Maintaining and repeating tocolysis: A reflection on evidence

Dehaene, Isabelle; Bergman, Lina; Turtiainen, Paula; Ridout, Alexandra; Mol, Ben Willem J.; Lorthe, Elsa

doi:10.1053/j.semperi.2017.08.005

Cited by 12 publications

(5 citation statements)

References 44 publications

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“…Prematurity is associated with higher morbidity and mortality rates; therefore, it seems obvious that prolongation of the pregnancy should improve the outcome. However, there are only a few studies which demonstrate that maintenance tocolysis improves maternal and neonatal (long-term) outcomes and does not merely prolong pregnancy 12 , 18 , 19 . Short-term tocolysis should be given for 48 h to allow the administration of antenatal corticosteroids to improve the neonatal outcome 20 , and it is often recommended that maintenance tocolysis should be avoided 8 , 21 , 22 , 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Repeated or prolonged tocolysis is controversial; it is not recommended in most guidelines or not even mentioned. In some cases, maintenance tocolysis could be indicated to allow the fetus to achieve a higher gestational age 12 . The German S2k-guideline does not recommend long-term tocolysis as it does not significantly reduce the preterm birth rate or fetal morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Kirchhoff

Schneider

Pichler³

et al. 2022

Geburtshilfe Frauenheilkd

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Introduction Preterm birth is defined as a live birth before 37 weeks of gestation and is associated with increased neonatal morbidity and mortality. The aim of this study is to compare the efficacy of hexoprenaline and atosiban for short- and long-term tocolysis and their effects on neonatal and maternal outcomes. Methods This retrospective cohort study included women with threatened preterm labor between 24 + 0 and 34 + 0 weeks of gestation without premature rupture of membranes. The tocolytic efficacy of hexoprenaline and atosiban was compared in women receiving one of the two medications for short- and long-term tocolysis. Continuous variables were compared using t-test or Mann–Whitney U test, as appropriate. Comparison of categorical variables between the two groups was done with χ2 test after Pearsonʼs and Fisherʼs exact test. Results 761 women were enrolled in this study; 387 women received atosiban and 374 women received hexoprenaline as their primary tocolytic agent. Atosiban showed a higher efficacy as a primary tocolytic agent (p = 0.000) within 48 hours. As regards long-term tocolysis, there were no differences between the treatment groups (p = 0.466). Maternal side effects such as tachycardia (p = 0.018) or palpitations (p = 0.000) occurred more frequently after the administration of hexoprenaline, while there were no differences between the two drugs administered with regard to any other maternal or neonatal outcome parameter. Conclusion Our retrospective study shows a significantly higher efficacy of atosiban in the first 48 hours, especially when administered at an early gestational age. There were no significant differences in terms of neonatal outcome but significantly more maternal adverse effects during the administration of hexoprenaline.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Kirchhoff

Schneider

Pichler³

et al. 2022

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

show abstract

“…The most acceptable strategy is acute tocolysis or 48 h of tocolytic agent use for steroid and magnesium sulphate (MgSO4) administration, as well as to gain time for maternal–fetal transfer [ 25 , 26 , 27 , 28 ]. As of now, it is still uncertain whether the maintenance and repeating of tocolysis will improve neonatal outcomes [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Indeed, a systematic review analyzing 16 different international guidelines, including those from the WHO, the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the United States of America (USA), Canada, the United Kingdom (UK), Belgium, France, Japan, China, Australia, and New Zealand, etc., showed that most guidelines agreed on acute tocolysis for threatened preterm labor and recommended against long-term tocolysis [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

Lee

Yeh

Yang

et al. 2022

IJERPH

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Preterm birth represents a great burden to the healthcare system, resulting in the consideration for the use of tocolytic therapy to provide a “better time” for delivery in order to buy time to accelerate fetal lung maturity, thereby minimizing prematurity-related morbidity and mortality. However, the benefits and potential side effects and risks of tocolytic treatment for preterm birth should be carefully balanced. Although many countries and societies provide guidelines or consensuses for the management for preterm birth, there is no standardized national guideline or consensus in Taiwan. As such, great heterogeneity is suspected in preterm labor management, contributing to the uncertainty of attitudes and practice patterns of obstetric specialists in Taiwan. This study attempts to understand the attitudes and practice patterns regarding tocolytic therapy in Taiwan. A paper-based survey was conducted at the 2020 Taiwan Society of Perinatology Conference on 8 December 2020, exploring how obstetric specialists would use tocolytics under nine different clinical scenarios, such as a short cervix, preterm labor, maintenance tocolysis, preterm premature rupture of membranes, etc. Three hundred ten specialists attended the conference, and 77 responded to the survey with a response rate of 24.8%. According to the survey, many of these specialists would prescribe tocolytics for less evidence-based indications, including 22% for abdominal tightness, 46% for a short cervix, 60% for maintenance tocolysis, and 89% for repeat tocolysis, with the preferred first line medication being ritodrine and nifedipine. We concluded that tocolysis is widely accepted and practiced in Taiwan. More research is needed to include Taiwan-specific economic and cultural factors as well as associated adverse effects and patients’ outcomes.

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“…Preterm labor is the major cause of perinatal mortality and morbidity in high-income countries and constitutes a huge economic burden on the healthcare system ( Blencowe et al, 2013 ). Administration of tocolytics can reduce the intensity and frequency of uterine contractions to prolong pregnancy, thereby providing time for further intrauterine maturation and interventions that may improve infant outcome ( Dehaene et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Chinese Herbal Medicines Have Potentially Beneficial Effects on the Perinatal Outcomes of Pregnant Women

et al. 2022

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Introduction: Tocolytic treatment is beneficial to pregnant women with a risk of premature labor or miscarriage. However, previous reports have shown that progestogen might not be effective and ritodrine may increase the risk of maternal vascular-related diseases. Chinese herbal products (CHP) are used as alternative therapies for pregnant women. The goal was to evaluate the efficacy of combined tocolytic therapy and CHP therapy in pregnancy outcomes for pregnant women in Taiwan.Materials and Methods: We conducted a retrospective cohort study based on the National Health Insurance Research Database. A total of 47,153 pregnant women treated with tocolytics aged 18–50 years from 2001 to 2015 were selected from two million random samples. According to the medical use of tocolytics and CHP, we divided the users into two groups: western medicine (WM) only (n = 40,961) and WM/CHP (n = 6,192) groups. A propensity score (PS)-matched cohort (6,192 pairs) was established based on baseline confounders. All participants were followed up to perinatal outcomes. Conditional logistic regression analysis was used to examine the effects of CHP use on the odds of miscarriage and preterm birth.Results: The adjusted odds ratio (OR) for premature birth in the WM/CHP group (n = 411, 6.64%) was significantly lower than in the WM group (n = 471, 7,61%) (0,86, 95% confidence interval [CI], 0.74–0.99). Further subgroup analysis based on the usage of formulae that activate blood and remove stasis or purgative formulae, the adjusted OR of preterm birth of those using these formulae was significantly lower in the WM/CHP group (n = 215, 6.32%) than that in the WM group (n = 265, 7.77%) (OR: 0.79, 95% CI: 0.65–0.96).Conclusion: We found that the combination of CHP and tocolytics can be beneficial to pregnant women in the prevention of premature birth. Further research is required to investigate causal relationships.

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Maintaining and repeating tocolysis: A reflection on evidence

Cited by 12 publications

References 44 publications

Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor

Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

Chinese Herbal Medicines Have Potentially Beneficial Effects on the Perinatal Outcomes of Pregnant Women

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