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Tocolytic

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61. Trimbow (beclometasone / formoterol / glycopyrronium bromide) - chronic obstructive pulmonary disease (COPD)

with Foster (BDP+FF – ratio 100+6) in the rat pre-postnatal development study. Also, it cannot be excluded that antimuscarinic effects of GB such as dry mouth or tachycardia could have compounded the tocolytic effects of FF and contributed to worsening the general health of the dams. The exposure levels at the NOAEL for FF and GB were below the human exposure levels at the recommended therapeutic dose of Trimbow in COPD patients and thus these effects may be of clinical relevance. Adequate information has

2017 European Medicines Agency - EPARs

62. CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy

affect labor? Beta agonists are tocolytics and often halt labour. [2] Which types of valvular heart disease cause the most problems during pregnancy? Mitral stenosis > class 1 fcor Advanced aortic stenosis Aortic or mitral lesions associated with pulmonary hypertension or ventricular dysfunction Mechanical prosthetic valves requiring anticoagulation See Table 179.5 in Rosen’s 9 th Edition Ddx of chest pain in pregnancy: Pulmonary embolus, reflux esophagitis, biliary colic, and aortic dissection

2018 CandiEM

63. Low-Dose Aspirin Use During Pregnancy

growth retardation. Br J Obstet Gynaecol 1997;104:450–9. 47. Abramovici A, Cantu J, Jenkins SM. Tocolytic therapy for acute preterm labor. Obstet Gynecol Clin North Am 2012; 39:77–87. 48. van Vliet EO, Askie LA, Mol BW, Oudijk MA. Antiplatelet agents and the prevention of spontaneous preterm birth: a systematic review and meta-analysis. Obstet Gynecol 2017;129:327–36. 49. Silver RM, Ahrens K, Wong LF, Perkins NJ, Galai N, LesherLL,et al.Low-doseaspirin and pretermbirth: aran- domized controlled trial

2018 American College of Obstetricians and Gynecologists

64. CRACKCast E180 – Labor & Delivery

. At this point, reduce the infusion rate to 1 to 2 mL/min. 7) List 8 factors linked to pre-term labor. Describe the management of premature labor in the ED. List 3 tocolytics. Preterm labor is defined as uterine contractions with cervical changes before 37 weeks of gestation. Early maternal signs and symptoms include an increase or change in vaginal discharge, pain resulting from uterine contractions (sometimes perceived as back pain), pelvic pressure, vaginal bleeding, and fluid leak. Box 181.2 – Factors (...) should mention the above because it is standard of care. Copied from Uptodate: Given the limited ability of tocolytic therapy to delay delivery for a prolonged period of time, the major goals of treatment of acute preterm labor are to: Delay delivery by at least 48 hours when it is safe to do so in order that antenatal corticosteroids (primary or rescue) given to the mother have time to achieve their maximum fetal/neonatal effects. Pre-delivery administration of reduces the risk of neonatal death

2018 CandiEM

65. CRACKCast E177 – Acute Complications of Pregnancy

oral tocolytic therapy with beta adrenergic agonists 8) How are BV, vaginal yeast infections and trichomonas infections managed during pregnancy? BV: BV associated with morbidity – so treat! 7-day course of metronidazole or 7-day course of clindamycin. Intravaginal treatment is not recommended in pregnant patients. Vaginal yeast infections: There is no association of Candida colonization with adverse pregnancy outcomes, and treatment is for relief of symptoms only. Oral azoles are contraindicated

2018 CandiEM

66. Induction of labour

intravenous (IV) fluids via new administration set · VE to assess cervical dilation and exclude cord prolapse · If persists, consider use of tocolytic 1 : o Terbutaline: 250 micrograms subcutaneously or o Terbutaline: 250 micrograms in 5 mL IV over 5 minutes 3 o Salbutamol: 100 micrograms by slow IV injection 3 o *Sublingual Glyceryl Trinitrate (GTN) spray 400 micrograms 3 o Excessive uterine activity in the absence of evidence of fetal compromise is not in itself an indication for tocolysis 3

2018 Queensland Health

67. Preterm labour and birth

as a diagnostic test for determining likelihood of birth within 48 hours for women who are 30 +0 weeks pregnant or more and in suspected preterm labour. What can obstetric units do to help? Raise awareness of when fetal fibronectin testing should be used and that it is a simple test that can be carried out in 5 minutes by healthcare professionals. The challenge: using tocolysis See recommendations 1.8.1–1.8.5. Giving an effective tocolytic medicine to women with intact membranes who are in suspected (...) or diagnosed preterm labour can delay the birth. This in turn can improve neonatal outcomes. Promoting the use of tocolysis Promoting the use of tocolysis Clinical practice varies in terms of which women in preterm labour are offered a tocolytic medicine, when it should be given and the choice of tocolytic. The decision to offer tocolysis should take into account whether neonatal care is available on-site or whether transfer to another hospital will be needed. T o overcome this, the lead clinician for each

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

68. Indomethacin and pregnancy

Indomethacin and pregnancy INDOMETHACIN AND PREGNANCY Approved by DSOG (Danish Society of Obstetrics and Gynecology) 2017 Recommendation Tocolytics Pain Polyhydramnios 48-72 timer: Konstriktion af DA sædvanligvis reversibel i løbet af 8 dage (19) Seponeres indometacin straks, når der påvises ductus konstiktion, normaliseres ductus forholdene sædvanligvis i løbet af tre dage (15). I mindst et tilfælde er det beskrevet at ductus dog først normaliseredes efter to uger (20). Et studie fandt ikke (...) , Kawaguchi C, Nakajima M, Ichijo M, et al. Renal impairment in very low birthweight infants following antenatal indomethacin administration. Acta Paediatr.Jpn. 1994 Apr;36(2):202 -206. (4) Vermillion ST, Landen CN. Prostaglandin inhibitors as tocolytic agents. Semin.Perinatol. 2001 Aug;25(4):256 -262. (5) Vermillion ST, Newman RB. Recent indomethacin tocolysis is not associated with neonatal complications in preterm infants. Am.J.Obstet.Gynecol. 1999 Nov;181(5 Pt 1):1083 -1086. (6) Berghella V, Rust OA

2017 Nordic Federation of Societies of Obstetrics and Gynecology

69. Cervical Cerclage

developers also address the placement of a second suture in addition to the primary cerclage, with both agreeing that no benefit of this approach has been demonstrated. With regard to the use of perioperative antibiotics and/or tocolytics, there is consensus among the guideline developers that there is no evidence to support their routine use. Cerclage Removal The guideline developers agree that a transvaginal cerclage is removed electively before labor, typically between 36 and 38 weeks gestation (ACOG (...) insufficiency and their use is discouraged. The standard transvaginal cerclage methods currently used include modifications of the McDonald and Shirodkar techniques. The superiority of one suture type or surgical technique over another has not been established. Cerclage may increase the risk of preterm birth in women with a twin pregnancy and an ultrasonographically detected cervical length less than 25 mm and is not recommended. Neither antibiotics nor prophylactic tocolytics have been shown to improve

2017 National Guideline Clearinghouse (partial archive)

71. Periviable Birth

), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time (...) . Protocols with guidelines for the initial management and safe transport of the periviable gestation should include recommendations for such treatments as antenatal corticosteroids, magnesium sulfate for neuroprotection, tocolytic therapy, antibiotics for latency after preterm PROM, and group B streptococci prophylaxis. In some cases, circumstances may preclude antenatal maternal transport because of a rapidly evolving clinical situation or because of maternal instability due to severe illness

2017 American College of Obstetricians and Gynecologists

72. Guidelines for the Use of Laparoscopy during Pregnancy

abnormalities have been reported in the literature [90, 127] . Preoperative and postoperative monitoring of the fetal heart rate for a fetus considered viable is the current standard, with no increased fetal morbidity having been reported [91, 93, 219] .The current lower limit of viability is between 22 weeks and 24 weeks [220, 221] . Tocolytics Guideline 22: Tocolytics should not be used prophylactically in pregnant women undergoing surgery but should be considered perioperatively when signs of preterm (...) labor are present (++++; Strong). Threatened preterm labor can be successfully managed with tocolytic therapy. The specific agent and indications for the use of tocolytics should be individualized and based on the recommendation of an obstetrician [222-225] . No literature supports the use of prophylactic tocolytics [226, 227] . Limitations of available literature More data have accumulated recently as laparoscopy has become common during pregnancy. Most of the data are found in case series

2017 Society of American Gastrointestinal and Endoscopic Surgeons

74. Effect of maternal body mass index on in vitro response to tocolytics in term myometrium. (Abstract)

Effect of maternal body mass index on in vitro response to tocolytics in term myometrium. We sought to investigate the effect of body mass index (BMI) on in vitro response to tocolytics.Myometrial biopsies were obtained at the time of scheduled cesarean deliveries from term nonlaboring women with BMI < or =29.9 (26.3 +/- 1.3; n = 7), 30-34.9 (31.8 +/- 1.2; n = 16), and > or = 35 (39.5 +/- 4.9; n = 9). Tissue strips were suspended in organ chambers for isometric tension recording. The effects (...) of cumulative doses (10(-10) to 10(-5) mol/L) of nifedipine or indomethacin on spontaneous uterine contractility were determined. Areas under the contraction curve were compared using 1-way analysis of variance with Tukey post hoc test.Myometrial response to tocolytics did not differ between the BMI groups. Nifedipine, but not indomethacin, significantly inhibited myometrial contractility independent of BMI.BMI does not affect uterine response to tocolytics in isolated uterine tissue from term nonlaboring

2010 American Journal of Obstetrics and Gynecology

75. Nifedipine alone or combined with sildenafil citrate for management of threatened preterm labour: a randomised trial (Abstract)

Nifedipine alone or combined with sildenafil citrate for management of threatened preterm labour: a randomised trial To study the tocolytic action of nifedipine combined with sildenafil citrate (SC) and if the combination is superior to nifedipine alone in inhibiting threatened preterm labour (PTL).Prospective randomised study.An Egyptian university hospital.Women with threatened PTL who received either nifedipine with SC or nifedipine alone.Patients were randomly allocated to receive either (1 (...) with nifedipine is an effective option for tocolytic therapy during threatened PTL.Vaginal SC enhances the tocolytic effect of nifedipine.© 2018 Royal College of Obstetricians and Gynaecologists.

2019 EvidenceUpdates

77. Anaesthetic Agents in Pregnant Women Undergoing Non-Obstetric Surgical or Endoscopic Procedures

. There was a statistically significantly higher rate of preterm labour requiring treatment with tocolytics in the group that received RA for laparoscopy (29 of 71; 29.6%) compared with GA for laparotomy (8 of 137; 5.8%), GA for laparoscopy (0 of 27), and the non-surgical control group (2614 of 80,527; 3.2%). In addition, the rate of premature delivery was significantly higher with surgery and anaesthesia compared with non-surgical controls; however, there was no statistically significant difference in these rates

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

79. Developing New Pharmaceutical Treatments for Obstetric Conditions

the requirements of the ethical and regulatory authorities. For example, there are no therapeutic trials demonstrating long-term benefits of delaying delivery in preterm labour, such that RCOG guidelines state that it is reasonable not to use tocolytics. 31 It is therefore logical to assume that there is equipoise regarding the administration of tocolysis. However, ethical committees (particularly in the USA) are unwilling to allow placebo-controlled trials because tocolysis is seen to be the standard of care (...) . Even where an investigative drug is administered, approval of study protocols may require rescue tocolysis (or even a second-line tocolytic), thereby preventing accurate evaluation of maternal, fetal and neonatal outcomes. Despite this, regulatory approval may require demonstrable improvements in outcome compared with placebo. Scientific Impact Paper No. 50 © Royal College of Obstetricians and Gynaecologists 7 of 12 The decision by regulatory authorities on whether to license a drug comprises two

2015 Royal College of Obstetricians and Gynaecologists

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