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

Combs, C. Andrew; McCune, Michelle; Clark, Reese H.; Fishman, Alan

doi:10.1016/j.ajog.2004.02.042

Cited by 28 publications

(23 citation statements)

References 11 publications

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“…The result showed that there were no significant differences in the latency period between the two groups. This finding supports other reports that tocolysis does not prolong the latency period [5,6,7,8,9]. …”

Section: Discussionsupporting

confidence: 82%

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Effect of Terbutaline on Latency Period in Preterm Premature Rupture of Membranes

Kulmala¹,

Phupong²

2012

Gynecol Obstet Invest

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Aims: To assess whether terbutaline is able to prolong the latency period in women with preterm premature rupture of membranes (PPROM) and compare maternal and neonatal morbidity and mortality in the terbutaline and nontocolysis groups. Methods: This study retrospectively analyzed data from women with singleton pregnancies (gestational ages between 28 and 34 weeks) suffering from PPROM from January 1998 to December 2009. Results: A total of 163 cases of PPROM were analyzed; there were 61 cases (37.4%) in the terbutaline group and 102 cases (62.6%) in the nontocolysis group. The median latency period was comparable in the two groups (78 vs. 75 h, p = 0.44). The percentage of patients who did not deliver within 48 h was significantly higher in the terbutaline group compared with the nontocolysis group (78.7 vs. 62.7%, p = 0.03). There were no differences in maternal morbidity and mortality, and neonatal mortality between the two groups. Interestingly, neonatal infectious morbidity was significantly higher in the terbutaline group when compared with the nontocolysis group. Conclusions: Terbutaline cannot prolong the latency period in PPROM. There were no differences in maternal morbidity and mortality. However, neonatal infectious morbidity was higher in the terbutaline group.

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Section: Discussionsupporting

confidence: 82%

“…This is similar to other previously mentioned studies [6,7,8]. The use of prophylactic antibiotics may have prevented maternal morbidity in both groups.…”

Section: Discussionsupporting

confidence: 79%

Effect of Terbutaline on Latency Period in Preterm Premature Rupture of Membranes

Kulmala¹,

Phupong²

2012

Gynecol Obstet Invest

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“…The latency in the subgroup with the youngest gestational age at delivery ( 1 24 to ^ 28.0 weeks) was two thirds of the mean latency (10.2 days). However, our mean latency is nearly twice that found by Combs et al [23] in the retrospective part of their study (7.8 8 10.5 days), and also higher than that in their prospective study of tocolysis limited to 48 h (12.1 8 17 days). In addition, our data showed signifi cantly higher Apgar scores at 1 and 10 min in the post-PPROM tocolysis group due to differences in delivery mode (lower rates of vaginal breech, ventouse and cesarean section).…”

Section: Discussioncontrasting

confidence: 46%

“…Madsuda et al [9] reported that infectious morbidity and low Apgar scores requiring ventilation were more frequent with tocolysis (in combination with antibiotics), while others found no difference in maternal and neonatal outcome [18,[20][21][22] . A recent combined retrospective and prospective study by Combs et al [23] failed to confi rm increased latency or decreased neonatal morbidity by aggressive tocolysis (tocolysis for as long as possible combined with antibiotics and corticosteroids), while maternal morbidity was actually increased. Our study showed a mean latency of 15.3 days: in 56.9 and 32.1% latency was 1 7 and 1 14 days, respectively.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Mortality and Morbidity after Aggressive Long-Term Tocolysis for Preterm Premature Rupture of the Membranes

Wolfensberger¹,

Zimmermann²,

Mandach³

2006

Fetal Diagn Ther

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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 (≤36.0 weeks) admitted to the neonatal intensive care unit between January 1, 1999 and June 30, 2003, comparing singletons born to mothers with PPROM + tocolysis for >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.

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“…Studies have looked at the use of other tocolytics in PPROM and found no benefit in prolongation of pregnancy, [30][31][32] with one study showing a 2.5 fold increase in chorioamnionitis after long term tocolysis in women with PPROM.…”

Section: Place In Therapymentioning

confidence: 99%

Atosiban in the Management of Preterm Labour

Fullerton

Black

Shetty

et al. 2011

Clin Med�Insights�Womens�Health

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Abstract:The purpose of this review was to look at the evidence available for the use of atosiban as a tocolytic in cases of threatened preterm labour. A Royal College of Obstetricians and Gynaecologists Green Top Guideline concluded that there was no clear evidence to show a benefit to tocolysis in reducing perinatal and neonatal morbidity and mortality. Using a systematic literature search, we summarise the evidence available on the use of atosiban for the prevention of preterm birth and compare it with other commonly used tocolytic agents in terms of efficacy, patient preference and drug safety. We conclude that although atosiban appears to be the tocolytic of choice, a clear benefit of using tocolysis in all cases of threatened preterm labour remains to be justified and clinical management should be tailored according to individual needs.

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

Cited by 28 publications

References 11 publications

Effect of Terbutaline on Latency Period in Preterm Premature Rupture of Membranes

Effect of Terbutaline on Latency Period in Preterm Premature Rupture of Membranes

Neonatal Mortality and Morbidity after Aggressive Long-Term Tocolysis for Preterm Premature Rupture of the Membranes

Atosiban in the Management of Preterm Labour

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