Analysis of the Effectiveness of Various Tocolytic Therapy Regimens
Study Objective: To compare the effectiveness of various tocolytic therapy regimens for prolonging pregnancy and improving neonatal outcomes in women with preterm labor, including those receiving tocolytic agents during transportation.
Study Design: This was a retrospective analysis.
Materials and Methods: The study analyzed 621 cases of preterm labor that occurred in 2015 at the Regional Perinatal Center, a government-funded healthcare institution in Yaroslavl Region. It included data from 63 women with preterm labor who received hexoprenaline (n = 16), atosiban (n = 12), nifedipine (n = 20), or indomethacin (n = 15) as tocolytic agents. In 21 cases, the pregnant women had received tocolytic agents during transportation to a level 3 hospital. The effectiveness of tocolytic therapy was assessed by length of prolongation of pregnancy, condition of the newborns, and whether or not preventive treatment for respiratory distress syndrome (RDS) was completed.
Study Results: Women receiving indomethacin and nifedipine had longer cervical length, and the number of full-term deliveries in these groups was significantly higher than in other groups (p < 0.05).
Preventive treatment for fetal RDS was given in all cases. This treatment was completed in all patients only in the indomethacin group (p < 0.05 in comparison to the other groups).
Analysis of tocolytic therapy given during transportation showed that preventive treatment for RDS had not been completed in only three patients (14.3%). Tocolytic therapy was considered ineffective in these cases. Two of the three women for whom tocolytic therapy was ineffective had received nifedipine, and one had received hexoprenaline. Thus, the rate of failure of tocolytic therapy given during transportation was 22.2% (two out of nine cases) with nifedipine, while it was 33.3% (one out of three cases) using hexoprenaline. Tocolytic therapy with atosiban and indomethacin given during transportation was considered effective.
Birth weight was significantly higher in the indomethacin group, than in other groups. The number of newborns with extremely low birth weight was significantly greater in the atosiban group (р < 0.05), and the rate of incomplete preventive treatment with dexamethasone was also higher in this group. RDS was, however, seen more often in Group 1 (hexoprenaline group) (р < 0.05). In addition, more low-birth-weight babies were born in the hexoprenaline group, in which, as well, preventive treatment for RDS was completed in a higher percentage of cases.
The rate of mild asphyxia during the first minute was significantly higher (р < 0.01) in the hexoprenaline group, which also had a significantly greater number of newborns with a 5-minute Apgar score of < 8 than other groups, and significantly fewer newborns with a 5-minute Apgar score of ≥ 8 (р < 0.05 for both comparisons).
Analysis of the routing of infants born to mothers who had received tocolytic agents showed significant differences among all the groups in the number of infants referred to a neonatal pathology unit and the number of babies discharged home (р < 0.05). The number of infants referred to a neonatal pathology unit was highest in the hexoprenaline group. Two cases of perinatal death were reported in the atosiban group.
Conclusion: None of the tocolytic agents studied can be considered superior in terms of neonatal outcomes or prolongation of pregnancy. The agent’s safety should be taken into consideration. If a patient is to be transported over distances longer than 100 km, atosiban should be the agent of choice.
O. V. Trokhanova — Yaroslavl State Medical University. E-mail: Trokhanova@yandex.ru
D. L. Guriev — Yaroslavl State Medical University. Regional Perinatal Center, Yaroslavl. E-mail: email@example.com
M. D. Bryantsev — Yaroslavl State Medical University. E-mail: firstname.lastname@example.org
D. D. Gurieva — Yaroslavl State Medical University. E-mail: email@example.com
Yu. O. Dylinova — Yaroslavl State Medical University. E-mail: firstname.lastname@example.org
F. B. Gumukova — Yaroslavl State Medical University. E-mail: email@example.com
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