Annual Report of the Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2016: Overall report on a comprehensive retrospective study of obstetric management of preterm labor and preterm premature rupture of the membranes

Abstract

We conducted a questionnaire survey on the current obstetric management of preterm labor (PL) and preterm premature rupture of the membranes (pPROM). The questionnaire covered approximately a third of all preterm deliveries and nearly half of the preterm deliveries before 32 gestational weeks. The diagnostic criterion for PL was either painful uterine contractions or cervical dilatation. Tocolytic agents were primarily used as long-term maintenance therapy. Intrauterine infection was clinically diagnosed at most responding institutions. Amniocentesis was performed for PL or pPROM at only a small number (10%) of institutions. Prenatal steroids were administered for PL or pPROM, if indicated, at approximately 40-60% of responding institutions. Prophylactic antibiotics to maintain pregnancy were administered for pPROM at approximately 90% and for PL at approximately 20% of institutions. Maintenance therapy with a tocolytic agent was used for pPROM at approximately 90% of institutions.

Impact of tocolysis‐intent magnesium sulfate and beta‐adrenergic agonists on perinatal brain damage in infants born between 28–36 weeks' gestation

“…The long‐term maintenance therapy with tocolytic agents has been shown ineffective to prevent preterm delivery by the recent meta‐analyses 12–14 . However, in some countries such as Japan, an acute tocolytic therapy is adopted only in 20% of 45 university hospitals and the remaining 80% use the maintenance therapy followed by the acute tocolysis, 15 which is advocated as one of the treatment choices by the guidelines 1 . Under these circumstances, we found that the prenatal exposure to maintenance magnesium sulfate treatment works protectively, while maintenance B2a treatment and combination treatment has no beneficial impact on the developing brain.…”

Effect on perinatal outcome of prophylactic antibiotics in preterm prelabor rupture of membranes: network meta‐analysis of randomized controlled trials

“…Second, commonly used antibiotics, especially cephalosporins, have been largely overlooked in RCTs. A 2018 survey in Japan showed that second-generation cephalosporins and penicillins were the most commonly used antibiotics 76 and, while cephalosporins have been studied in non-randomized trials 77,78 , there is only one small randomized trial in which cephalosporin alone was compared to its combination with erythromycin or clarithromycin 51 . Third, there are antibiotic regimens that have shown promising results in non-randomized trials 79 , but their effectiveness has not been confirmed in RCTs.…”

Associations of GNAS and RGS Gene Polymorphisms with the Risk of Ritodrine-Induced Adverse Events in Korean Women with Preterm Labor: A Cohort Study

“…They include β2-adrenergic receptor agonists, oxytocin antagonists, calcium channel blockers, non-steroidal anti-inflammatory drugs, and magnesium sulfate [7,8]. Among them, ritodrine, a β2-adrenergic receptor agonist, is among the most commonly prescribed tocolytic agents, particularly in Asia and Europe [9,10]. However, due to safety issues, ritodrine has been withdrawn from the market in several Pharmaceutics 2022, 14, 1220 2 of 9 countries, including the United States [11].…”