treat threatened preterm labor. Evaluating the side effects of this practice is crucial. We examined whether ritodrine hydrochloride had been administered in cases of maternal death, aiming to investigate any relationship between ritodrine administration and maternal death. Methods: This retrospective cohort study used reports of maternal deaths from multiple institutions in Japan between 2010 and 2020. Data on the reported cases were retrospectively analyzed, and data on the route of administration, administered dose, and clinical findings, including causes of maternal death, were extracted. The amount of tocolytic agents was compared between maternal deaths with ritodrine administration and those without. Results: A total of 390 maternal deaths were reported to the Maternal Death Exploratory Committee in Japan during the study period. Ritodrine hydrochloride was administered in 32 of these cases. The frequencies (n) and median doses (range) of oral or intravenous ritodrine hydrochloride were 34.4% (11) and 945 (5–2100) mg and 84.4% (27) and 4032 (50–18 680) mg, respectively. Frequencies of perinatal cardiomyopathy, cerebral hemorrhage, diabetic ketoacidosis, and pulmonary edema as causes of maternal death were significantly higher with ritodrine administration than without it. Conclusions: Our results suggest a relationship between long‐term administration of ritodrine hydrochloride and an increased risk of maternal death due to perinatal cardiomyopathy, cerebral hemorrhage, diabetic ketoacidosis, and pulmonary edema. In cases where ritodrine should be administered to prevent preterm labor, careful management and monitoring of maternal symptoms are required. [ABSTRACT FROM AUTHOR]

What Is Known and Objective. Tocolytic agents are used to prolong gestational age and prevent immediate preterm birth (PTB). This study aims to provide an overview of the use of tocolytics among patients with PTB in China through retrospectively analyzing trends in application, influencing factors, and inappropriate prescriptions. Methods. The prescription data of five tocolytic agents from 2016 to 2021 were extracted from the database of the Hospital Prescription Analysis Cooperation Project. Drug consumption was expressed as number of prescriptions, cost of prescriptions, and DDDs (defined daily doses). Pearson correlation analysis was used to examine the association between DDDs and DDC (defined daily cost). The appropriateness of prescriptions was analyzed in terms of drug dosage form, administration, clinical diagnosis, and combined medication. Results. The total number of tocolytic prescriptions and the total cost of tocolytic agents increased by 6.12% and 387.58%, respectively, over the six‐year duration of the study. From 2016 to 2021, the ranking of the number of prescriptions and DDDs of tocolytic agents was magnesium sulfate > ritodrine > nifedipine > indomethacin > atosiban. During the study period, the cost of tocolytic agents increased significantly, which was mainly related to the increased costs of magnesium sulfate in 2017 and atosiban in 2018 and 2019. The ranking of DDCs was atosiban > ritodrine > magnesium sulfate > nifedipine = indomethacin from 2016 to 2021. For atosiban, the DDC was negatively correlated with the DDDs. Inappropriate prescription, which accounted for 14.84% of all prescriptions, was mainly manifested in the inappropriate selection of nifedipine dosage form, low frequency of nifedipine and indomethacin, and overdosing of ritodrine. Furthermore, 22.87% of tocolytic prescriptions remained active after 34 weeks of gestation, and 7.24% of the prescriptions authorized the use of combination drugs, with magnesium sulfate and nifedipine being the most commonly prescribed combination. What Is New and Conclusion. Magnesium sulfate, ritodrine, and nifedipine were the top three tocolytic agents. As the inappropriate use of tocolytic agents continues to persist, it is important to intensify efforts to ensure the safety and the appropriateness of maternal medication. [ABSTRACT FROM AUTHOR]

• The cervical pessary is not useful in the prevention of preterm births (<34 weeks) in triplet pregnancies. • It is likely that being pregnant with triplets is a powerful independent factor associated with prematurity. • Triplet pregnancies and at risk of preterm labor and those taking tocolytics±glucocorticoids may benefit from pessary insertion. Premature births are a health problem arising in triplet pregnancies, resulting in high levels of morbidity and mortality. The objective of this study is to evaluate the utility of cervical pessaries in reducing prematurity (<34 weeks) in triplet pregnancies. This is a single-center, retrospective case-control study regarding triplet pregnancies with follow-up at the La Paz University Hospital between 2000 and 2023. Maternal characteristics, obstetric and perinatal outcomes, and the use of cervical pessaries were examined. 165 triplet pregnancies were analyzed: 87 (52.7 %) in the case group (premature triplet pregnancies) and 78 in the control group (non-premature triplet pregnancies). A cervical pessary was inserted in 15 (17.2 %) triplet pregnancies in the case group and in 12 (16.7 %) triplet pregnancies in the control group (p = 0.92; OR = 1.04 (0.46–2.35)). A pessary was later inserted in the non-premature group (p = 0.01). The risk of preterm labor and the use of tocolytics ± glucocorticoids were found to be significantly more frequent in the premature group, with p = 0.01; OR = 2.30 (1.21–4.36) and p < 0.01; OR = 2.36 (1.23–4.44), respectively. Protocol-based cesarean sections were more frequent in the non-premature group (p < 0.01), while cesarean sections due to maternal complications (p < 0.01) and premature membrane rupture (p < 0.01) were more frequent in the premature group. The cervical pessary is not useful in preventing preterm births (< 34 weeks) in triplet pregnancies. It is likely that being pregnant with triplets is a powerful independent factor associated with prematurity, despite other pregnancy conditions. Women who are pregnant with triplets and at risk of preterm labor and those taking tocolytics ± glucocorticoids may benefit from pessary insertion. [ABSTRACT FROM AUTHOR]

Preterm birth remains a significant global health challenge, affecting approximately 10% of pregnancies and resulting in one million deaths globally every year. Tocolytic agents, used to manage preterm labour, have considerable limitations including lack of efficacy, and adverse side effects, emphasising the urgent need for innovative solutions. Here, we explore repurposing an antiplatelet cardioprotective drug, ticagrelor, as a potential treatment to prevent preterm birth. Ticagrelor has demonstrated pleiotropic actions beyond platelet inhibition, including relaxant effects on smooth muscle cells and anti-inflammatory effects in models of diabetes and sepsis. As preterm birth is underscored by inflammatory processes triggering uterine contractions, these actions position ticagrelor as an attractive candidate for prevention or delay of preterm birth. Utilising primary human myometrial tissue, human myometrial cells, and a mouse model of preterm birth, we investigated ticagrelor's potential as a safe and effective therapy for preterm birth. We showed that ticagrelor did not reduce the frequency or strength of spontaneous muscle contractions of ex vivo myometrial tissue nor did it reduce in vitro inflammation-induced contractility in myometrial cells. Additionally, ticagrelor did not exhibit the anticipated anti-inflammatory effects in myometrial cell culture experiments. In our mouse model of preterm birth, ticagrelor neither improved the preterm birth rate or fetal survival outcomes. Gene expression of pro-inflammatory cytokines and contraction-associated proteins in postpartum mouse uteri were unaltered by ticagrelor. In conclusion, ticagrelor is not a strong candidate to continue investigations in clinical trial for the treatment of preterm labour and prevention of preterm birth. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the efficacy of nifedipine use in our clinic for treatment of preterm labor with diferent effacement degrees, and to compare our results with the literature. Methods: 440 Singleton pregnant women with intact amnionic membrane pregnant women in their 23 and 36 weeks were retrospectively evaluated. Because of different criterias defining preterm labor in the literature, patients were divided into two groups as 4 or over contractions in 20 minutes and cervical opening at 2 cm and/or above and/or effachment at 80% or above (Group A, n = 230) and 4 or over contractions in 20 minutes and cervical opening below 2 min and effechment below 80% (Group B, n = 210). Descriptive statistics were conducted using chi-square and Mann Whitney U test, and statistically significance was P < 0.05. Results: Demographics, reproductive history and pregnancy weeks of the groups were similar. The average time between the start of tocolysis and the birth was 4 times higer in Group B (0.1-99.2, mean 28.4) than that of Group A (0.1-78.9, mean 7.4 days, P < 0.001). Delay after tocoloysis at days 1 to 7 was statistically remarkable in Group B (P < 0.001, for each). Preterm labor resulting in early birth was more remarkable in Group A in both before 34 weeks and 37 weeks (P < 0.001, for each; n = 88, 38.3% vs n = 36, 17.1% and n = 171, 74.3% vs n = 98, 46.7%, respectively and n = 269/124, 28.2 vs 61.1%). Delay with nifedipine at day 1 (87.5%), day 2 (79.1%), day 3 (74.8%) and day 7 (65.5%) was also compatable with the literature. Conclusions: Nifedipine is an effective tocolytic agent in preterm labor regardless of the effachment degree. [ABSTRACT FROM AUTHOR]

Preterm delivery is a considerable burden on prenatal healthcare and a major risk factor for neurological impairment and disability. A study looked at whether an aqueous extract of Syzygium cumini (AESC) bark could stop rats from giving birth too early. The DPPH and ABTS radical scavenging assays were used to evaluate the antioxidant activity of AESC in vitro, and the results showed that this extract possesses free radical scavenging activity, which helps to prevent premature labour. A piece of an isolated rat uterus was used for in-vitro pharmacological testing of the AESC at 25 mg/ml and 50 mg/ml. The extract showed free radical scavenging activity, effectively suppressing uterine contractions by 45.7% and 66.9%, respectively. The researchers concluded that AESC has considerable tocolytic activity, resulting in a decrease in the rate of premature birth. The extract showed no significant adverse effects on mothers or their infants, suggesting it may be a safe option for pregnant individuals seeking to prevent preterm labor. The extract also exhibited a dose-dependent effect, with higher doses resulting in a greater reduction in premature birth rates, further supporting its efficacy as a tocolytic agent. [ABSTRACT FROM AUTHOR]

Introduction: Wide use of medical management of preterm labour has been obstructed due to low success rate of arrest of labour. This is aggravated by higher incidence of serious side effect of the available tocolytic agents, especially betamimetic tocolytics. With this background, the present study was carried out to compare the efficacy and maternal side effect of magnesium sulphate and Isoxsuprine in the arrest of preterm labour. Methodology: This was a comparative prospective interventional study conducted among pregnant women coming to department of obstetrics and gynaecology with 28 to 37 weeks of gestation. Patients were divided in to two groups - Group 1 receiving Isoxsuprine and Group 2 receiving Magnesium Sulphate. Base line profile and outcome were compared between the two study groups. Results: Magnesium sulphate was more effective in arresting labour compared to Isoxsuprine (p<0.05). Tachycardia and hypotension were observed more frequently in group1 (Isoxsuprine) compared to group 2 (MgSO4). In cases having <1 cm dilatation and or less than 25% effacement MgSO4 was significantly more effective that Isoxsuprine for tocolysis. Conclusion: Magnesium sulphate is a more effective tocolytic agent than Isoxsuprine. Magnesium sulphate produce lesser maternal and foetal side effects like hypotension, palpitation, tachycardia as compared to Isoxsuprine. [ABSTRACT FROM AUTHOR]

This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the management of preterm labor. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of examinations with the aim to improve the accuracy in diagnosing preterm labor and allow timely and appropriate administration of tocolytics, antenatal corticosteroids and magnesium sulphate and avoid unnecessary or excessive interventions. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world in the light of scientific literature and serves as a guideline for use in clinical practice. [ABSTRACT FROM AUTHOR]

Twins represent 3.2% of all live births. However, they account for 20% of all preterm deliveries, 60% delivering <37 weeks, 10.7% <32 weeks, and 5 times higher risk of infant death. Risk factors for preterm birth (PTB) include the history of preterm delivery, monochorionic twins, short cervical length, and cervical surgery. Transvaginal cervical length <24 weeks is the best tool to predict PTB. Only vaginal progesterone in women with transvaginal cervical length <25 mm and physical exam indicated cerclage in women with cervical dilation >1 cm have shown a significant decrease in PTB and improvement in neonatal outcomes. INSET: 0. [ABSTRACT FROM AUTHOR]

We evaluated the impact of cervical cerclage combined with one or more uterine contraction inhibitors in persistent inhibition of uterine contraction for the treatment of late abortion and premature delivery. This retrospective case series study analysed the medical data of 58 patients who underwent cervical cerclage for cervical insufficiency and simultaneously received one or more uterine contraction inhibitors (indomethacin, ritodrine, and atosiban) and magnesium sulphate at the Zibo Maternal and Child Health Hospital between January 2019 and December 2020. Patients are normal pregnancy who received cervical cerclage without complications. The rate of successful treatment was 74.14% (43/58). The prolonged gestation duration was 16.42 ± 7.84 weeks, and the average delivery gestational age was 35.91 ± 5.16 weeks. The longest duration of treatment with a uterine contraction inhibitor or inhibitors in combination or with magnesium sulphate alone was 15.34 ± 13.16 days, and nine cases developed adverse reactions. Persistent uterine contraction inhibition after cervical cerclage could prolong pregnancy and improve pregnancy outcomes. What is already known on this subject? A crucial reason for treatment failure of cervical cerclage is that uterine contraction was not effectively inhibited. What do the results of this study add? Persistent inhibition of uterine contraction after cervical cerclage prolonged pregnancy duration, increased gestational age at delivery, and improved pregnancy outcomes. What are the implications of these findings for clinical practice and/or further research? This study may provide a clinical basis for prolonging gestational age, preventing late abortion and premature delivery, and improving the survival rate and quality of life of premature infants. [ABSTRACT FROM AUTHOR]

Background: Preterm birth has been a common concern with increasing incidence globally and is a continuous challenge for Obstetricians. Preterm birth is seen to be complicating nearly 8-10% of the birth rate. The etiology of preterm birth is still unknown and the associated burden is quite high. Aim: To assess the safety and efficacy of Nitroglycerine used transdermally as a tocolytic agent in females with preterm labor. Methods: The present prospective clinical study assessed 200 females having preterm labor. These 200 females were divided into two groups with 100 subjects each which were randomly divided into bed rest alone or the Nitroglycerine patch group. The study was done for 6 months period. Results: Pregnancy was prolonged by <48 hours in 6% (n=6) subjects, by 48-72 hours in 8% (n=8) subjects, 73-96 hours in 22% (n=22) subjects, and by ≥7 days in 56% (n=56) study subjects. Tocolysis induced in 100 Group I subject was successful in 94% (n=94) subjects and was unsuccessful in 6% (n=6) study subjects. The resuscitation needs and Apgar scores of <7 at 5 minutes were significantly lesser in Group I with p=0.02 for both. The number of Low-birth-weight subjects with a weight of =1.8 kg and 1.9-2.1 kg was significantly lesser in group I with 10 and 14 subjects compared to Group II subjects where it was 16 and 34 subjects. Conclusion: The present study concludes that Nitroglycerine used transdermally in females with preterm labor has equal efficacy as other commonly used tocolytic agents. Nitroglycerine is a drug of choice for the acute relaxation of the uterus in subjects with preterm labor. [ABSTRACT FROM AUTHOR]

Preterm labor occurs in around 10% of pregnancies worldwide. Once diagnosed, significant efforts must be made to reduce the likelihood of morbidity and mortality associated with preterm birth. In high‐resource settings, access to hospitals with a neonatal intensive care unit (NICU) is readily available, whereas access to NICU care is limited in low‐ and middle‐income countries (LMICs) and many rural settings. Use of FIGO's Prep‐for‐Labor triage method rapidly identifies low‐ and high‐risk patients with preterm labor to enable clinicians to decide whether the patient can be managed on site or if transfer to a level II–IV facility is needed. The management steps described in this paper aim to minimize the morbidity and mortality associated with preterm labor and in the setting of preterm labor with preterm premature rupture of membranes (PPROM). The methods for accurate diagnosis of PPROM and chorioamnionitis are described. When the risk of preterm birth is high, antenatal corticosteroids should be administered for lung maturation combined with limited tocolysis for 48 hours to permit the corticosteroid course to be completed. Magnesium sulfate is also administered for fetal neuroprotection. Implementation of FIGO's Prep‐for‐Labor triage method in an LMIC setting will help improve maternal and neonatal outcomes. Synopsis: FIGO's Prep‐for‐Labor triage method to manage preterm labor, PPROM, and chorioamnionitis includes administration of antibiotics, corticosteroids, magnesium sulfate, and tocolytics. [ABSTRACT FROM AUTHOR]

To investigate the adherence of German perinatal specialist units and those of basic obstetric care to the national guideline we compared data from a nation-wide survey on the practice of maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in the perioperative setting of cervical cerclage, and bedrest during and after tocolysis with recommendations from the current German Guideline 015/025 "Prevention and Treatment of Preterm Birth". A total of 632 obstetric clinics in Germany were approached and received a link to an online questionnaire. Data were descriptively analyzed by performing measures of frequency. To compare two or more groups Fisherʼs exact test was used. The response rate was 19%; 23 (19.2%) of respondents did not perform maintenance tocolysis, while 97 (80.8%) conducted maintenance tocolysis; 30 (25.0%) of obstetric units performed cervical cerclage without tocolysis and 90 (75.0%) combined cervical cerclage with tocolysis; 11 (9.2%) of respondents did not use tocolytics in patients with preterm premature rupture of membranes, while 109 (90.8%) conducted tocolysis in these patients; 69 (57.5%) of obstetric units did not recommend bed rest during tocolysis, whereas 51 (42.5%) favored bedrest. Perinatal care centers of basic obstetric care recommend bed arrest during tocolysis statistically significant more often to their patients than those of higher perinatal care levels (53.6 vs. 32.8%, p=0.0269). The results of our survey are in accordance to others from different countries and reveal considerable discrepancies between evidence-based guideline recommendations and daily clinical practice. [ABSTRACT FROM AUTHOR]

Preterm labor leading to preterm birth is the leading cause of infant morbidity and mortality. At the present time, nothing can reliably halt labor once it begins. The knowledge that agonists of the β2 adrenergic receptor relax airway smooth muscle and are effective in the treatment of asthma led to the notion that β2 mimetics would prevent preterm birth by relaxing uterine smooth muscle. The activation of cAMP-dependent protein kinase by β2 receptors is unable to provide meaningful tocolysis. The failure of β2 agonists such as ritodrine and terbutaline to prevent preterm birth suggests that the regulation of uterine smooth muscle is disparate from that of airway. Other smooth muscle quiescent-mediating molecules, such as nitric oxide, relax vascular smooth muscle in a cGMP-protein kinase G-dependent manner; however, nitric oxide activation of protein kinase G fails to explain the relaxation of the myometrium to nitric oxide. Moreover, nitric oxide-mediated relaxation is blunted in preterm labor, and thus, for this reason and because of the fall in maternal blood pressure, nitric oxide cannot be employed as a tocolytic. The β3 adrenergic receptor-mediated relaxation of the human myometrium is claimed to be cAMP-dependent protein kinase-dependent. This is scientifically displeasing given the failure of β2 agonists as tocolytics and suggests a non-canonical signaling role for β3AR in myometrium. The addition of the β3 agonist mirabegron to pregnant human myometrial strips in the tissue bath relaxes oxytocin-induced contractions. Mirabegron stimulates nitric oxide production in myometrial microvascular endothelial cells, and the relaxation of uterine tissue in vitro is partially blocked by the addition of the endothelial nitric oxide synthase blocker Nω-Nitro-L-arginine. Recent data suggest that both endothelial and smooth muscle cells respond to β3 stimulation and contribute to relaxation through disparate signaling pathways. The repurposing of approved medications such as mirabegron (Mybetriq™) tested in human myometrium as uterine tocolytics can advance the prevention of preterm birth. [ABSTRACT FROM AUTHOR]

Background Preterm birth (PTB) is the most common cause of neonatal morbidity and mortality worldwide. Tocolytic drugs had not been shown to improve fetal outcome, but were used to postpone delivery for 48 h to allow for maximal effect of parenteral steroids administered to the mother. The aim of the current study was to evaluate the outcomes of nursing monitoring for the pregnant mother under tocolytic therapy. Design An observational, comparative design was used to achieve the aim of the study. Setting The study was conducted at El Manial University Hosbital and El Galaa Maternity Teaching Hospital. Sample A convenience sample collected throughout one year of 30 preterm pregnant mothers under tocolytic therapy in each hospital. Tools Four tools were used: tool (1) Structured interviewing questionnaire, (2) Tocolytic monitoring, (3) Partograph, and (4) Apgar score. Result The study findings showed that 53.4% of mothers in group A as compared with 63.3% in group B received Epilate as a tocolytic agent. It shows that there were no statistically significant differences among both groups related to mean frequency of uterine contractions and mean duration of U.C, P=(0.329 and 0.189, respectively). It also shows that the side effects of tocolytic drugs in the first 24 h were dizziness, headache, tachycardia, and hypotension in group A (3.3%, 10%, 3.3%, and 6.7, respectively) as compared with (0%, 6.7%, 0%, and 10%, respectively). While only one 3.3% mother in group A had a fetus with bradycardia as a side effect of tocolytic drugs. In all, 93% and 96.7% of mothers in both groups had inhibition of uterine contractions and prolonged their pregnancy for 24 h. Conclusion Based on the results of this study, it could be concluded that tocolytic agents that were administered for 48 h reduced the uterine contractions and increased the period of pregnancy for preterm pregnant mother and improved neonatal outcomes by giving corticosteroids, but they had minimal side effects that occurred for mother and fetus in both groups. Recommendation (1) Close monitoring for all preterm pregnant women who are under tocolytic agents, (2) the newborn for women under tocolytic agents should be under close monitoring, and (3) provide education in the same strain to all nurses working in the maternity hospital with regard to care of women under tocolytic agents. [ABSTRACT FROM AUTHOR]

Introduction: Preterm delivery and its complications are among the biggest challenges and health risks in obstetrical practice. Several tocolytic agents are used in clinical practice, although the efficacy and side effect profiles of these drugs are not satisfying. The aim of this study was to investigate the uterus relaxant effect of the coadministration of β2‐mimetic terbutaline and magnesium sulfate (MgSO4) in an isolated organ bath and to perform in vivo smooth muscle electromyographic (SMEMG) studies in pregnant rats. In addition, we also investigated whether the tachycardia‐inducing effect of terbutaline can be reduced by the presence of magnesium, due to the opposite heart rate modifying effects of the two agents. Material and methods: In the isolated organ bath studies, rhythmic contractions of 22‐day‐ pregnant Sprague–Dawley rats were stimulated with KCl, and cumulative dose–response curves were constructed in the presence of MgSO4 or terbutaline. The uterus‐relaxing effects of terbutaline were also investigated in the presence of MgSO4 in both normal buffer and Ca2+‐poor buffer. The in vivo SMEMG studies were carried out under anesthesia with the subcutaneous implantation of an electrode pair. The animals were treated with MgSO4 or terbutaline alone or in combination in a cumulative bolus injection. The implanted electrode pair also detected the heart rate. Results: Both MgSO4 and terbutaline reduced uterine contractions in vitro and in vivo, furthermore, the administration of a small dose of MgSO4 significantly enhanced the relaxant effect of terbutaline, especially in the lower range. However, in Ca2+‐poor environment, MgSO4 was not able to increase the effect of terbutaline, indicating the role of MgSO4 as a Ca2+ channel blocker. In the cardiovascular studies, MgSO4 significantly decreased the tachycardia‐inducing effect of terbutaline in late pregnant rats. Conclusions: The combined application of MgSO4 and terbutaline may have clinical significance in tocolysis, which must be confirmed in clinical trials. Furthermore, MgSO4 could substantially reduce the tachycardia‐inducing side effect of terbutaline. [ABSTRACT FROM AUTHOR]

This systematic review aimed to identify the benefits and possible harms of tocolytic therapy for preterm labour management in the context of pregnant women with extremely preterm birth, multiple gestations, or growth-restricted foetuses. A comprehensive search using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO Global Index Medicus databases was conducted from 10 to 15 July 2021. We included randomized controlled trials and non-randomized studies that assessed the effects of tocolysis compared with placebo or no treatment. We found 744 reports and, finally, nine studies (three randomized controlled trials and six cohort studies) pertaining to women with <28 weeks of gestation were included. No eligible studies were identified among women with a multiple pregnancy or a growth-restricted foetus. A meta-analysis of the trial data showed that there were no clear differences in perinatal death nor for a delay in birth. Non-randomized evidence showed that tocolysis delayed birth by 7 days, though there was no clear difference for preterm birth. In summary, it remains unclear whether tocolytic therapy for inhibiting preterm labour is beneficial for these subgroups of women and their newborns. Further well-designed randomized controlled trials and observational studies are needed to address the lack of evidence regarding tocolytic agents in these populations. [ABSTRACT FROM AUTHOR]

The article focuses on the implications of Nakamura et al.'s study, which highlights the risks associated with long-term ritodrine use during perinatal care. Topics include the author's personal reflections on the continued use of ritodrine despite known risks, the belief in Japan's ability to manage adverse effects, and the need to reassess reliance on personal experience versus evidence-based medicine.

Human gestation and birthing result in many deviations from usual physiology that are nonetheless normal to be seen. However, on occasion, certain complications in the obstetric patient can be life-threatening to both mother and fetus. Timely recognition of these disorders and allocation of the appropriate resources are especially important. These conditions often require an intensive care unit admission for closer monitoring and supportive care. They can affect an array of physiological systems and can lead to significant morbidity. Such complications are discussed in greater detail in this article. [ABSTRACT FROM AUTHOR]

Objective  Physical examination–indicated cerclage for cervical insufficiency prolongs gestation, but evidence on the addition of adjuncts to further prolong latency is limited. The aim of this systematic review and meta-analysis was to compare gestational latency between those who did and did not receive adjunct antibiotic or tocolytic therapy at the time of examination-indicated cerclage. Study Design  Electronic databases (1966–2020) were searched for randomized controlled trials (RCTs) and cohort studies comparing adjunct antibiotic or tocolytic use versus nonuse at time of examination-indicated cerclage, defined as placement for cervical dilation ≥1 cm, in a current singleton pregnancy. Studies including individuals with intra-amniotic infection, cerclage in place, nonviable gestation, or ruptured membranes were excluded. The primary outcome was latency from cerclage placement to delivery. Secondary outcomes included preterm birth, preterm premature rupture of membranes, birth weight, and neonatal survival. Risk of bias was assessed using standardized tools. Heterogeneity was assessed using χ 2 and I 2 tests. Results were pooled and analyzed using a random-effects model. This study is registered with The International Prospective Register of Systematic Reviews (PROSPERO) with registration no.: CRD42021216370. Results  Of 923 unique records, 163 were reviewed in full. Three met inclusion criteria: one RCT and two retrospective cohorts. The included RCT (n  = 50) and one cohort (n  = 142) compared outcomes with and without adjunct use of antibiotic and tocolytic, while the second cohort (n  = 150) compared outcomes with and without adjunct tocolytic, with a subpopulation also receiving antibiotics. The RCT was nested within one of the cohorts, and therefore only one of these two studies was utilized for any given outcome to eliminate counting individuals twice. Risk of bias was "critical" for one cohort study, "moderate" for the other cohort study, and "some concerns" for the RCT. Gestational latency could not be pooled and meta-analyzed. Adjunct tocolytic-antibiotic therapy was not associated with a decrease in risk of preterm delivery <28 weeks (relative risk [RR] = 0.90, 95% confidence interval [CI]: 0.65–1.26; χ 2  = 0.0, I 2  = 0.0%) or neonatal survival to discharge (RR = 1.11, 95% CI: 0.91–1.35; χ 2  = 0.05, I 2  = 0.0%). Conclusion  There is not enough evidence to robustly evaluate the use of adjunct tocolytics or antibiotics at time of examination-indicated cerclage to prolong latency. Key Points Limited data on adjunct antibiotic tocolytics at cerclage. Widely variable practices at time of cerclage identified. Role of adjunct therapies at time of examination-indicated cerclage remains unclear. [ABSTRACT FROM AUTHOR]

Objective  Since 2010, the American College of Obstetrics and Gynecology have released three committee opinions to recommend and reaffirm the utility of magnesium sulfate for neuroprotection and later for tocolysis to achieve antenatal steroid course completion in preterm labor. We sought to determine changes in antenatal magnesium sulfate exposure and other tocolytic agents for pregnancies resulting in neonatal intensive care unit (NICU)-admitted preterm infants. Study Design  Using the Pediatrix Clinical Data Warehouse, we evaluated all inborn infants delivered between 22 and 33 weeks' gestation and admitted to the intensive care units from 2009 to 2018. We classified patients based on antenatal exposure to tocolytic medications: calcium channel blockers (nifedipine and amlodipine), betamimetics (terbutaline, theophylline, and ritodrine), prostaglandin inhibitors (indomethacin), and magnesium sulfate. Results  A total of 229,781 patients met inclusion criteria. During the study period, magnesium sulfate exposure increased from 27.6 to 57.7% of births while betamimetic exposure decreased from 10.2 to 5.2%. Increasing magnesium sulfate exposure over time was seen at all gestational ages examined and magnesium exposure was most common between 23 and 31 weeks' gestation. By 2017 to 2018, 70.5% of 24 to 29 weeks' gestation NICU infants received exposure to at least one tocolytic agent while this remained at 53.7% of 32 to 33 weeks' NICU admitted infants. Antenatal steroid exposure increased from 74.8 to 87.4% during the study period. Conclusion  For NICU-admitted preterm infants, prenatal exposure patterns to tocolytic agents has shifted since 2009 with prenatal magnesium sulfate exposure increasing significantly. Antenatal steroid exposure has risen concurrently. Exposure to tocolytic agents is the highest among preterm infants born between 24 and 29 weeks' gestation. Key Points Exposure to magnesium sulfate significantly increased from 2009 to 2018 for NICU admitted infants. Concurrently, the use of other tocolytics decreased significantly. The use of antenatal steroids has been rising over time. [ABSTRACT FROM AUTHOR]

Aims:This study compared nifedipine and indomethacin treatments, commonly used tocolytic agents, in terms of efficacy and maternal side effects.Methods:This retrospective study included pregnant women spontaneous preterm labor between 24 and 32 weeks of gestation who were treated with indomethacin or nifedipine between January 2017 and June 2020. Subjects with polyhydramnios, multiple pregnancies, preterm premature rupture of membranes, and those with 4 cm or more cervical dilatation, and who required emergency cesarean delivery were excluded. Study endpoints were delivery within 48 h, prolongation of pregnancy up to 34 weeks and 37 weeks, and maternal side effects.Results:A total of 307 pregnant women were analyzed. Nifedipine and indomethacin were administered to 205 and 102 patients, respectively. The median maternal age was 25 years in both groups. The rate of delivery within 48 h was significantly higher by 20.6% among subjects who received indomethacin compared with the 9.8% delivery rate among subjects who received nifedipine (p=0.009). However, delivery after gestational 34 weeks and 37 weeks were significantly higher in the nifedipine group (p

1990; 50(6): 429-433. doi:10.1055/s-2008-10262762198191 14 Arabin B, Halbesma JR, Vork F, Hübener M, van Eyck J. Is treatment with vaginal pessaries an option in patients with a sonographically detected short cervix? For patients with a short cervix, interventions that have been studied include supplemental vaginal progesterone, cervical cerclage, and cervical pessary. A key weakness of the study is the inability to determine the root causes of the excess perinatal deaths in the pessary group to determine if this was attributable to pessary use or some other confounding factor. Perhaps the best studied pessary for preterm birth prevention was developed by Arabin and Alfirevic[12] in the late 1970s; prior to this, obstetricians primarily used pessaries designed to treat pelvic organ prolapse. [Extracted from the article]

Objective  The aim of this study was to determine the effects of a 2-day prenatal course of indomethacin on the premature kidney as reflected by serum creatinine and urinary biomarkers. Study Design  Urine of infants ≤32 weeks was collected for the first 14 days and analyzed for cystatin C, neutrophil gelatinase-associated lipocalin, osteopontin, β2 microglobulin, epidermal growth factor, uromodulin, and microalbumin. Bivariate analysis compared serum creatinine and biomarkers of exposed (INDO) and unexposed (CONT) subjects. Results  Fifty-seven infants (35 CONT and 22 INDO) were studied. The cohorts were similar in gestational age, birthweight, race, gender, nephrotoxic medication exposure, and Apgar's scores. CONT had more dopamine exposure and included more pre-eclamptic mothers (p  = 0.005). No difference in creatinine-based acute kidney injury or the log transformed mean, maximum, and minimum values of urinary biomarkers was detected. Conclusion  Our findings suggest that a short course of tocolytic indomethacin does not result in neonatal acute kidney injury. Key Points A short prenatal course of indomethacin does not result in neonatal acute kidney injury (AKI). Urinary EGF might have a promising role as a more sensitive biomarker for early detection of AKI in premature infants. [ABSTRACT FROM AUTHOR]

Objectives: Since late preterm neonates are physiologically less mature than term neonates, the use of antenatal corticosteroids in the late preterm period has been recommended. The use of tocolytics can also be considered to gain valuable time for using antenatal corticosteroids in the late preterm period. In this study, we examined the efficacy of tocolytics on prolonging pregnancy in the late preterm period, by comparing women who received tocolytics with those who received none.Study Design: This retrospective cohort study included women who were admitted due to preterm labor after 34 weeks of gestation and delivered in the late preterm period. Primary outcome was time from admission to delivery (days). Secondary outcomes were the proportion of preterm births within 2 days, and within 7 days, completed cycles of antenatal corticosteroids, and the neonatal outcomes. Primary and secondary outcomes were compared according to the use of tocolytics. Propensity score matching was performed to create comparable groups. The maternal age, pre-pregnancy body mass index, nulliparity, history of preterm birth, hypertensive disease during pregnancy, gestational diabetes mellitus, history of preterm labor, gestational age at admission, cervical length, and the number of contractions were the baseline characteristics included in the propensity score.Results: Of 275 women, 44 women received tocolytics (tocolytics group) and 231 women did not (no tocolytics group). We matched 44 women who received tocolytics and 44 women who didn't. The tocolytics group was shown to exhibit a longer time from admission to delivery than the no tocolytics group, with a hazard ratio for tocolytics of 0.4 (95 % confidence interval, 0.2-0.6). In addition, the proportion of preterm births occurring within 2 days and 7 days were lower in those receiving tocolytics compared to those that didn't.Conclusion: In this propensity score matched-study, the use of tocolytics had a significant effect on pregnancy prolongation, which allows more time for use of corticosteroids in women with preterm labor after 34 weeks of gestation. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of calcium channel blockers in tocolytic therapy on obstetric outcomes. Material and methods: For our study, as a retrospective case control study, data were obtained from hospital records. During 2018, there were 65 patients hospitalized with a diagnosis of preterm labor and were treated with calcium channel blockers used as tocolytics (nifedipine, nicardipine) and these patients constituted the study group. Pregnant women with systemic disease were excluded from the total of 1552 patients who were followed and who gave birth in 2018. After exclusion to equalize the samples, we chose 65 healthy pregnant women from the remaining 646 healthy pregnancies using a simple random number table and these patients formed the control group. The obstetric and neonatal results of both groups were compared. Results: There was no difference between the groups in terms of birth week, preterm labor rate, low birth weight, and delivery type. While birth weights were significantly lower, the need for neonatal intensive care and the number of infants weighing 2500-3000 g were higher in the study group (p < 0.05). When the results of pregnancies that gave birth at term weeks and were not administered steroids were compared, the birth weight was lower and the number of infants weighing 2500-3000 g was higher in the study group. Conclusion: The use of calcium channel blockers in pregnancy may adversely affect birth weight gain and the need for intensive care. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of nifedipine used for tocolysis on cardiac morphology and functions. Methods: The study included 47 pregnant women diagnosed with preterm labor at 32–33 weeks. Fetal echocardiographic evaluation was performed with two‐dimensional (2D) imaging, M‐mode, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI) before and after the 48th hour of nifedipine treatment. Results: No significant change was observed in Doppler parameters (pulsatility indices of the umbilical artery, middle cerebral artery, ductus venosus) and cardiac morphology (cardiothoracic ratio, end‐diastolic longitudinal diameters, sphericity indices, wall thickness) after nifedipine treatment. The parameters obtained with TDI (e', a', s', e'/a', E/e' of mitral and tricuspid valves), M‐ mode (TAPSE, MAPSE), pulsed Doppler (myocardial performance index, left cardiac output, right cardiac output, tricuspid E, A waves, tricuspid E/A ratio, mitral E, A waves, mitral E/A ratio) did not change after nifedipine treatment. Conclusion: To date, this is the first study to examine the effects of nifedipine on the fetal heart using the TDI. Since nifedipine is a drug that is frequently used and well‐tolerated in the prevention of preterm labor, it is crucial that it does not cause changes in fetal cardiac parameters during tocolysis. Therefore, we used TDI in addition to conventional methods to evaluate the effect of nifedipine, which is frequently used in obstetrics, on cardiac functions in the early period. Nifedipine treatment seems not to affect systolic or diastolic functions. This indicates that nifedipine is reliable on cardiac functions and morphology in pregnancies treated for preterm labor. [ABSTRACT FROM AUTHOR]

What is known and objective: Premature birth affects more than 15 million infants, as well as mothers and families around the world. With the relaxation of the two‐child policy, the problem of premature birth has become relatively prominent in China. According to statistics, China had a birth population of 15.23 million in 2018, with a considerably large number of premature births. This study aims to evaluate the efficacy and safety of tocolysis in the treatment of preterm delivery, provide clinical evidence for medical staff and promote the self‐management of patients with premature births. Methods: Four English databases (PubMed, Embase, Cochrane Library and Web of Science) were retrieved by computer, the retrieval time was from the establishment of each database to November 2021, and the randomized controlled trials for the treatment of preterm delivery were screened according to the pre‐set natriuretic exclusion criteria. After literature screening, data selection and risk of bias evaluation were independently conducted by two researchers. R 4.1.1 and Stata 17.0 software were used for statistical analysis. Results and discussion: A total of 44 RCTs were included, including 6939 patients. The results of network meta‐analysis reveal that in terms of effectiveness, indomethacin was the most effective intervention measure, followed by nifedipine, and the difference was statistically significant; regarding safety, nifedipine was the safest intervention measure, followed by indomethacin, and the difference was statistically significant; and in respect of adverse reactions, ritodrine had the highest probability, and the difference was statistically significant. What is new and conclusion: Nifedipine may be better for delayed delivery and less likely to produce adverse pregnancy outcomes, followed by indomethacin. Limited by the number and quality of recipient studies, the aforementioned conclusions need to be verified through more high‐quality studies. At the same time, the focus should be on patients with twin pregnancy and patients with clinical manifestations of extreme preterm delivery. [ABSTRACT FROM AUTHOR]

Abstract Background We report a case of pulmonary edema induced by tocolytic agents that was successfully managed with noninvasive positive-pressure ventilation (NPPV) and resulted in extended gestation. Case presentation A 36-year-old Japanese pregnant woman received tocolytic therapy with ritodrine hydrochloride, magnesium sulfate, nifedipine, and betamethasone from 28 weeks of gestation. She developed respiratory failure. and her chest X-ray showed enlarged pulmonary vascular shadows. At 29 weeks and 1 day of gestation, she was diagnosed with pulmonary edema induced by tocolytic agents. Because respiratory failure worsened 2 days after ritodrine hydrochloride and magnesium sulfate were stopped, NPPV was initiated. Her respiratory status improved and she was weaned off of NPPV after 3 days. She underwent cesarean section because of breech presentation at 30 weeks and 0 days of gestation due to initiation of labor pains. Conclusions NPPV can be safely administered in cases of tocolytic agent-induced pulmonary edema during pregnancy.

The article focuses on the response to Professor Matsubara's comments regarding the use of ritodrine in perinatal care. Topics include the limitations of ritodrine in preventing preterm birth, the meticulous nature of perinatal management in Japan, and the need for increased awareness of the risks associated with long-term ritodrine use to prevent maternal deaths.

No consistent recommendations concerning the preferred tocolytic agents for intrauterine foetal resuscitation are available. We evaluated the effects of acute tocolysis (AT) using ritodrine hydrochloride on foetal heart rate (FHR) patterns and neonatal outcomes. We retrospectively analysed the data of patients undergoing emergency caesarean section because of non-reassuring foetal status indicated by foetal scalp electrodes. Patients were classified into AT (ritodrine hydrochloride approximately 500 µg/min) and control groups with 15 and 12 participants, respectively. FHR patterns, Apgar scores, umbilical arterial analysis, and neonatal admission were compared. All participants had FHR category II; decelerations disappeared in all foetuses in the AT group, with no significant difference in neonatal outcomes. The AT group had a higher baseline FHR and lower short-term FHR variability than the control group, indicating foetal autonomic responses. Further studies are needed to clarify the effects of AT on FHR patterns, neonatal outcomes, and foetal and neonatal autonomic responses. What is already known on this subject? The usefulness of acute tocolysis using ritodrine hydrochloride has been well-documented in several studies; however, such an application often induces side effects, such as maternal tachycardia, palpitations, and tremors. What the results of this study add? The short-term administration of ritodrine hydrochloride eliminated decelerations, with no significant difference in neonatal outcomes in pregnant women with foetal heart rate category II. Meanwhile, there were higher foetal heart rate and lower short-term foetal heart rate variability in pregnant women administered with ritodrine hydrochloride, indicating foetal autonomic responses. What the implications are of these findings for clinical practice and/or further research? Ritodrine hydrochloride administration, even for short-term, appears to be associated with foetal autonomic responses. Further studies with stratification of patient groups based on the severity and aetiology of non-reassuring foetal status, including pregnant women with foetal category III, would elucidate the risk and benefit of acute tocolysis using ritodrine hydrochloride, based on foetal heart rate patterns, neonatal outcomes, and foetal and neonatal autonomic responses. [ABSTRACT FROM AUTHOR]

Aims: This study compared nifedipine and indomethacin treatments, commonly used tocolytic agents, in terms of efficacy and maternal side effects. Methods: This retrospective study included pregnant women spontaneous preterm labor between 24 and 32 weeks of gestation who were treated with indomethacin or nifedipine between January 2017 and June 2020. Subjects with polyhydramnios, multiple pregnancies, preterm premature rupture of membranes, and those with 4 cm or more cervical dilatation, and who required emergency cesarean delivery were excluded. Study endpoints were delivery within 48 h, prolongation of pregnancy up to 34 weeks and 37 weeks, and maternal side effects. Results: A total of 307 pregnant women were analyzed. Nifedipine and indomethacin were administered to 205 and 102 patients, respectively. The median maternal age was 25 years in both groups. The rate of delivery within 48 h was significantly higher by 20.6% among subjects who received indomethacin compared with the 9.8% delivery rate among subjects who received nifedipine (p=0.009). However, delivery after gestational 34 weeks and 37 weeks were significantly higher in the nifedipine group (p<0.001 and p=0.003, respectively). No patients in the indomethacin group had side effects, but 6.8% of the nifedipine group required drug change due to side effects. Conclusions: This study showed that nifedipine was superior to indomethacin in achieving a 48-hour delay in preterm labor, increasing the gestational age at birth, and decreasing the preterm delivery rates. [ABSTRACT FROM AUTHOR]

Objectives: Current international guidelines recommend tocolytic treatment by at least 48 h to complete fetal lung maturation and to ensure in-utero transfer to a perinatal center before 34 weeks of gestation in patients with threatened preterm birth. According to the results of former surveys, significant differences between daily clinical practice patterns and evidence-based guideline recommendations regarding tocolytic treatment have been demonstrated. We compared data from a nation-wide survey on the practice of initial tocolysis with recommendations from the current German Guideline 015/025 "Prevention and Treatment of Preterm Birth".Study Design: 632 obstetric units in Germany received a link to an online questionnaire between January 20th and March 31st 2020, which was developed according to national and international recommendations and guidelines. Collected data was descriptively analyzed by performing measures of frequency.Results: The response rate was 19%; 51 (42.5%) of the respondents consider CTG tracing with ≥ 4 contractions within 20 min, 49 (40.8%) cervical length measurement of ≤ 25 mm and 13 (10.9%) subjective contractions as the most significant decision-making criteria for tocolysis; 47 (39.2%) of obstetric units initiate tocolysis earliest at 23 + 0, 34 (28.3%) at 22 + 0, 26 (21.7%) at 23 + 5 and 13 (10.8%) at 24 + 0 weeks of gestation; 104 (86.7%) stop tocolysis latest at the 34 + 0 weeks of gestation, 42 (35.0%) obstetric units administer antenatal corticosteroids at 23 + 5, 16 (13.3%) at 22 + 0, and 13 (10.8%) at 24 + 0 weeks of gestation. Calcium channel blockers are the first-line tocolytic drug used by 59 (49.1%) of the obstetric units, followed by intravenous betamimetics as bolus (n = 26, 21.7%) and atosiban (n = 20, 16.7%). Severe side-effects were observed by 105 (70%) of the respondents in association with the use of betamimetics, 14 (9.3%) with the use of nifedipine and 30 (20.0%) with nitroglycerine patches. The German guideline was considered the most important decision-making support by 78 (65%) of the obstetric units, followed by hospital specific SOPs/algorithms (n = 31, 25.8%).Conclusion: Our survey highlights a considerable discrepancy between evidence-based guideline recommendations and daily clinical practice. [ABSTRACT FROM AUTHOR]

Rationale: Daily limited access to palatable food or drink at a fixed time is commonly used in rodent models of bingeing. Under these conditions, entrainment may modulate intake patterns. Oxytocin is involved in circadian patterns of intake and, when administered peripherally, reduces sucrose intake. However, oxytocin's effects on intake under limited-access conditions and its potential interaction with entrainment have not been explored. Objectives: This study examined the role of entrainment on intake patterns, oxytocin's effects on sucrose intakes and locomotor activity and whether oxytocin's effects were mediated by its actions at the oxytocin receptor. Methods: Sated rats received daily 1-h access to 10% sucrose solution either at a fixed or varied time of day. Rats received intraperitoneal oxytocin (0 mg/kg, 0.3 mg/kg, 1 mg/kg, 3 mg/kg) prior to sucrose access, and spontaneous locomotor activity was assessed in an open-field test. Rats were then pre-treated with an oxytocin receptor antagonist, L368,899, prior to oxytocin before sucrose access. Results: Intake patterns did not differ between fixed- or varied-time presentations; rats consumed more sucrose solution in the middle as opposed to the early-dark phase. Oxytocin dose-dependently reduced sucrose intakes, but also reduced locomotor activity. There was some evidence of partial blockade of oxytocin-induced sucrose intake reductions by L368,899, but the results were unclear. Conclusions: Time of day and oxytocin impact sucrose solution intake under daily limited access in rats and the sedative-like effects of oxytocin should be considered in future studies on oxytocin and food intake. [ABSTRACT FROM AUTHOR]

Introduction: Preterm delivery is the leading cause of neonatal morbidity and mortality and its prevention is always under serious concern.Objective: The aim of the present study was to determine the efficacy of rectal progesterone as a maintenance tocolytic after arresting preterm labor, for increasing the duration of pregnancy, and postponing preterm birth.Method: The study was performed as a double blind randomized clinical trial on women with preterm labor in whom contractions have been stopped. The eligible women were randomly divided into two groups. In the intervention group (progesterone group), progesterone was administered rectally as a dose of 200 mg daily until 36+6 weeks or spontaneous delivery before that time, whichever came first; and in the placebo group, placebo was administered in a similar manner. Primary outcomes were number of deliveries before 37 weeks of gestation and time to delivery interval in two groups. Secondary outcomes were neonatal Apgar score and weight, and need for NICU admission.Results: 160 women finished the study (80 women in each group). The women of the two groups did not have significant difference according to the baseline characteristics. Frequency of preterm labor (earlier than 37 weeks) and mean gestational age at the time of delivery did not show significant difference in two groups. Also, neonatal outcome including Apgar score, birth weight, NICU admission and neonatal complications were not different between the two groups. The pregnancy length was longer in progesterone group (28.84 ± 3.36 VS 21.19 ± 4.62 days), [p = .001, CI 95%: 3.71-4.83]. The time-to-event (delivery) analysis showed a hazard ratio of 1.02 (95% CI 0.36-2.77).Conclusion: Rectal progesterone at a daily dose of 200 mg as a maintenance tocolytic agent, cannot lower the frequency of preterm delivery but was suggested to prolong pregnancy length. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of atosiban versus ritodrine as tocolytics in external cephalic version (ECV).Materials and Methods: A prospective comparative trial was carried out in a tertiary hospital. 430 women with singleton breech pregnancies ≥36 weeks were recruited for ECV, 215 with ritodrine and 215 with atosiban as tocolytic agents. The efficacy, complications and perinatal outcomes were compared between both groups. The associations between variables were analyzed using the chi-square test (χ2) (qualitative), Student's t test (quantitative, parametric) or Mann-Whitney test (nonparametric). Statistical significance was established as p < .05.Results: The overall ECV success rate was 47.9% (206/430), 46.0% in the atosiban group (99/215) and 49.8% in the ritodrine group (107/215). This difference showed no statistical significance (p = .440). A higher rate of uterine contractions after the maneuver was observed in the atosiban group (34.4 versus 22.8%; p = .008), but without clinical relevance. Perinatal outcomes were similar in both groups, with no significant differences.Conclusion: Atosiban and ritodrine showed similar efficacy as tocolytic agents in ECV, with no differences in complications and perinatal outcomes between these two agents. [ABSTRACT FROM AUTHOR]

Tocolysis is an obstetrical procedure carried out with the use of medicines for delaying the parturition presenting preterm contractions. Various tocolytics have been studied with the objective of stopping preterm labor, increasing gestational age at parturition and preventing complications related to preterm birth. Preterm parturition accounts for about 70% of neonatal calf deaths. Commonly used tocolytic medications include ß2 agonists, calcium channel blockers, NSAIDs, oxytocin and prostaglandin antagonistic and magnesium sulfate. These can assist in delaying preterm delivery by suppressing uterine muscle contractions and their use is intended to reduce fetal morbidity and mortality associated with preterm birth. The tocolytic medicated animal must be kept under intensive observation because of its adverse effects on cardiovascular system and other complications. The suppression of contractions is often only partial and tocolytics can only be relied to delay birth for a few days. Further research and professional guidelines are needed on optimal use of these agents. This review aims to summarize the major classes of tocolytics, their effects and review the evidence regarding use of each. [ABSTRACT FROM AUTHOR]

Introduction: Preterm birth is associated with increased mortality and morbidity. Tocolytic drugs, such as indomethacin, are often used to postpone preterm delivery. Indomethacin has been proven to be more effective than other tocolytic agents in terms of delaying birth but is often prescribed with caution because of its potential association with adverse neonatal outcomes. We aim to study the effects of antenatal indomethacin on neonatal outcomes after controlling for potential confounders, as compared to nifedipine and/or atosiban.Methods: In this cohort study, we performed a retrospective analysis of maternal and neonatal data. Women were included if they received indomethacin, nifedipine or atosiban as a tocolytic drug for imminent preterm labor and gave birth at a gestational age (GA) between 235/7 and 320/7 weeks, between 2010 and 2015. Main outcome measures were: neonatal death, necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), patent ductus arteriosus (PDA) and its treatment.Results: Four hundred seventy-four women, delivering 610 infants were investigated. The incidence of the following adverse neonatal outcomes were significantly higher after indomethacin use: neonatal death (p = .017), NEC (p = .026), SIP (p = .008), PDA (p = .000) and PDA ligation (p = .000). However, these associations showed to be nonsignificant after adjusting for confounders (adjusted odds ratio neonatal mortality 1.6 (0.7-3.8)), NEC 1.6 (0.6-4.4), SIP 2.8 (0.3-30.0), PDA 1.1 (0.6-2.2) and PDA ligation 2.2 (0.7-6.5).Conclusions: The presumed association between antenatal indomethacin exposure and several adverse neonatal outcomes may be based upon indication bias. Taking important confounding factors, such as GA at birth and neonatal birth weight into account, antenatal indomethacin exposure does not result in a higher incidence of adverse neonatal outcomes. However, there may be a higher risk for spontaneous intestinal perforation. [ABSTRACT FROM AUTHOR]