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Reshama Navathe, Vincenzo Berghella
PURPOSE OF REVIEW: Tocolytic agents have been used for over 60 years in the fight against preterm labor, which ultimately can lead to preterm birth. Currently, clinicians can choose from a variety of drug classes to achieve the primary goal of delaying delivery by 48 h, thereby allowing time for administration of corticosteroids for fetal lung maturity, and if appropriate, starting magnesium sulfate for fetal neuroprotection. However, there are currently no known therapies to maintain the tocolytic effect beyond those initial 48 h...
October 18, 2016: Current Opinion in Obstetrics & Gynecology
Montse Palacio, Stefania Ronzoni, Luis Sánchez-Ramos, Kellie E Murphy
OBJECTIVE: To evaluate the efficacy of maintenance tocolysis with progestogens compared with placebo or no treatment in women with singleton pregnancies and arrested preterm labor. DATA SOURCES: Studies without language restrictions were identified from MEDLINE, EMBASE, PubMed, Scopus, the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Central Register of Controlled Trials, and from inception to June 2015. MeSH headings for progestogens were combined with terms regarding labor, tocolysis, or preterm birth...
October 6, 2016: Obstetrics and Gynecology
Giovanni Grandi, Lucrezia Pignatti, Francesca Ferrari, Giulia Dante, Isabella Neri, Fabio Facchinetti
INTRODUCTION: Inflammation might be an important underlying cause of preterm birth. Our aim is to explore whether vaginal administration α-lipoic acid reduces cervical inflammation and shortening after primary tocolysis. Matherials and Methods: Singleton pregnancies between 24-30 weeks remaining undelivered after hospitalization for preterm labor were randomly allocated to placebo (20 women, 15 analyzed) or vaginal ALA 400 mg daily (20 women, 17 analyzed) for 30 days. A cervical swab to quantify pro-inflammatory (IL1, IL2, IL6, IL8, TNFα) and anti-inflammatory (IL4, IL10) cytokines as well as transvaginal ultrasound cervical length measurement (CL) were performed before and after treatment...
October 9, 2016: Journal of Maternal-fetal & Neonatal Medicine
Ljiljana Bjelakovic, Tatjana Trajkovic, Gordana Kocic, Dragan Radovanovic, Nikola Zivkovic, Aleksandra Klisic, Vladimir Antic, Nebojsa Kavaric, Bojko Bjelakovic
BACKGROUND: To date there are no clinical studies analyzing potential effects of tocolytics on breastfeeding duration in humans. OBJECTIVES: The purpose of this study was to evaluate the association between beta 2 agonists prescribed for tocolysis during pregnancy and breastfeeding duration. METHODS: We conducted a cross-sectional questionnaire study of 114 mothers and filled in the questionnaire developed to directly address the goals of the study...
October 5, 2016: Breastfeeding Medicine: the Official Journal of the Academy of Breastfeeding Medicine
Jian-Ling Chen, Jian-Ming Yang, Ya-Zhe Huang, Ying Li
PURPOSE: This study aims to investigate the clinical curative effect of lymphocyte active immunotherapy (LAI) on unexplained recurrent spontaneous abortion (RSA). METHODS: A total of 749 RSA patients who received medical service in our hospital from October 2009 to June 2013 were enrolled into this study. These patients were randomly divided into two groups: LAI group (treatment group) and routine progesterone for maintenance tocolysis group (control group). A comparative analysis on the pregnancy outcomes in these two groups was conducted...
September 24, 2016: International Immunopharmacology
Masamitsu Nakamura, Junichi Hasegawa, Tatsuya Arakaki, Shoko Hamada, Hiroko Takita, Tomohiro Oba, Keiko Koide, Ryu Matsuoka, Akihiko Sekizawa
AIM: The aim of this study was to evaluate the effect of long-term use of tocolytic agents to prevent preterm delivery and improve perinatal outcome. METHODS: A historical cohort study was performed in a single perinatal center. The maternal characteristics, frequency of preterm labor and prescribed dose of tocolytic agents were compared before and after changing the management protocol for threatened premature delivery. RESULTS: A total of 1548 deliveries were carried out before changing the protocol for the use of tocolytic agents for threatened premature delivery and 1444 deliveries afterwards...
September 19, 2016: Journal of Obstetrics and Gynaecology Research
Toby Shipway, Elaine Johnson, Sheridan Bell, Jodie Martin, Peter Clark
OBJECTIVE: There has been much newspaper and online news coverage of in-flight obstetric births on commercial aircraft over several decades. This case series reviews several cases of in-flight birth and immediate maternal and neonatal outcomes from air medical retrievals in the Northern Territory of Australia over a 3-year period. METHODS: This is a retrospective written case note and electronic medical retrieval record analysis of 4 patients undergoing in-flight, at altitude, obstetric birth...
September 2016: Air Medical Journal
Tobias A J Nijman, Elvira O G van Vliet, Christiana A Naaktgeboren, Katrien Oude Rengerink, Thomas S de Lange, Caroline J Bax, Kitty W M Bloemenkamp, Jim van Eyck, Marjolein Kok, Hubertina C J Scheepers, Mallory Woiski, Arie Franx, Ben Willem J Mol, Martijn A Oudijk
OBJECTIVE: Preterm birth is the most common cause of neonatal morbidity and mortality. Around one third of preterm deliveries starts with preterm prelabor rupture of membranes (PPROM). The aim of this trial was to study the effect of prolonged tocolysis with nifedipine versus placebo in women with PPROM on perinatal outcome and prolongation of pregnancy. STUDY DESIGN: The Apostel IV was a nationwide multicenter randomized placebo controlled trial. We included women with PPROM without contractions between 24(+0) and 33(+6) weeks of gestation...
October 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Sarah Arrowsmith, James Neilson, Susan Wray
BACKGROUND: Preterm birth before 37 weeks' gestation is the most common and costly complication of pregnancy and remains the leading cause of neonatal morbidity, mortality and reduced achievement in surviving infants. Magnesium sulfate is one class of tocolytics for threatened preterm labor however its clinical efficacy has been questioned. Twin pregnancies are at increased risk of preterm delivery compared to singleton gestations, suggesting there is twin-specific risk to preterm delivery in twins...
August 20, 2016: American Journal of Obstetrics and Gynecology
Eog van Vliet, G H Dijkema, E Schuit, K Y Heida, C Roos, Jam van der Post, E C Parry, L McCowan, D J Lyell, Y Y El-Sayed, D B Carr, A L Clark, Z A Mahdy, M Uma, N C Sayin, G F Varol, B W Mol, M A Oudijk
BACKGROUND: Preterm birth is the leading cause of neonatal mortality and morbidity in developed countries. Whether continued tocolysis after 48 hours of rescue tocolysis improves neonatal outcome is unproven. OBJECTIVES: To evaluate the effectiveness of maintenance tocolytic therapy with oral nifedipine on the reduction of adverse neonatal outcomes and the prolongation of pregnancy by performing an individual patient data meta-analysis (IPDMA). SEARCH STRATEGY: We searched PubMed, Embase, and Cochrane databases for randomised controlled trials of maintenance tocolysis therapy with nifedipine in preterm labour...
October 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Kishwar Azad, Jiji Mathews
Preterm births (PTBs), defined as births before 37 weeks of gestation account for the majority of deaths in the newborn period. Prediction and prevention of PTB is challenging. A history of preterm labour or second trimester losses and accurate measurement of cervical length help to identify women who would benefit from progesterone and cerclage. Fibronectin estimation in the cervicovaginal secretions of a symptomatic woman with an undilated cervix can predict PTB within 10 days of testing. Antibiotics should be given to women with preterm prelabour rupture of membranes but tocolysis has a limited role in the management of preterm labour...
June 24, 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
Beata Modzelewska
One hundred and twenty years after the description of extracts from the adrenal medulla, the use of beta-blockers and beta-agonists evolved from antianginal drugs and tocolytics to ligand-directed signaling. Beta-blockers in the fields of obstetrics and gynecology have so far been limited to the consideration of continuing treatment of disorders of the cardiovascular system and other dysfunctions that started before pregnancy. Studies in recent years have shown that beta-adrenoceptor signaling might be crucial in carcinogenesis and metastasis, apoptosis and anoikis...
April 2016: Developmental Period Medicine
Frederik J R Hermans, Ewoud Schuit, Brent C Opmeer, Martijn A Oudijk, Mireille Bekker, Mallory Woiski, Caroline J Bax, Marieke Sueters, Hubertina C J Scheepers, Maureen T M Franssen, Eva Pajkrt, Ben Willem J Mol, Marjolein Kok
BACKGROUND: Preterm birth is a major cause of neonatal mortality and morbidity. As preventive strategies are largely ineffective, threatened preterm labor is a frequent problem that affects approximately 10 % of pregnancies. In recent years, risk assessment in these women has incorporated cervical length measurement and fetal fibronectin testing, and this has improved the capacity to identify women at increased risk for delivery within 14 days. Despite these improvements, risk for preterm birth continues to be increased in women who did not deliver after an episode of threatened preterm labor, as indicated by a preterm birth rate between 30 to 60 % in this group of women...
2016: BMC Pregnancy and Childbirth
Golnaz Rezaeizadeh, Sedigheh Hantoushzadeh, Sima Ghiasi, Shekoufeh Nikfar, Mohammad Abdollahi
BACKGROUND: Preterm birth is a worldwide tragedy with a high incidence. Several medications are used to inhibit acute preterm labor, but tocolysis by these medicines do not extend pregnancy beyond 1-2 days. OBJECTIVES: The purpose of this study was to discover new medications from plant extracts or their active compounds which inhibit the uterine contractions in order to treat preterm labor. DATA SOURCES: PubMed, Google Scholar, Scopus and IranMedex databases were searched up to 1st February 2012 with the most relevant keywords...
2016: Current Pharmaceutical Biotechnology
Ming-Xia Ding, Xin Luo, Xue-Mei Zhang, Bing Bai, Ju-Xiang Sun, Hong-Bo Qi
OBJECTIVE: No treatment is recommended for routine maintenance tocolysis after an arrested preterm birth. Our present study aimed to evaluate the effect of progesterone and nifedipine as maintenance tocolysis therapy after an arrested preterm birth. MATERIALS AND METHODS: For relevant studies, we systematically searched the literature in databases of PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library. Only randomized controlled trials were included...
June 2016: Taiwanese Journal of Obstetrics & Gynecology
J Scaffidi, B W Mol, J A Keelan
OBJECTIVE: To undertake a survey of the world's clinical trial registries to provide current data on the number, nature, funding source and geographical distribution of pregnancy drug trials (PDT). DESIGN AND SETTING: Comprehensive analysis of WHO-certified clinical trial registries. METHODS: Sixteen registries containing 301 538 trials (168 826 active in 2013-2014) were analysed to identify the numbers, location, funding sources, and areas of interest/development of PDTs...
June 14, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Scott A Shainker, Anna M Modest, Michele R Hacker, Steven J Ralston
Objective The objective of this study was to evaluate the effect of a universal cervical length screening program on the incidence of antepartum interventions. Study Design This retrospective cohort study included women delivering ≥ 20 weeks of gestation with singleton pregnancies before and after implementing universal cervical length screening. Antepartum interventions included admission for threatened preterm birth, ≥ 2 cervical length measurements, cervical cerclage, neonatology consultation, betamethasone, antibiotic administration for preterm premature rupture of membranes, and tocolysis...
April 2016: American Journal of Perinatology Reports
Ana L Neves, Tiago Henriques-Coelho, Adelino Leite-Moreira, José C Areias
The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed access to MEDLINE citations; ). The search strategy included the following medical subject headings and text terms for the key words: "cardiac injury biomarkers", "creatine kinase-MB", "myoglobin", "troponin", "children", "neonate/s", "newborn/s", "infant/s" and echocardiography. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication and can be used as predictors of subsequent cardiac recovery and mortality...
June 2, 2016: Heart Failure Reviews
Jonathan T Ho, Jeffrey M Feldman
High-dose desflurane is an uncommon need during general anesthesia. At our institution, open fetal surgery cases are managed with high desflurane concentrations to ensure uterine relaxation. We present a case of a 32-year-old parturient with a history of mild cardiomyopathy undergoing open fetal myelomeningocele repair. Phenylephrine and dopamine infusions helped maintain hemodynamic stability at 18% desflurane, while cardiac function was monitored with transthoracic echocardiography. This case is notable for the unknown risk of using high-dose desflurane with a preexisting cardiomyopathy and raises the question of the acceptable maternal risk in the setting of fetal surgery...
July 15, 2016: A & A Case Reports
Meredith J Alston, Kara Alexandrovic, Norma Stiglich, Torri D Metz
OBJECTIVE: To evaluate the impact of discontinuation of tocolytics on the completion of the corticosteroid course among preterm neonates in an academic safety net hospital. STUDY DESIGN: Retrospective cohort study of all singleton pregnancies with preterm labor resulting in delivery between 24 and 34 weeks' gestation at Denver Health Medical Center (DHMC) between 1/1/2004 and 5/31/2009. In January 2007 DHMC discontinued the use of tocolytic therapy for preterm labor...
March 2016: Journal of Reproductive Medicine
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