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At least 19 recordsLinked to original sources

PubMed1987

[Comparison of the effectiveness of Partusisten and ethanol tocolysis. III: Comparison of long-term and short-term tocolysis with Partusisten and ethanol].

The effectivity of Partusisten or ethanol long term respectively short term tocolysis by combination of a retrospective and a prospective-randomised study has been compared. Long term tocolysis was better than short term tocolysis. Partusisten was more effective than ethanol. Partusisten long term tocolysis was different to other forms or treatment with a high significance. 70% of newborns after Partusisten long term tocolysis had a birth weight of 2500 g or more.

Birth Weight↗

PubMed1987

[Comparison of the effectiveness of Partusisten and ethanol tocolysis. I: long-term tocolysis with Partusisten or ethanol].

Effectiveness of long term tocolysis with fenoterol (Partusisten) (n = 124) or ethanol (n = 117) has been compared in a retrospective study of the years 1978 to 1980. Situation of starting therapy has been estimated by Bishop-Score, tocolysis index and gestational week. Criterias of success were duration of gestation (reaching greater than or equal to 37th gestational week), neonatal parameters (weight greater than or equal to 2500 g, RDS morbidity, neonatal mortality) and prolongation index by Richter and success score by Weidinger. Fenoterol (Partusisten) is the better drug for treatment of premature labor. In cases of contraindications or incompatibility ethanol tocolysis is justified.

Adult↗

PubMed1987

[Comparison of the effectiveness of Partusisten and ethanol tocolysis. II. Short-term tocolysis with Partusisten or ethanol].

A prospectively randomised study for treatment of premature labor either by Partusisten or ethanol short term tocolysis was done in the years 1981 to 1983. The tocolysis was successful in 54 per cent (Partusisten) respectively 50 per cent (ethanol) by reaching a birth weight 2,500 g. 36 per cent respectively 37 per cent pregnant women reached 37th gestational week. Prolongation index 21 or more allows to predict a birth weight of 2,500 g or more. Success score 12 is not identical with corresponding birth weight. Ethanol tocolysis is an alternative to Partusisten treatment.

Adult↗

PubMed1987

A study of maternal ECG characteristics before and during intravenous tocolysis with beta-sympathicomimetics. Effects of i.v. tocolysis on maternal ECG characteristics.

Severe maternal complications during beta-mimetic therapy have been reported. In a study of maternal complications related to intravenous tocolysis, which covering a period of 2 years, we paid special attention to the maternal ECG before and during treatment. There was a high prevalence of pretreatment ECG changes: tachycardia (23.6%), disorders of impulse conduction (43.6%), ST-depression (14.5%) and disorders of repolarization (43.6%). During intravenous beta-mimetic therapy there was an increase in the prevalence of tachycardia, prolonged QT-time and disorders of repolarization. We also studied the course in time of the different ECG characteristics during treatment. With regard to the ST-depression, a possible physiological adaptation to the beta-mimetic drug is described. We could not find this possible adaptation with regard to the other ECG characteristics. None of the women in the studied group showed clinical signs of myocardial ischemia, notwithstanding the high prevalence of ECG changes. We conclude that the ECG criteria for discontinuation of tocolytic therapy need re-evaluation.

Adult↗

PubMed1989

A prospective randomised controlled trial of external cephalic version comparing two methods of uterine tocolysis with a non-tocolysis group.

The use of tocolvtic agents to enhance uterine relaxation and facilitate external cephalic version (ECV) has come under recent debate. We studied 90 breech presentations in late pregnancy who did not have contra-indications to ECV. The patients were randomised into 3 groups of 30 patients each: one was administered oral salbutamol 4 mg t.d.s.; another had intravenous salbutamol infused until the maternal heart rate rose above 100 bpm for 30 mins; and the last served as a control group. All patients in each group were matched for parity and gestation, and each had an intravenous line, thereby masking the treatment group from the 2 doctors who performed half the number of ECVs each. There was no significant difference in the success of ECV between the treatment and control groups (46.6% vs 50.0% vs 46.6%). The gestational age, the placental site, the attitude of the breech, the abdominal girth, and the maternal weight and fetal birth weights did not seem to influence results. On the other hand, there was a significant difference in successful ECV between nullipara (26%) and multipara (75%) (p less than 0.001). There were no cases of abruptio placenta or foetal distress, and one patient entered labour one day after the ECV at 39 weeks gestation. There were 2 cases of spontaneous version after failed ECV, and one case of spontaneous reversion to breech after successful ECV. We conclude that the use of salbutamol does not increase the incidence of successful ECV, but multiparity predicts for a successful outcome.

Adult↗

PubMedDate not supplied

Amniotic fluid interleukin-6 and interleukin-8 levels predict the success of tocolysis in patients with preterm labor.

OBJECTIVE: To determine whether the levels of the cytokines interleukin-6 (IL-6) and IL-8 in amniotic fluid identify patients with preterm labor who are resistant to tocolysis. METHODS: Amniocenteses were performed in 23 women with documented preterm labor at 20-32 weeks' gestational age who were treated subsequently with tocolytics. The concentrations of IL-6 and IL-8 in amniotic fluid were determined by double-antibody radioimmunoassay methods using recombinant human IL standards. RESULTS: Of the 23 patients, five failed to respond to tocolysis (four delivered within 48 hours), and of the remaining 18, all delivered more than 9 days after tocolysis was initiated (mean 31 +/- 10 days; range 9-61). In women who had failed tocolysis, discriminatory concentrations of IL-6 and IL-8 were 20 and 15 ng/mL, respectively. Of the patients who had amniotic fluid concentrations higher than these thresholds, all failed tocolysis (100% positive predictive value) and delivered within 6 days. The patients with levels below these discriminatory concentrations had successful tocolysis, and 17 of 18 delivered more than 2 weeks after treatment (95% negative predictive value). CONCLUSION: The success of tocolysis and thus delivery remote from an episode of preterm labor is associated with discriminatory amniotic fluid IL-6 and IL-8 levels of less than 20 and less than 15 ng/mL, respectively. If the immunologic response that causes the release of IL-6 and IL-8 has not occurred, the likelihood of successful tocolysis is extremely high. However, if both IL-6 and IL-8 are elevated, tocolysis is likely to fail and delivery may occur within 48 hours.

Adult↗

PubMed1988

The therapeutic efficacy and cost-effectiveness of aggressive tocolysis for premature labor associated with premature rupture of the membranes.

We conducted a randomized trial comparing bed rest with tocolysis to determine the therapeutic efficacy, safety, and cost-effectiveness of tocolysis for the treatment of preterm labor after membrane rupture. One hundred nine women participated over a 26-month interval. Treatment groups did not differ significantly in terms of gestational age at membrane rupture, gestational age at delivery, birth weight, maternal or fetal infectious morbidity, respiratory distress syndrome, necrotizing enterocolitis, or perinatal mortality. Prolongation of intrauterine time after the onset of uterine contractions was seen in women receiving tocolysis (105.2 +/- 157 hours versus 62.1 +/- 77 hours, p = 0.06). This prolongation was not associated with a significant reduction in the total cost per surviving infant (tocolysis, $38,593 +/- $40,887 versus bed rest, $43,158 +/- $37,116; p = 0.445). The cost difference was artifactual. The number of very premature infants born (less than 28 weeks' gestation) was unequal in the two groups (12 in the bed rest group and 5 in the tocolysis group) and skewed the results. Before 28 weeks' gestation tocolysis was associated with a significant increase in intrauterine time after the onset of regular contractions (p = 0.05). However, there was no identifiable perinatal benefit garnered from the additional 5 days. After 28 weeks there were no significant differences between treatment groups in terms of intrauterine time after the onset of regular contractions and total cost per surviving infant. Because tocolysis does not improve perinatal outcome and can itself be associated with major maternal morbidity, it should be avoided after 28 weeks' gestation. Before 28 weeks' gestation tocolysis may greatly increase intrauterine time, but the benefit of this prolongation is not clear.

Adult↗

PubMed1989

Bolus tocolysis: treatment of preterm labor with pulsatile administration of a beta-adrenergic agonist.

The treatment of premature labor with beta-adrenergic substances is complicated by side effects. Although most human control mechanisms are pulsatile, therapy is usually administered continuously. We designed a microprocessor-controlled pump to allow pulsatile tocolytic infusion, hoping to reduce the total dose and thus the side effects. In 33 patients pulsatile bolus tocolysis was compared with continuous tocolysis in a control group of 38 patients. Bolus tocolysis required considerably less beta-sympathomimetic agent for comparable therapeutic success (median dosage 3.0 versus 15.9 mg, p less than 0.001). Duration of therapy under bolus tocolysis was also significantly shorter (p less than 0.05). Birth weight was higher after bolus tocolysis (median 3070 versus 2580 gm, p = 0.05). Additional indicators favored bolus tocolysis but were not statistically significant: a longer gestational period, fewer infants weighing less than 2500 gm, and a lower incidence of respiratory distress syndrome. Pulmonary edema occurred in one patient during continuous tocolysis.

Adrenergic beta-Agonists↗

PubMed1997

Successful tocolysis: does cervical change affect time to delivery?

Generally, it is preferable to tocolyze patients with idiopathic preterm labor (PTL). Little information is available about ultimate outcomes after successful tocolysis. Our objective is to evaluate the relationship between cervical change after the initiation of tocolysis and the delay in time to delivery in patients with preterm labor. A historical analysis of all patients with successful tocolysis after PTL between January 1992 and December 1993 was undertaken. The patients were then placed in one of three categories (regression, unchanged, or progression) based on cervical change after the initiation of tocolysis. Various demographic pregnancy characteristics and pregnancy outcome data were analyzed. One hundred and twenty-six patients had successful tocolysis and met the admission criteria. Patients who had cervical progression had shorter delay to delivery, delivered at an earlier gestational age (31.7 weeks compared to 34.0 and 34.1 weeks, respectively, p < 0.05), and were more likely to deliver before 35 weeks (88% compared to 50.0 and 55.0%, respectively, p < 0.05). Also, neonates remained in the hospital longer and were more likely to have respiratory distress syndrome when compared to the other two groups. Patients who had cervical progression after the initiation of tocolysis are more likely to deliver prematurely, had a shorter delay to delivery, and delivered lower birth weight infants than did patients whose cervix regressed or remained unchanged. In our population, patients who had successful tocolysis had a preterm delivery rate of 59.5% before the 35th week of gestation.

Adolescent↗

PubMed1993

Effect of intravenous beta-sympathomimetic tocolysis on human fetal serum erythropoietin levels.

OBJECTIVE: The major stimulus for erythropoietin production is tissue hypoxia. We sought to investigate the relationship of beta-sympathomimetic administration for tocolysis and fetal serum erythropoietin. STUDY DESIGN: Umbilical cord blood was obtained from infants whose mothers received intravenous beta-sympathomimetic tocolysis and who were delivered at < or = 34 weeks' gestation. Serum erythropoietin was measured by radioimmunoassay. On the basis of the presumed 2- to 4-hour half-life of fetal erythropoietin, the infants were divided into two groups. In group 1 (n = 16) beta-sympathomimetic therapy was discontinued < 24 hours before delivery; in group 2 (n = 11) it was discontinued > or = 24 hours before delivery. RESULTS: Group 1 fetuses had significantly higher erythropoietin levels than did group 2 fetuses (37.3 vs 13.9 mU/ml, p = 0.02). The duration of beta-sympathomimetic tocolysis and the maximum infusion rate were not different. The two groups did not differ in gestational age, birth weight, route of delivery, presence of labor, or duration of first or second stage of labor. CONCLUSIONS: We speculate that intravenous beta-sympathomimetic tocolytic therapy stimulates fetal erythropoietin production by decreasing fetal oxygenation as a result of the reversible fetal metabolic effects of the tocolysis. These data suggest that beta-sympathomimetic tocolysis should be undertaken cautiously if fetal compromise is suspected, fetal well-being should be assessed carefully if tocolysis is undertaken, and treatment should be discontinued promptly if a clear benefit is not realized.

Erythropoietin↗

PubMed1985

Maternal paralytic ileus as a complication of magnesium sulfate tocolysis.

Beta-adrenergic agonists tocolysis is currently the most popular treatment modality in the United States. However, magnesium sulfate is receiving increasing attention as an alternating tocolytic agent in the presence of various clinical situations, such as the treatment of insulin-dependent diabetes. While there is an abundance of information about the maternal and fetal side effects associated with beta-adrenergic tocolysis, little information is available about maternal adverse side effects of magnesium sulfate treatment for preterm labor. Side effects such as pulmonary edema, respiratory depression, hypocalcemia, and hypermagnesemia have been reported in patients receiving this agent for either tocolysis or pre-eclampsia, though their occurrence is quite rare. One of the infrequent complications of beta-adrenergic agonist tocolysis is the occurrence of a paralytic ileus, which to our knowledge has not yet been reported in association with magnesium sulfate tocolysis. This article therefore concerns the development of a paralytic ileus in a patient receiving parenteral magnesium sulfate for tocolysis. The clinical features are described and the possible mechanisms involved discussed.

Adult↗

PubMed1986

[Indications for tocolysis. A prospective study].

In a prospectively randomised group of pregnant patients showing signs of prematurity, who had undergone long-term tocolysis between the 28th and 38th week of gestation--mainly with Fenoterol--the interval between the end of the tocolytic therapy and the delivery is noted. According to the duration of the end of tocolysis to delivery interval (TEDI) the indication for tocolysis can be retrospectively investigated. In patients where the TEDI was 72 hours or less, tocolysis is regarded as being necessary, and in patients with TEDI of longer than 72 hours, tocolysis is regarded as questionable or unnecessary. In this study in 49% of the cases tocolysis was necessary, whereby the primapara had a shorter TEDI on the average than the multipara. Both groups with short and long TEDI are compared with reference to obstetrical parameters, whereby virtually only the greater anamnestic strain of the patients with short TEDI emerged. There is not easily recognizable uniform criterion which can identify prospectively those patients whose baby is born within 72 hours after the tocolytic therapy has been discontinued. The results are discussed under the aspect of unsolved problems in the indication for tocolytic treatment.

Aspirin↗

PubMed1982

[Studies of the clinical effectiveness of intravenous long-term tocolysis].

Possible retardation of delivery following different periods of intravenous Partusisten tocolysis was studied in 701 premature births, between the 28th and 36th weeks of pregnancy. The studies were conducted separately, for all probands together and by gestational age groups. Various symptoms of imminent premature birth were not weighed. The rate of failure amounted to 23 per cent, that is delivery occurred within 24 hours from beginning of treatment. Extension of pregnancy by something between two and seven days was achieved in 45 per cent of the probands or by more than seven days in 32 per cent. Growing length of intravenous tocolysis was followed by significant rise in the number of women with genuine prolongation of pregnancy (between eight and 28 days or even more), however, without any unambiguous evidence to differentiation between gestational age groups with regard to therapeutic responsiveness. Significant percentual rise in prematurity between the 34th and 36th weeks of pregnancy by almost 30 per cent (with 20 per cent in the 36th week of pregnancy alone) seems to indicate a measurable clinical benefit of intravenous long-term tocolysis in terms of higher life expectancy and better survival quality. --The above findings were compared with results that had been obtained from 1,037 prematurely born infants of the same gestational age groups without preceding tocolysis. The conclusion was that intravenous tocolysis in general and long-term tocolysis in particular failed to have the slightest negative impact in terms of acidosis and RDS morbidity, average birth weight, hypotrophy, and survival chance. The need for properly timed detection of prematurity as part of routine care may be seen from the great number of untreated premature births, that is cases beyond any possibility of treatment. The point is made that the effectiveness of tocolytic therapy can be measured only by those premature newborns who had received treatment rather than by the totality of premature newborns.

Ethanolamines↗

PubMedDate not supplied

Diltiazem for maintenance tocolysis of preterm labor: comparison to nifedipine in a randomized trial.

The objective of this study was to compare the safety and efficacy of maintenance tocolysis with oral diltiazem to oral nifedipine in achieving 37 weeks gestation. After successful intravenous tocolysis with magnesium sulfate, 69 women with preterm labor at <35 weeks gestation were randomly assigned to nifedipine (20 mg orally every 4-6 hr), or diltiazem (30-60 mg orally every 4-6 hr). The primary outcome was the percentage of patients achieving 37 weeks gestation. Maternal cardiovascular alterations and neonatal outcomes were also assessed. Sixty-nine patients were available for final analysis. Less patients on diltiazem as compared to nifedipine achieved 37 weeks (15.1% vs. 41.7%, P = 0.019). Gestational age at delivery was also less for patients receiving diltiazem (35.5 +/- 3.5 weeks vs. 33.4 +/- 3.9 weeks, P = 0.022). There were fewer days gained in utero from randomization to delivery with diltiazem as compared to nifedipine; however, this difference was not statistically significant (22.4 +/- 16.3 days vs. 31.2 +/- 24.4 days, P = 0.084). Maternal blood pressure and pulse during tocolysis did not differ significantly between groups. Despite the theoretical advantages of diltiazem tocolysis, maintenance tocolysis with diltiazem offered no benefit over nifedipine in achieving 37 weeks gestation. The cardiovascular alterations with either drug in normotensive, pregnant patients appear minimal.

Amniotic Fluid↗

PubMed1995

Tocolysis in advanced preterm labor: impact on neonatal outcome.

Chart review of 73 patients with 3.5 cm or more dilation, intact membranes, and regular contractions at less than 36 weeks. Forty-four (group A) received tocolysis with magnesium sulfate, and 13 of the 44 also received indomethacin. Twenty-nine (group B) received no tocolysis. Obstetric and neonatal outcomes were compared. Demographic factors and admission gestational age, cervical dilation, effacement, and uterine activity were similar. Twenty-one of the 44 in group A versus 3 of 29 in group B had delivery delayed by more than 48 hours (p = 0.002). Group A had a lower incidence of severe respiratory distress syndrome; 4 of 48 babies in group A versus 9 of 32 in group B (p = 0.04; RR = 0.47; confidence interval [CI], 0.2, 1.0). Tocolysis in advanced preterm labor delays delivery by more than 48 hours in 50% of patients. The neonatal benefits of aggressive tocolysis in cases with advanced cervical dilation may outweigh the potential maternal risks of tocolysis, particularly in the setting of extreme prematurity. Delay in delivery enabling steroid enhancement of pulmonary maturity reduces the severity of respiratory distress syndrome.

Cohort Studies↗

PubMed1990

Tocolysis in the management of third trimester bleeding.

Fifteen patients were identified in a retrospective analysis of one institution's experience with the use of tocolysis in selected patients with an admission diagnosis of placenta previa or abruptio placentae. There were no fetal deaths after admission, and the two neonatal deaths were related to prematurity. Eight of the 15 patients receiving tocolysis had their pregnancies prolonged by 2 weeks or more, and there were no fetal or neonatal deaths in this group. Both neonatal deaths occurred in patients who underwent tocolysis but who gave birth within 1 day of admission. These data suggest the safety of tocolysis in preterm patients with the diagnosis of placenta previa or abruption who are bleeding. A prospective, randomized trial is required to evaluate whether tocolysis is superior to expectant management or to immediate delivery. The clinical difficulty in differentiating between these two diagnoses, despite liberal use of ultrasonography, is discussed.

Abruptio Placentae↗

PubMed1987

A randomized trial of ritodrine tocolysis versus expectant management in patients with premature rupture of membranes at 25 to 30 weeks of gestation.

Expectant management was compared with similar management plus ritodrine tocolysis in a randomized controlled trial in patients with premature rupture of membranes at 25 to 30 weeks of gestation. In the tocolysis group intravenously administered ritodrine was instituted at the onset of labor and then changed to the oral form if successful. Tocolysis was discontinued or not instituted after 31 weeks of gestation. Seventy-nine patients were randomized over a 4-year period, 39 in the tocolysis group and 40 in the expectant group. Twenty-three patients in the tocolysis group actually received ritodrine. No difference between the two groups was demonstrated in the interval between premature rupture of membranes and delivery or in reaching 32 weeks of gestation. No statistical difference was seen in maternal morbidity. Birth weights and gestational ages at delivery were similar between the two groups as were the incidences of neonatal morbidities caused by prematurity and infection and in the duration of neonatal hospital stays. Despite being conducted in those gestational ages in which prolongation of pregnancy might be expected to be of most benefit, no difference could be demonstrated with the addition of tocolytic therapy over expectant management alone.

Adult↗

PubMed1980

[Tocolysis with a beta-receptor stimulating compound in patients with WPW-syndrome. A casuistic report (author's transl)].

During a previous pregnancy supraventricular tachycardia complicated delivery in time in a woman with WPW-syndrome (Typ A) known since seven years. In the 34th week of the second pregnancy onset of preterm labor with a pelvic score of 7 and a tocolysis index of 5 was indication for tocolytic therapy. For protection against paroxysmal supraventricular tachycardia tocolysis with the semiselective beta 2-stimulating compound Fenoterol was started in combination with the beta 1-selective blocking compound Metoprolol. Tocolysis lasted 6 days without cardiac complications. Also during labor no tachycardia set on. The duration of tocolysis with Fenoterol/Metoprolol in this case was comparable with the duration of tocolysis reported for monotherapy with Fenoterol in similar obstetric states. In patients with WPW-syndrome the combination of a semiselective beta 2-simulating compound with a beta 1-blocking agent seems to offer a new possibility for tocolytic therapy.

Adult↗