Atosiban vs ritodrine used prophylactically with cerclage in ICSI pregnancies to prevent pre-term birth in women identified as being at high risk on the basis of transvaginal ultrasound scan

Abstract

Our objective was to compare the effectiveness and safety of atosiban and ritodrine, in pregnancies obtained by intracytoplasmic sperm injection (ICSI) undergoing cervical cerclage. Data from a prospective study were compared with those from a retrospective study. Sixteen ICSI pregnant women, 20-24 weeks' gestation and maternal age >18 years, received atosiban (bolus dose 6.75 mg i.v., followed by 300 microg/min i.v. for 3 h and 100 microg/min i.v. for 45 h). Cervical cerclage was performed 3 h after starting atosiban. The control group (group B) of 16 ICSI pregnant women were matched and received ritodrine hydrochloride (100-350 microg/min) for 48 h. Cervical cerclage was performed after 24 h. Pre-term rupture of membranes occurred within 48 h of cervical cerclage in one woman receiving atosiban and in four women receiving ritodrine. There was no significant difference in terms of pregnancies not delivered at 48 h (short-term tocolysis) and at 7 days (long-term tocolysis). However, there was a significantly higher incidence of maternal tachycardia with ritodrine compared with atosiban (p < 0.001). The mean gestational age at delivery was significantly higher for atosiban compared with ritodrine (36 vs 33 weeks; p < 0.001). The neonatal outcome was poorer for ritodrine than atosiban, as there were very low birth weight infants (p = 0.008), resulting in lower Apgar scores (p = 0.005) and there were more neonates requiring a long stay in the neonatal intensive care unit (p = 0.005). We conclude that atosiban is associated with a significantly lower incidence of maternal tachycardia and improved neonatal outcome compared with ritodrine.

Lactoferrin in Aseptic and Septic Inflammation

“…Several interventions, such as cervical cerclage and bed rest, as well as common therapies, such as beta mimetics, atosiban and calcium channel blockers were mostly ineffective in preventing PTD [100,101]. Conversely, bLf, due to its anti-inflammatory activity especially against IL-6 axis [50], has been demonstrated to be a promising candidate for PTD treatment.…”

Cervical Insufficiency and Cervical Cerclage

“…61 Unless it is contraindicated, regional anaesthesia is usually preferred to general anaesthesia in light of its lesser associated risks. 62,63 It should be noted that for prophylactic cerclage, no randomized trials have presented findings free of confounding variables to support the routine use of tocolytics, 64,65 corticosteroids, or antibiotics, [66][67][68] although for cerclages placed in gestations close to fetal viability, corticosteroid usage should be considered. Similarly, data on the use of progesterone in women who have a cerclage in place are limited.…”

Archivée: Insuffisance cervicale et cerclage cervical

“…Nous nous devons de souligner que, en ce qui concerne le cerclage prophylactique, aucun essai randomisé n'a été en mesure d'obtenir des résultats exempts de variables de confusion permettant de soutenir l'utilisation systématique de tocolytiques 64,65 , de corticostéroides ou d'antibiotiques 66e68 ; toutefois, en ce qui concerne les cerclages mis en place dans le cadre de gestations s'approchant de la viabilité foetale, l'utilisation de corticostéroides devrait être envisagée. De façon semblable, les données sur l'utilisation de progestérone chez des femmes présentant un cerclage sont limitées.…”