Comparison of Nifedipine and Ritodrine for the Treatment of Preterm Labor

Bracero, Luis A.; Leikin, Enid; Kirshenbaum, Nancy; Tejani, Nergesh

doi:10.1055/s-2007-999417

Cited by 129 publications

(33 citation statements)

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“…Various studies have compared ritodrine with nifedipine and found that both are equally effective in suppressing preterm labor but side effects were significantly less with nifedipine [8][9][10][11][12]. In our study also no significant difference was noted in maternal and neonatal side effects but less side effects were noted in nifedipine group.…”

Section: Discussionsupporting

confidence: 52%

Comparative Study of Nifedipine and Isoxpurine as Tocolytics for Preterm Labor

Singh

Seth

2011

J Obstet Gynecol India

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Objectives This study was done to compare isoxpurine hydrochloride and nifedipine as tocolytic drugs for preterm labor. Methods A prospective cohort study of 832 antenatal women with preterm labor was conducted in the Department of Obstetrics & Gynecology. Out of 400 women found eligible for tocolysis, 200 were given isoxpurine hydrochloride while the other 200 were given nifedipine randomly. The data obtained was statistically analyzed on SPSS 10.0 of Windows 2003. Results Incidence of preterm labor was 22% while the incidence of preterm delivery was 20.9%. Nifedipine was twice more effective than isoxpurine hydrochloride as a tocolytic agent as a tocolytic agent (P value 0.006) while side effects were comparable (P value 0.133). In earlydiagnosed preterm labor, nifedipine had higher efficacy than isoxpurine (P value 6.45 9 10 -6 ) and also higher efficacy than its own in late diagnosed preterm labor (P value 2.08 9 10 -5 ). Conclusions There is a high incidence of preterm labor in India. Nifedipine is a better tocolytic drug than isoxpurine hydrochloride, especially when started with the earliest signs of preterm labor.

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Section: Discussionsupporting

confidence: 52%

Comparative Study of Nifedipine and Isoxpurine as Tocolytics for Preterm Labor

Singh

Seth

2011

J Obstet Gynecol India

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“…564 The review of inhibition of threatened preterm labour with calcium channel blockers 565 included 12 RCTs. [566][567][568][569][570][571][572][573][574][575][576][577] Updating the searches retrieved a further five RCTs. [578][579][580][581][582] Further details of the review can be found in Appendix 6, Table 133.…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

“…The quality of the included studies is generally good (Figure 194). Calcium channel blockers used were nifedipine and nicardipine and comparators were magnesium sulphate, 569,574,580,581 a betamimetic (ritodrine, terbutaline, salbutamol), 566-568,570-573, [575][576][577][578][579] and an oxytocin antagonist (atosiban). 582 No placebo-controlled trials were found.…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

“…[566][567][568][569][571][572][573][574][575][578][579][580] Twelve studies excluded women with multiple gestations. [566][567][568][569]571,[574][575][576][577][578]580,581 Studies that included women with multiple gestations are denoted with an asterisk in the forest plots. 570,572,573,579,582 Data were available on the following outcomes: birth within 48 hours of intervention, birth within 7 days of intervention, spontaneous preterm birth before 37 weeks' gestation, spontaneous preterm birth before 34 weeks' gestation, perinatal mortality and admission to neonatal intensive care.…”

Section: Calcium Channel Blockersmentioning

confidence: 99%

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Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

Honest

Ca²,

Durée³

et al. 2009

Health Technol Assess

189

146

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For primary prevention, an effective, affordable and safe intervention applied to all mothers without preceding testing is likely to be the most cost-effective approach in asymptomatic women in early pregnancy. For secondary prevention among women at risk of preterm labour in later pregnancy, a management strategy based on the results of testing is likely to be more cost-effective. Implementation of a treat-all strategy with simple interventions, such as fish oils, would be premature for asymptomatic women. Universal provision of high-quality ultrasound machines in labour wards is more strongly indicated for predicting spontaneous preterm birth among symptomatic women than direct management, although staffing issues and the feasibility and acceptability to mothers and health providers of such strategies need to be explored. Further research should include investigations of low-cost and effective tests and treatments to reduce and delay spontaneous preterm birth and reduce the risk of perinatal mortality arising from preterm birth.

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“…Several randomized, controlled trials have compared the efficacy of calcium channel blockers, usually nifedipine and betamimetics. Although most trials had important methodological limitations, and conclusions varied regarding effectiveness (most reporting similar tocolysis [16][17][18][19][20] and some suggesting the superiority of nifedipine [21,22], all reported a better side effect profile with nifedipine with fewer women requiring cessation of therapy due to adverse events [6,[21][22][23][24].…”

mentioning

confidence: 99%

Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial

Padovani

Guyatt

Lopes

2014

Basic Clin Pharma Tox

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Although previous evidence suggests advantages of nifedipine over terbutaline as tocolytic agents, in some jurisdictions, terbutaline is approved for use and nifedipine is not. In women in preterm labour, we compared the impact of terbutaline versus nifedipine on inhibition of uterine contractions, preterm birth, neonatal sepsis, intracranial haemorrhage or necrotizing enterocolitis, death or admission to a neonatal intensive care unit and maternal adverse reactions. We randomized 32 women to nifedipine and 34 to terbutaline. We found no difference between groups in tocolysis or preterm birth. No serious maternal adverse effects or serious neonatal adverse outcome occurred in either group. Less serious maternal adverse effects less common with terbutaline included flushing (2.94% versus 43.7%) and headache (5.9% versus 31.2%). The administration of terbutaline increased tremor (76.4% versus 0%), nausea (58.8% versus 9.4%) and dizziness (29.4% versus 6.25%). The total number of side effects, and the proportion of women experiencing one or more side effects, proved greater with terbutaline. In this study, terbutaline and nifedipine performed similarly in their tocolytic effects. Each drug has specific side effects, although overall, nifedipine was associated with fewer adverse effects.Premature birth is common (over 5% and, in some countries, over 10%) [1,2] and is responsible for approximately 75% of all neonatal deaths and 50% of childhood neurological morbidities [3,4]. Preterm infants often require intensive care that is associated with emotional and economic costs to both the family and society [5].Approximately 75% of preterm birth is attributable to spontaneous preterm labour [1]. Delay in preterm labour therefore provides a potential opportunity for decreasing neonatal morbidity and mortality [6].The optimal medical management of threatened preterm labour is controversial [7]. Despite theoretical benefits of keeping the foetus in utero long enough to enable administration of a full course of corticosteroids to assist in foetal lung maturation, and to organize transfer to an appropriate neonatal care unit, no agent has been shown to improve neonatal outcome [2,7]. Thus, the choice of therapy has focused on delay in delivery and minimization of adverse effects.The drugs registered for tocolysis include the b adrenoceptor agonist ritodrine (United States and Europe), terbutaline (Brazil) and the oxytocin receptor antagonist atosiban (Europe) [8]. Calcium channel blockers (nifedipine) and cyclooxygenase inhibitors (indomethacin) are also used for inhibiting preterm labour although, in many countries, they are not currently registered for this indication [9].Betamimetics (isoxsuprine, ritodrine, terbutaline, fenoterol and salbutamol) delay labour [10][11][12], but their use has been limited by a high incidence of maternal adverse effects [10,13,14]. Many centres use nifedipine, which also has established effectiveness in delaying labour [15] and has advantages of oral administration and relatively low...

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Comparison of Nifedipine and Ritodrine for the Treatment of Preterm Labor

Cited by 129 publications

References 0 publications

Comparative Study of Nifedipine and Isoxpurine as Tocolytics for Preterm Labor

Comparative Study of Nifedipine and Isoxpurine as Tocolytics for Preterm Labor

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial

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