Nifedipine therapy for preterm labor: effects on placental, fetal cerebral and atrioventricular Doppler parameters in the first 48 hours

Güçlü, Serkan; Göl, Mert; Saygılı, Uğur; Demir, Namık; Sezer, Orçun; Baschat, Ahmet

doi:10.1002/uog.2728

Cited by 39 publications

(40 citation statements)

References 59 publications

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“…In contrast to our findings, Guclu et al detected significant fall in uterine artery pulsatility index at 24 and 48 h of tocolysis. 16 Similar to our findings they showed no changes in the blood flow in umbilical artery (RI and PI) at the same point of time.…”

Section: Discussionsupporting

confidence: 91%

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

Abdellateef¹,

Shorbagy²,

Hagras³

et al. 2017

Gynecol Obstet Res Open J

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CitationAbdellateef SS, El Shorbagy SH, Hagras AM, Ghareeb AE. Assessment of maternal nifedipine as a tocolytic agent on the Doppler indices of uterine and fetal umbilical and middle cerebral arteries. This study was designed to assess the effects of maternal nifedipine administration on blood flow resistance in uterine, umbilical and fetal middle cerebral arteries by evaluating resistance index (RI) and pulsatility index (PI). Patients and Methods: This was a prospective, observational, analytic cohort study performed in 50 pregnant women undergoing nifedipine tocolysis, all women with a singleton pregnancy between 24 and 34 weeks of gestation, each subject acting as her own control. Doppler assessment of uterine, umbilical and fetal middle cerebral (MCA) arteries was performed before and 24 h and 72 h after an initial 20 mg oral dose, which was repeated at 20 min intervals if contractions failed to diminish up to a total maximum dose of 60 mg. The maintenance dose consisted of 20 mg orally every 6 h. We analyzed whether there was a time effect and compared values at the different time-points. Results: The research showed that the UtA-RI has increased significantly after 24 h and after 72 h of nifedipine administration (0 h=0.53; 24 h=0.56; 72 h=0.55; p=0.002, p=0.015 respectively). The MCA-RI had decreased significantly after 24 h (p=0.003) of tocolysis returning to baseline after 72 h (0 h=0.75; 24 h=0.73; 72 h=0.74; p=0.150). The MCA-PI had decreased significantly after 24 h (P=0.024) of tocolysis returning to baseline between 24 h and 72 h (0 h=1.85; 24 h=1.75; 72 h=1.79; p=0.204), with no differences in UtA-PI or in the umbilical arteries Doppler (RI & PI) or in the MCA to umbilical artery ratio. Conclusions: Nifedipine tocolysis is associated with a reduction in RI and PI in the MCA, and an increase in RI in uterine arteries after 24 h but returning to baseline within 72 h, with no long-term effect on fetomaternal circulation in pregnant women at risk of preterm delivery.

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Section: Discussionsupporting

confidence: 91%

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

Abdellateef¹,

Shorbagy²,

Hagras³

et al. 2017

Gynecol Obstet Res Open J

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“…Several studies have investigated the possible effects of nifedipine on fetomaternal blood flow . Two previous studies reported that nifedipine does not cause a significant change in uteroplacental and fetal Doppler parameters.…”

Section: Discussionmentioning

confidence: 99%

Effects of betamethasone on fetoplacental and maternal hemodynamics in preterm pregnancies

İnan

Sayın

Dolgun

et al. 2018

Intl J Gynecology & Obste

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“…Others have reported significantly decreased pulsatility and resistance indices of the fetal middle cerebral artery in the first 24-48 h after tocolysis with nifedipine [10,26]. However, Verhagen et al [24] and Grzesiak et al [27] did not find an effect of nifedipine on neonatal cFTOE or fetal CBF, respectively.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Maternal Antihypertensive Drugs on the Cerebral, Renal and Splanchnic Tissue Oxygen Extraction of Preterm Neonates

et al. 2016

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Background: Drugs with antihypertensive action are frequently used in obstetrics for the treatment of preeclampsia (labetalol) and tocolysis (nifedipine) or for neuroprotection (MgSO₄), and may affect the hemodynamics of preterm born neonates. Objective: The aim of this study was to assess whether maternal antihypertensive drugs affect multisite oxygenation levels of the neonate. Methods: Eighty preterm neonates of ≤32 weeks of gestational age were monitored using near-infrared spectroscopy. Mean cerebral, renal and splanchnic fractional tissue oxygen extractions (cFTOE, rFTOE and sFTOE) were calculated for the first 5 postnatal days. We determined the effect of various maternal antihypertensive drugs on cFTOE and rFTOE using multilevel analysis, and on sFTOE using Kruskal-Wallis and Mann-Whitney U tests. Results: Eleven infants were exposed to labetalol ± MgSO₄, 7 to nifedipine ± MgSO₄, 20 to MgSO₄ only, and 42 to no maternal antihypertensive drugs. The infants exposed to labetalol ± MgSO₄ had a lower cFTOE on days 1 (0.14, p = 0.031), 2 (0.13, p = 0.035) and 4 (0.18, p = 0.046) than nonexposed infants on the corresponding days (0.22, 0.20 and 0.24, respectively). On day 2, cFTOE was also lower in infants exposed to nifedipine ± MgSO₄ (0.11, p = 0.028) and to MgSO₄ only (0.15, p = 0.047). sFTOE was higher in infants exposed to labetalol ± MgSO₄ on days 1 (µ = 0.71) and 2 (µ = 0.82) than in nonexposed infants (µ = 0.26, p = 0.04 and µ = 0.55, p = 0.007, respectively). Maternal antihypertensive drugs did not affect rFTOE. Conclusions: Low neonatal cFTOE found with maternal antihypertensive drug exposure may relate to either increased cerebral perfusion or neurologic depression induced by the medication, or preferential brain perfusion associated with preeclampsia placental insufficiency. Concomitantly high sFTOE found with labetalol exposure supports the latter, while renal autoregulation may explain rFTOE stability.

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Nifedipine therapy for preterm labor: effects on placental, fetal cerebral and atrioventricular Doppler parameters in the first 48 hours

Abstract: Objective To assess the effect of nifedipine tocolysis on Doppler parameters of the uterine, umbilical and fetal middle cerebral arteries and atrioventricular valves in the first 48 h of therapy. Methods

Cited by 39 publications

References 59 publications

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

Effects of betamethasone on fetoplacental and maternal hemodynamics in preterm pregnancies

The Effect of Maternal Antihypertensive Drugs on the Cerebral, Renal and Splanchnic Tissue Oxygen Extraction of Preterm Neonates

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