The contemporary use of β‐agonists

Lamont, Ronnie

doi:10.1111/j.1471-0528.1993.tb15100.x

Cited by 25 publications

(10 citation statements)

References 8 publications

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“…The prevention and treatment of premature labor are major goals of modern obstetrics, since preterm births account for a significantly disproportionate percentage of perinatal deaths and serious complications [50]. Adrenergic modulation of uterine contraction includes P-adrenergic induced relaxation mediated by increases in CAMP and a-adrenergic promotion of contraction.…”

Section: Uterine Contraction and Labormentioning

confidence: 99%

Do Receptors Get Pregnant Too? Adrenergic Receptor Alterations in Human Pregnancy

Smiley

Finster

1996

J Matern Fetal Neonatal Med

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In this review we discuss adrenergic receptor number and function during pregnancy, with emphasis on evidence that pregnancy results in specific receptor alterations from the nonpregnant state. Changes in adrenergic receptor function or distribution in vascular smooth muscle may be in part responsible for the decreased vascular responsiveness seen in human pregnancy, and the lack of the normal alterations may be a part of the syndromes of gestational hypertension, including preeclampsia-eclampsia. The onset of labor may be influenced by adrenergic modulation, and receptor or postreceptor level molecular alterations may trigger or facilitate normal or preterm labor. Human studies are emphasized when possible to assess the role of adrenergic signal transduction regulation in the physiology and pathophysiology of normal and complicated human pregnancy. o 1996 WtIcy-Liss, IIK.

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Section: Uterine Contraction and Labormentioning

confidence: 99%

Do Receptors Get Pregnant Too? Adrenergic Receptor Alterations in Human Pregnancy

Smiley

Finster

1996

J Matern Fetal Neonatal Med

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“…Clinically relevant side effects, such as maternal tachycardia, and palpitation, and fetal tachycardia have caused treatment discontinuations in 14% of women 12 . Rare and life threatening maternal cardiovascular events such as myocardial ischaemia 14 and pulmonary oedema 15 are also well documented 13 . Consequently, there is a medical need to develop more uterine-speci®c tocolytic agents to overcome these potentially harmful systemic side effects 10 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of the oxytocin antagonist atosiban versus beta‐adrenergic agonists in the treatment of preterm labour

2001

BJOG

144

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Objective To compare the effectiveness and safety of the oxytocin antagonist atosiban with conventional betaadrenergic agonist (beta-agonist) therapy in the treatment of preterm labour.Design Three multinational, multicentre, double-blind, randomised, controlled trials.Setting Hospitals in Australia, Canada, Czech Republic, Denmark, France, Israel, Sweden, and the UK. Population Women diagnosed with preterm labour at 23±33 completed weeks of gestation.Methods Seven hundred and forty-two women were randomised; 733 received atosiban (n 363; intravenous (iv) bolus dose of 6.75 mg, then 300 mg/minute iv. for 3h and 100 mg/min iv thereafter) or beta-agonist (n 379; ritodrine, salbutamol or terbutaline iv; dose titrated) for at least 18h and up to 48 hours. Uterine contraction rate, cervical dilatation and effacement were used to assess progression of labour. An all patients treated analysis, using the Cochran-Mantel-Haenszel test, was performed.Main outcome measures Tocolytic effectiveness was assessed in terms of the number of women undelivered after 48 hours and seven days. Safety was assessed in terms of maternal side effects and neonatal morbidity. Results There were no signi®cant differences between atosiban and b -agonists in delaying delivery for 48h (88.1% vs 88.9%; P 0.99) or seven days (79.7% versus 77.6%; P 0.28). Tocolytic effectiveness was also similar in terms of mean [SD] ConclusionsIn the largest study of tocolytic therapy to date, atosiban was comparable in clinical effectiveness to conventional beta-agonist therapy, but was associated with fewer maternal cardiovascular side effects. We conclude that atosiban has clinical advantages over current tocolytic therapy.

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“…In the five studies that reported on side-effects, nifedipine had 23/147 (16%) and ritodrine 73/132 (45%) patients with side-effects. Even an increased risk of cardiac ischaemia was reported with the use of ritodrine [24]. From the perspective of obsterical outcome in aborting premature uterine contractions and short-term neonatal outcomes, nifedipine should therefore be the drug of first choice.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study Comparing Nifedipine versus Ritodrine for the Suppression of Preterm Labour

Al-Qattan¹,

Omu²,

Labeeb³

2000

Med Princ Pract

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Nifedipine is a dihydropyridine and a calcium channel blocker during the second phase of the action potential of uterine smooth muscle cells, and ritodrine is a β-sympathomimetic. Objective of Study: To compare the efficacy and side-effects of oral nifedipine to ritodrine in the inhibition of preterm labour. Methodology: Sixty parturients admitted to the Maternity Hospital with preterm labour who fulfilled the inclusion criteria were randomized into two equal therapy groups: (a) oral nifedipine (n = 30) and (b) intravenous ritodrine (n = 30). During the period, the parturients were under continuous monitoring of fetal well-being, maternal uterine contractions, blood pressure, and pulse and respiratory rates. Both groups were given dexamethasone and followed up through delivery and the early neonatal period. Results: The incidence of preterm deliveries during the study period was 6.5%. Ritodrine had a quicker onset of inhibition of uterine contractions, especially between 20 and 40 min after initiation of tocolytic therapy (p < 0.04). Labour was delayed on the average for 40 h in the nifedipine group compared to 24 h in the ritodrine group (p < 0.05). Eighteen patients (60%) in the nifedipine group had cessation for more than 48 h compared to 7 (30.4%) in the ritodrine group (p < 0.05). Nifedipine inhibited uterine contractions for more than 7 days in more patients than ritodrine (13 versus 5, p < 0.05). Ten patients in the nifedipine group went beyond 36 weeks of gestation compared to 4 in the ritodrine group (p < 0.03). In 5 (17.9%) of the ritodrine group compared to none in the nifedipine group, treatment was abandoned because of severe side-effects of nausea (11 versus 2, p < 0.01) and palpitations (16 versus 3, p < 0.004). There were no significant differences in the Apgar scores and neonatal morbidity. More infants in the ritodrine group (17, 73.9%) than in the nifedipine group (14, 46.1%, p < 0.05) were admitted to the neonatal unit. Conclusion: Nifedipine is recommended for aborting preterm contractions because it has fewer side-effects, superior efficacy and greater ease of administration than intravenous ritodrine.

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The contemporary use of β‐agonists

Cited by 25 publications

References 8 publications

Do Receptors Get Pregnant Too? Adrenergic Receptor Alterations in Human Pregnancy

Do Receptors Get Pregnant Too? Adrenergic Receptor Alterations in Human Pregnancy

Effectiveness and safety of the oxytocin antagonist atosiban versus beta‐adrenergic agonists in the treatment of preterm labour

A Prospective Randomized Study Comparing Nifedipine versus Ritodrine for the Suppression of Preterm Labour

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