Acute Tocolysis – a Critical Analysis of Evidence-Based Data

Rath, Werner; Kehl, Sven

doi:10.1055/a-0717-5329

Cited by 18 publications

(16 citation statements)

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“…In view of a preterm birth rate in Europe between 5 – 18% (in Germany 2017: 8.6%), tocolysis is among the most frequent obstetric measures. In pregnant women with preterm labour, common tocolytics are able to prolong the pregnancy by 48 h in 75 – 93% of cases and by 7 days in 61 – 78% of patients 48 . The increase in the tocolytic efficacy with a simultaneous reduction in maternal adverse effects through additional measures is a worthwhile pursuit of clinical research for practical application.…”

Section: Discussionmentioning

confidence: 99%

“…Angesichts einer Frühgeburtenrate in Europa zwischen 5 – 18% (in Deutschland 2017: 8,6%) gehört die Tokolyse zu den häufigsten geburtshilflichen Maßnahmen. Gebräuchliche Tokolytika sind in der Lage, bei Schwangeren mit vorzeitigen Wehen die Schwangerschaft in 75 – 93% der Fälle um 48 h und bei 61 – 78% der Patientinnen um 7 Tage zu verlängern 48 . Die Steigerung der tokolytischen Effizienz bei gleichzeitiger Reduktion maternaler Nebenwirkungen durch zusätzliche Maßnahmen ist ein lohnenswertes Ziel der klinischen Forschung für die Praxis.…”

Section: Diskussionunclassified

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Progesterone – Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?

Rath

Kuon

2019

Geburtshilfe Frauenheilkd

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Numerous experimental studies indicate that natural progesterone, through various mechanisms, exerts an inhibitory effect on uterine contractility and sensitises the myometrium for tocolytics. It was therefore appropriate to investigate the possible benefits of oral/vaginal progesterone and the synthetic progesterone derivative 17-α-hydroxyprogesterone caproate, applied intramuscularly, in clinical studies on primary tocolysis, additively to established tocolytics (“adjunctive tocolysis”) and as maintenance treatment after successful tocolysis in cases of threatened preterm birth. Three studies with a small number of cases do not yield any sufficient evidence for recommending progesterone/17-α-hydroxyprogesterone caproate as primary tocolysis in women with preterm labour. There is also no evidence that progesterone or 17-α-hydroxyprogesterone caproate combined with commonly used tocolytics leads to a prolongation of pregnancy and a significant decrease in the rate of preterm birth. The data on the use of progesterone as maintenance treatment is controversial. While randomised, controlled studies with low quality showed promising results, studies with high quality did not reveal any significant differences with regard to the rate of preterm birth < 37 weeks of gestation, the latency period until delivery and in the neonatal outcome between progesterone/17-α-hydroxyprogesterone caproate and placebo or no treatment. Significant differences in the methodology, the inclusion and outcome criteria, the mode of application and the dosages of the substances as well as the inadequate statistical power as a result of low numbers of cases make interpretation and comparability of the studies difficult. Therefore, well-designed randomised, placebo-controlled, double-blind studies with uniform primary outcome criteria are needed in order to clarify whether progesterone and via which route of administration and at which dosage is of clinical benefit for patients with manifest preterm contractions and as maintenance treatment after arrested preterm labour.

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Section: Discussionmentioning

confidence: 99%

Section: Diskussionunclassified

Progesterone – Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?

Rath

Kuon

2019

Geburtshilfe Frauenheilkd

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“…However, there are conflicting reports on the role of MgSO 4 in reducing the rates of premature birth; moreover, most of these reports are based on the use this tocolytic agent in spontaneous preterm labor and not following fetal surgery 5–7 . The use of MgSO 4 is associated with a wide variety of adverse effects, including flushing, headache, blurred vision, nausea, and pulmonary edema 8 . The MOMS trial utilized 50‐mg indomethacin preoperatively, followed by a 6‐g loading dose of MgSO 4 postoperatively, and then 2–4 g/h of MgSO 4 was continued for 18–48 h following surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] The use of MgSO 4 is associated with a wide variety of adverse effects, including flushing, headache, blurred vision, nausea, and pulmonary edema. 8 The MOMS trial utilized 50-mg indomethacin preoperatively, followed by a 6-g loading dose of MgSO 4 postoperatively, and then 2-4 g/h of MgSO 4 was continued for 18-48 h following surgery. In addition, indomethacin was given asevery 6 h for the first 48 h. Nifedipine was then given for maintenance therapy until 37 weeks' gestation.…”

Section: Introductionmentioning

confidence: 99%

Magnesium sulfate titration reduces maternal complications following fetoscopic closure of spina bifida

et al. 2021

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Objective: To evaluate if magnesium sulfate (MgSO 4 ) titration following fetoscopic spina bifida closure is associated with fewer maternal complications than the Management of Myelomeningocele Study (MOMS) tocolytic regimen.Methods: This prospective cohort study included 73 consecutive patients undergoing fetoscopic closure of spina bifida between 2015 and 2020. A policy of using the MgSO 4 regimen per the MOMS trial was changed to a flexible one in which MgSO 4 was titrated according to the frequency of the uterine contractions following surgery. The frequency of maternal pulmonary edema, low maternal oxygen saturation requiring oxygen supplementation, atelectasis, hypocalcemia, and preterm delivery was compared before and after the policy was changed.Results: A higher proportion of women in the group that used the MOMS MgSO 4 regimen had pulmonary edema compared to those in the flexible one (26.1% [6/23] vs. 6% [3/50]; p = 0.024). Multivariate analysis showed that the MOMS tocolytic regimen was independently associated with a higher risk of pulmonary edema (adjusted odds ratio: 8.57; 95% confidence interval: 1.54-47.7; p = 0.014) than a flexible one. There was no difference in the rate of preterm delivery. Conclusion:Following fetoscopic closure of spina bifida, the MOMS MgSO 4 regimen is associated with an increased risk of pulmonary edema than a more flexible regimen.

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“…Im Rahmen der Prävention der Frühgeburt stellt die Behandlung vorzeitiger Wehen nur eine „symptomatische Therapie“ dar (Übersicht bei 7 ). Zur primären und sekundären Prävention ist die Gabe von Progesteron angesichts einer Vielzahl neuer Studien zunehmend in den Fokus des Interesses gerückt und wird derzeit kontrovers diskutiert 8 .…”

Section: Introductionunclassified

Progesterone for the Prevention of Preterm Birth – an Update of Evidence-Based Indications

Kuon

Voss

Rath

2019

Geburtshilfe Frauenheilkd

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The prevention and treatment of preterm birth remains one of the biggest challenges in obstetrics. Worldwide, 11% of all children are born prematurely with far-reaching consequences for the children concerned, their families and the health system. Experimental studies suggest that progesterone inhibits uterine contractions, stabilises the cervix and has immunomodulatory effects. Recent years have seen the publication of numerous clinical trials using progestogens for the prevention of preterm birth. As a result of different inclusion criteria and the use of different progestogens and their methods of administration, it is difficult to draw comparisons between these studies. A critical evaluation of the available studies was therefore carried out on the basis of a search of the literature (1956 to 09/2018). Taking into account the most recent randomised, controlled studies, the following evidence-based recommendations emerge: In asymptomatic women with singleton pregnancies and a short cervical length on ultrasound of ≤ 25 mm before 24 weeks of gestation (WG), daily administration of vaginal progesterone (200 mg capsule or 90 mg gel) up until 36 + 6 WG leads to a significant reduction in the preterm birth rate and an improvement in neonatal outcome. The latest data also suggest positive effects of treatment with progesterone in cases of twin pregnancies with a short cervical length on ultrasound of ≤ 25 mm before 24 WG. The study data for the administration of progesterone in women with singleton pregnancies with a previous preterm birth have become much more heterogeneous, however. It is not possible to make a general recommendation for this indication at present, and decisions must therefore be made on a case-by-case basis. Even if progesterone use is considered to be safe in terms of possible long-term consequences, exposure should be avoided where it is not indicated. Careful patient selection is crucial for the success of treatment.

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Acute Tocolysis – a Critical Analysis of Evidence-Based Data

Cited by 18 publications

References 64 publications

Progesterone – Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?

Progesterone – Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?

Magnesium sulfate titration reduces maternal complications following fetoscopic closure of spina bifida

Progesterone for the Prevention of Preterm Birth – an Update of Evidence-Based Indications

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