Tocolysis in women with advanced preterm labor: a secondary analysis of a randomized clinical trial

Klauser, Chad K.; Briery, Christian; Tucker, Ann; Martin, Rick W.; Magann, Everett F.; Chauhan, Suneet P.; Morrison, John C.

doi:10.3109/14767058.2015.1018171

Cited by 10 publications

(7 citation statements)

References 11 publications

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“…On the other hand, very limited studies are available about the effect of COXis on uteri or cervices near term. In one study (Klauser et al, 2016), the tocolytic efficacy of magnesium sulfate, nifedipine, and indomethacin was investigated in women in acute preterm labor with advanced cervical dilation. It was found that indomethacin could stop the preterm labor and gain 15.7 6 20.6 days, but no difference was found in the efficacy of the investigated tocolytic agents.…”

Section: Discussionmentioning

confidence: 99%

α-Tocopherol Potentiates the Cervical Resistance Decreasing Effects of COX Inhibitors in Pregnant Rats: The Putative Role of Cyclooxygenase-2 Inhibition

Kothencz

Hajagos-Tóth

Szűcs

et al. 2018

J Pharmacol Exp Ther

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Vitamin E and their analogs as antioxidant and lipid-soluble compounds can have diverse effects on the physiologic processes. By binding to receptors and enzymes, they may modify the action of drugs. It has been proved that a-tocopherol succinate modifies the effects of b 2 agonist terbutaline and cyclooxygenase (COX) inhibitors on rat trachea and myometrium. Our aim was to investigate how a-tocopherol and COX inhibitors may influence cervical resistance in rats. The cervical resistance of nonpregnant and 22 day-pregnant Sprague-Dawley rats was determined in an isolated organ bath in vitro. a-Tocopherol-succinate (10 2 7 M) was used, whereas the COX-nonselective diclofenac (10 2 6 M), the COX-2-selective rofecoxib (10 26 M), and the COX-1-selective SC-560 (10 26 M) were applied as inhibitors. The COX activities of the cervices were measured by enzyme immunoassay. The modifying effect of single doses of COX inhibitors and tocopherol on the onset of labor was investigated in vivo. The cervical resistance of nonpregnant samples was not changed by either a-tocopherol or COX inhibitors. On pregnant cervices, tocopherol, diclofenac, or rofecoxib pretreatment decreased cervical resistance that was further reduced by COX inhibitors after pretreatment with tocopherol. a-Tocopherol elicited a significant COX-2 enzyme inhibition in cervical samples from pregnant rats. By coadministration of tocopherol and rofecoxib, the parturition was initiated earlier than in the other groups. It is supposed that COXs play a significant role not only in cervical ripening, but also in the contraction of the cervical smooth muscle a few hours before parturition. This latter action may be developed by COX-2-liberated prostaglandins.

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Section: Discussionmentioning

confidence: 99%

α-Tocopherol Potentiates the Cervical Resistance Decreasing Effects of COX Inhibitors in Pregnant Rats: The Putative Role of Cyclooxygenase-2 Inhibition

Kothencz

Hajagos-Tóth

Szűcs

et al. 2018

J Pharmacol Exp Ther

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“…One recent secondary analysis of a randomized clinical trial examined 92 women presenting between 4–6 cm dilated at 24–32 weeks gestation and found, similar to our study, no differences in pregnancy prolongation by tocolytic regimen (indomethacin, magnesium, or nifedipine). 24 …”

Section: Discussionmentioning

confidence: 99%

Tocolysis for Women With Early Spontaneous Preterm Labor and Advanced Cervical Dilation

Manuck

Herrera

Korgenski

et al. 2015

Obstetrics &Amp; Gynecology

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Objective To characterize tocolytic use and examine perinatal outcomes among women presenting very preterm with spontaneous labor and cervical dilation ≥4 cm. Methods This was a retrospective cohort study. Data from January 2000 to June 2011 in a single healthcare system were reviewed. Women with singleton, non-anomalous fetuses, and preterm labor with intact membranes between 23.0–32.0 weeks gestation who had cervical dilation ≥4 cm and <8 cm at admission were included. Women receiving one or more tocolytics (magnesium sulfate, indomethacin, or nifedipine) were compared to those who did not receive tocolysis. The primary outcome was composite major neonatal morbidity. Results Two hundred ninety seven women were included; 233 (78.5%) received at least one tocolytic. Women receiving tocolysis were slightly less dilated (median 5 vs. 6 cm, p<0.001) at presentation, and were more likely to receive at least a partial course of corticosteroids (88.4% vs. 56.3%, p<0.001). Initial composite severe neonatal morbidity rates were similar (41.6% vs. 43.8%, p=0.761) regardless of tocolytic administration. Those receiving tocolysis were significantly more likely to be pregnant at least 48 hours after admission (23.6% vs. 7.8%, p=0.005), but a similar proportion delivered within 7 days of admission (94.8% vs. 95.3%, p>0.99), and delivery gestational ages were similar (28.9 vs. 29.2 weeks, p=0.408). The incidence of chorioamnionitis and postpartum endometritis were similar between groups. Conclusion The majority of women presenting very preterm with advanced cervical dilation received tocolysis. Although tocolysis administration increased the likelihood of achieving at least 48 hours of latency, initial neonatal outcomes were similar.

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“…However, data on tocolysis and advanced preterm labor are limited and the appropriate management is controversial. [ 12 13 14 ]…”

Section: Discussionmentioning

confidence: 99%

Relationship between cervical dilation and time to delivery in women with preterm labor

et al. 2015

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Background:Early recognition of the signs and symptoms of preterm labor (PTL) is important in order to establish treatment. Our aim was to determine the relation between cervical dilatation and time interval from admission to delivery in women with preterm labor.Materials and Methods:A retrospective cohort study was conducted on 83 singleton gestations admitted for preterm labor between 24 weeks and 34 weeks, who subsequently delivered preterm. Women were categorized into three groups of cervical dilatation (0-2 cm, 3-6 cm, >6 cm) and the time interval from admission to delivery was compared. Cox regression analysis was performed to assess the association between cervical dilatation and time interval from admission to delivery. The other variables examined were gestational age (GA) at admission and length of the cervix, when performed.Results:The time interval from admission to delivery was significantly shorter in women with higher dilatation of the cervix (p < 0.02) and in those admitted at a more advanced gestational age (p < 0.05). Forty-eight percent of women with cervical dilatation 0-2 cm delivered in the first 48 h compared to 85% of the women with a dilatation of 3-6 cm. No significant association was found between the length of the cervix and the time interval to delivery.Conclusion:Dilatation of the cervix and gestational age at admission are associated with the time interval to delivery in women with preterm labor. The assessment of the length of the cervix is unlikely to add clinical information in women with an already dilated cervix.

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Tocolysis in women with advanced preterm labor: a secondary analysis of a randomized clinical trial

Cited by 10 publications

References 11 publications

α-Tocopherol Potentiates the Cervical Resistance Decreasing Effects of COX Inhibitors in Pregnant Rats: The Putative Role of Cyclooxygenase-2 Inhibition

α-Tocopherol Potentiates the Cervical Resistance Decreasing Effects of COX Inhibitors in Pregnant Rats: The Putative Role of Cyclooxygenase-2 Inhibition

Tocolysis for Women With Early Spontaneous Preterm Labor and Advanced Cervical Dilation

Relationship between cervical dilation and time to delivery in women with preterm labor

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