Tocolytic Treatment for Preterm Contractions with and Without Cervical Changes

Abstract

Our purpose was to evaluate the impact of intravenous and oral tocolysis on prolongation of gestation for women with preterm uterine contractions and/or labor. Candidates for evaluation and treatment including women with contractions between 24 and 35 weeks. Two hundred women (group I) without cervical changes met the protocol criteria and 175 women (group II) who presented with or developed cervical changes were treated by protocol. A representative sample of both groups received oral terbutaline maintenance therapy until 37 weeks' gestation. Primary outcome variables included the length of gestation obtained following initial treatment and the preterm birth rate. Women in group II were twice as likely to deliver before 35 weeks, 23% versus 9.5%, respectively, and to have a delivery before 37 weeks' gestation, 45% versus 22%, respectively, (p < 0.05). There was no significant difference in days gained in utero for women on oral terbutaline for either group. Women in group II on oral therapy were more likely to be readmitted and retreated with parenteral tocolysis. In conclusion, oral maintenance tocolysis has no significant impact on further prolongation of pregnancy after intravenous tocolysis.

Evaluation of a Community-Wide Preterm Birth Prevention Program

“…The failure of either of these components impedes a change in the outcome. This may be a reflection of a variety of factors including a lack of confidence in tocolytic drugs (given the controversy surrounding their use 11,12 ). Indeed, until clinically effective tocolytics are available, communitywide preterm birth prevention programs will be ineffective in lengthening gestation.…”

The oxytocin antagonist atosiban versus the β‐agonist terbutaline in the treatment of preterm labor

“…This rather limited application is probably due to the considerable number of systemic adverse events associated with the non‐specific tocolytic agents currently available, particularly the β‐agonists. Terbutaline is one of the most widely used tocolytic drugs (36) but there is considerable variation in the efficacy, tolerability and administration of terbutaline reported in the literature (37–47). Although more acceptable methods of administering β‐agonists are being developed, including iv terbutaline pumps for maintenance therapy (37, 47) and oral sustained‐release ritodrine (48, 49), an inconvenient dose‐titration regimen, as used in this study, is still the common practice and this will also contribute to restricting the use of tocolysis.…”

Preterm labor in the triage setting

“…Twenty‐six percent of all pregnant women report uterine contractions before 37 weeks gestation (5). Approximately 30% of those who present with preterm contractions stop contracting on their own without treatment (42). When comparing complaints of contractions between patients delivering preterm to those who continued their pregnancy to term, no statistically significant difference was noted (5).…”

“…This will help avoid needless drug therapy with its potential adverse side effects (5). It is estimated that from 50% to 80% of the diagnoses of PTL are incorrect when based on contractions alone (5, 42). Clinical trials have shown that 40%–50% of those who receive placebo treatments for the complaint of contractions alone went on to deliver a term infant.…”

“…Terbutaline is also a β‐sympathomimetic agent and is an alternative to ritodrine. It is thought by some to be more effective, although recent studies have failed to show a significant difference (5,42,46,47). Side effects and contraindications are similar to those associated with ritodrine (12,48,49).…”