Efficacy and side effect of ritodrine and magnesium sulfate in threatened preterm labor

Abstract

ObjectiveIn terms of efficacy, several previous studies have shown that the success rate in inhibiting preterm labor was not different between magnesium sulfate and ritodrine. However, there is a paucity of information regarding the efficacy of both medications after consideration of intra-amniotic infection, which is one of the most important prognostic factors in patients of threatened preterm birth. The objective of this study was to compare the efficacy and safety of magnesium sulfate with that of ritodrine in preterm labor.MethodsIn this retrospective cohort study, we included patients who were admitted and treated with either ritodrine or magnesium sulfate with the diagnosis of preterm labor at 24–33.6 weeks of gestational age between January 2005 to April 2015. Patients were divided into 2 groups according to the first-used tocolytics (ritodrine group and magnesium sulfate group). We compared the efficacy and prevalence of side effect in each group. The efficacy of both tocolytics was evaluated in terms of preterm delivery within 48 hours, 7 days, or 37 weeks of gestation and need for 2nd line therapy.ResultsA total number of 201 patients were enrolled including 177 cases in ritodrine group and 24 cases in magnesium sulfate group. The efficacy of both tocolytics (preterm delivery within 48 hours, 7 days, or 37 weeks of gestation and need for 2nd line therapy) was not different between the 2 groups of cases. In multivariate analysis, gestational age at treatment, twin gestation, intra-amniotic infection and maternal C-reactive protein (CRP) was associated with treatment failure (preterm delivery within 48 hours), but the type of tocolytics was not significantly associated with treatment failure. The type of side effect was different in the 2 groups, but the frequency of total adverse effect, need for discontinuation of therapy because of maternal adverse effect, and severe adverse effect were not different between the two groups of cases.ConclusionThe efficacy and safety of magnesium sulfate was similar to ritodrine, and can be a substitute tocolytics. Additionally, failure of tocolytic therapy was determined by gestational age at treatment, twin gestation, intra-amniotic infection, and maternal CRP, not by the type of tocolytics.

Different impacts of various tocolytic agents on increased risk of postoperative hemorrhage in preterm labor women undergoing Cesarean delivery

“…[ 21 ] However, our data demonstrated an approximately 40% higher risk of postoperative hemorrhage in those using MgSO 4 compared with those using ritodrine, which contradicted the previous data. [ 19 – 21 ] Although the mechanisms are as yet unclear, our data indicated that MgSO 4 may cause more serious adverse effects than ritodrine. Previous experimental data also showed similar results when MgSO 4 , but not ritodrine, was observed to worsen maternal hypotension in gravid ewes complicated with hemorrhage.…”

“…One possible substitute is MgSO 4 . [ 19 , 20 ] Studies have demonstrated that MgSO 4 shows therapeutic efficacy and safety comparable with that of ritodrine. [ 19 , 20 ] Another study further indicated that the adverse effects caused by MgSO 4 tended to be less serious than ritodrine.…”

“…[ 19 , 20 ] Studies have demonstrated that MgSO 4 shows therapeutic efficacy and safety comparable with that of ritodrine. [ 19 , 20 ] Another study further indicated that the adverse effects caused by MgSO 4 tended to be less serious than ritodrine. [ 21 ] However, our data demonstrated an approximately 40% higher risk of postoperative hemorrhage in those using MgSO 4 compared with those using ritodrine, which contradicted the previous data.…”

Efficacy of allylestrenol combined with ritodrine on threatened premature labor and its influence on inflammatory factors in peripheral blood

“…There are many clinical reports on the treatment of TPTL with combination drugs. For example, RD combined with nifedipine can prolong pregnancy >7 days more effectively than RD alone (18), and there is no obvious difference in the efficacy and adverse reactions between RD and MgSO 4 (19). However, there are few reports on AT combined with RD in the treatment of TPTL.…”

Tocolitics in premature labor

“…Entre los efectos maternos se describen diaforesis, bochornos, náusea, vómito, cefalea, letargia, nistagmus, visión borrosa, diplopía, palpitaciones y edema pulmonar (75,76) en especial relacionado a una administración muy rápida del fármaco.…”