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Tocolytic

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82. Nifedipine alone or combined with sildenafil citrate for management of threatened preterm labour: a randomised trial

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

83. Preterm labour and birth

Tocolysis Table 13. Tocolysis Aspect Consideration Context • Tocolytic drugs may delay birth and allow: o Administration of corticosteroids o Administration of Magnesium Sulfate for neuroprotection o In-utero transfer to an appropriate level facility • Tocolysis not associated with a clear reduction in perinatal mortality or serious neonatal morbidity 53 • No evidence to support the use of prophylactic tocolytic therapy after contractions have ceased 54 • Recommend when a 48 hour delay in birth (...) will benefit the newborn PPROM • There is limited evidence about the use of tocolytics in the setting of PPROM 55 • Gestational age is a major determinant for management • Tocolysis in women with PPROM before 34 weeks associated with 55 : o A lower risk of birth within 48 hours o An increased risk of chorioamnionitis without significant maternal or neonatal benefit • Tocolysis before viability not generally recommended 55 Contraindications • Maternal contraindications to tocolysis (agent specific) • Any

2016 Queensland Health

84. Biomarker tests to help diagnose preterm labour in women with intact membranes

#notice-of-rights). Page 21 of 36Costs Costs 4.30 The following costs, from companies, published literature and routine sources of NHS costs, were used in the model: fetal fibronectin test: £66 (includes 15 minutes of midwife time) Actim Partus test: £35 (includes 10 minutes of midwife time) PartoSure test: £52 (includes 10 minutes of midwife time) maternal steroid injection: £5 tocolytics (atosiban plus infusion equipment): £362 inpatient hospital stay: £1,325 in utero transfer: £965 long-term

2018 National Institute for Health and Clinical Excellence - Diagnostics Guidance

85. Tocolytics for Preterm Labor (PubMed)

Tocolytics for Preterm Labor 19609410 2011 07 14 2016 11 14 1941-2797 2 2 2009 Spring Reviews in obstetrics & gynecology Rev Obstet Gynecol Tocolytics for preterm labor. 128-9 Kent Athol A Department of Obstetrics & Gynaecology, University of Cape Town Rondebosch, South Africa. eng Journal Article United States Rev Obstet Gynecol 101479674 1941-2797 2009 7 18 9 0 2009 7 18 9 0 2009 7 18 9 1 ppublish 19609410 PMC2709323

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2009 Reviews in obstetrics and gynecology

86. Tocolytic therapy: a meta-analysis and decision analysis. (PubMed)

Tocolytic therapy: a meta-analysis and decision analysis. 19546783 2009 08 20 2009 10 26 0029-7844 114 1 2009 Jul Obstetrics and gynecology Obstet Gynecol Tocolytic therapy: a meta-analysis and decision analysis. 170-1; author reply 171 10.1097/AOG.0b013e3181ac43f2 Jacquemyn Yves Y Van Overmeire Bart B eng Comment Letter Meta-Analysis United States Obstet Gynecol 0401101 0029-7844 0 Calcium Channel Blockers 0 Prostaglandin Antagonists AIM IM Obstet Gynecol. 2009 Mar;113(3):585-94 19300321

2009 Obstetrics and Gynecology

87. The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow. (PubMed)

The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow. The choice of first-line tocolytic agent is a topic of worldwide debate. The oxytocin receptor antagonist atosiban and the calcium antagonist nifedipine appear to be effective in postponing delivery. However, information is lacking on their possible effects on the fetal biophysical profile.To study the direct fetal effects of tocolysis with atosiban or nifedipine combined with a course (...) of betamethasone.We performed a randomised controlled study including women with preterm labour requiring tocolytic treatment. Primary outcome measures were the effects on fetal heart rate (FHR) and its variation. Secondary endpoints were the effects on fetal movement and blood flow (pulsatility index - PI) of the umbilical (UA) and medial cerebral arteries (MCA).One-hour recordings of FHR and fetal movements were made on each of five successive days (days 0-4). Fetal blood flow velocity patterns were studied

2009 The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

88. Factors associated with tocolytic hospitalizations in Taiwan: evidence from a population-based and longitudinal study from 1997 to 2004. (PubMed)

Factors associated with tocolytic hospitalizations in Taiwan: evidence from a population-based and longitudinal study from 1997 to 2004. The use of tocolytic hospitalization in antenatal care is controversial and worthy of more research. We investigated individual, institutional, and area factors that affect the use of tocolytic hospitalizations in Taiwan where fertility has rapidly declined.Longitudinal data from the 1996 to 2004 National Health Insurance Research Database in Taiwan were used (...) to identify tocolytic hospitalizations. The probit model was used to estimate factors associated with tocolytic hospitalizations.The decline in fertility was significantly associated with the probability of tocolytic hospitalizations. Several physician and institutional factors-including physician's age, hospital ownership, accreditation status, bed size, and teaching status-were also significantly correlated to the dependent variables.The provision of inpatient tocolysis is influenced not only

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2009 BMC Pregnancy and Childbirth

89. Anaesthesiological considerations on tocolytic and uterotonic therapy in obstetrics. (PubMed)

Anaesthesiological considerations on tocolytic and uterotonic therapy in obstetrics. Significant side effects of tocolytic and uterotonic substances may be of concern to the anaesthesiologist. Recently, new drugs have been introduced having less side effects for both the mother and the neonate.A literature search was undertaken mainly focusing on meta-analyses, to review the possible side effects that might affect the course of anaesthesia and to suggest which precautions should be considered (...) to prevent the occurrence of significant interactions with anaesthetic manipulations and drugs.Magnesium sulphate has a proven benefit in lowering systolic blood pressure and preventing the occurrence of eclampsia, but not as a tocolytic. beta-adrenergic agonists are being abandoned due to the availability of tocolytic agents causing less side effects. Calcium channel blockers (CCB) are frequently used but can cause major maternal cardiovascular complications. Nitroglycerin seems to be appreciated

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2009 Acta Anaesthesiologica Scandinavica

90. Why eicosanoids could represent a new class of tocolytics on uterine activity in pregnant women. (PubMed)

Why eicosanoids could represent a new class of tocolytics on uterine activity in pregnant women. The purpose of this study was to assess the effects of exogenous eicosanoids on spontaneous uterine contractile activity.Eight uterine biopsies were performed from women who were undergoing elective cesarean delivery. Tension measurements were performed in vitro on myometrial strips. Contractile activities were quantified by the calculation of the area under the curve. The effects of eicosanoids (...) and specific enzyme inhibitors were assessed. Fractions from various uterine tissues were analyzed by Western blot.Data demonstrate the presence, in some tested tissues, of cytochrome P-450 epoxygenase and soluble epoxide hydrolase, which respectively produce and degrade epoxyeicosatrienoic acid regioisomers. Inhibition of soluble epoxide hydrolase with 12-(3-adamantan-1-yl-ureido)-dodecanoic acid or omega-hydroxylase with N-methylsulfonyl-12,12-dibromododec-11-enamide resulted in a tocolytic effect; N

2009 American Journal of Obstetrics and Gynecology

91. Computerized evaluation of fetal heart rate during tocolytic treatment: comparison between atosiban and ritodrine. (PubMed)

Computerized evaluation of fetal heart rate during tocolytic treatment: comparison between atosiban and ritodrine. We compared the effects of ritodrine and atosiban treatments on fetal cardiovascular behavior by computerized nonstress test (c-NST) analysis. Women diagnosed with preterm labor were randomized to receive either atosiban or ritodrine. A c-NST was performed at least 12 hours after the last corticosteroid administration. Differences in fetal cardiovascular behavior were evident when

2009 American journal of perinatology

92. Cyclo-oxygenase (COX) inhibitors for treating preterm labour. (PubMed)

Cyclo-oxygenase (COX) inhibitors for treating preterm labour. Preterm birth is a major cause of perinatal mortality and morbidity. Cyclo-oxygenase (COX) inhibitors inhibit uterine contractions, are easily administered and appear to have few maternal side effects. However, adverse effects have been reported in the fetus and newborn as a result of exposure to COX inhibitors.To assess the effects on maternal and neonatal outcomes of COX inhibitors administered as a tocolytic agent to women (...) in preterm labour when compared with (i) placebo or no intervention and (ii) other tocolytics. In addition, to compare the effects of non-selective COX inhibitors with COX-2 selective inhibitors.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (24 August 2014). We also contacted recognised experts and searched reference lists of retrieved studies.All published and unpublished randomised trials in which COX inhibitors were used for tocolysis for women in labour between 20 and 36

2015 Cochrane

93. Different treatment regimens of magnesium sulphate for tocolysis in women in preterm labour. (PubMed)

Different treatment regimens of magnesium sulphate for tocolysis in women in preterm labour. Magnesium sulphate has been used to inhibit preterm labour to prevent preterm birth. There is no consensus as to the safety profile of different treatment regimens with respect to dose, duration, route and timing of administration.To assess the efficacy and safety of alternative magnesium sulphate regimens when used as single agent tocolytic therapy during pregnancy.We searched the Cochrane Pregnancy (...) and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies.Randomised trials comparing different magnesium sulphate treatment regimens when used as single agent tocolytic therapy during pregnancy in women in preterm labour. Quasi-randomised trials were eligible for inclusion but none were identified. Cross-over and cluster trials were not eligible for inclusion. Health outcomes were considered at the level of the mother, the infant/child and the health

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2015 Cochrane

94. Ethanol for preventing preterm birth in threatened preterm labor. (PubMed)

Ethanol for preventing preterm birth in threatened preterm labor. Preterm birth is the leading cause of death and disability in newborns worldwide. A wide variety of tocolytic agents have been utilized to delay birth for women in preterm labor. One of the earliest tocolytics utilized for this purpose was ethanol infusion, although this is not generally used in current practice due to safety concerns for both the mother and her baby.To determine the efficacy of ethanol in stopping preterm labor (...) infusion to stop preterm labor versus placebo/control or versus other tocolytic drugs.At least two review authors independently assessed studies for inclusion and risk of bias. At least two review authors independently extracted data. Data were checked for accuracy.Twelve trials involving 1586 women met inclusion criteria for this review. One trial did not report on the outcomes of interest in this review.Risk of bias of included studies: The included studies generally were of low quality based

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2015 Cochrane

95. Nitroglycerin for management of retained placenta. (PubMed)

Nitroglycerin for management of retained placenta. Retained placenta affects 0.5% to 3% of women following delivery, with considerable morbidity if left untreated. Use of nitroglycerin (NTG), either alone or in combination with uterotonics, may be of value to minimise the need for manual removal of the placenta in theatre under anaesthesia.To evaluate the benefits and harms of NTG as a tocolytic, either alone or in addition to uterotonics, in the management of retained placenta.We searched

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2015 Cochrane

96. Home uterine monitoring for detecting preterm labour. (PubMed)

Home uterine monitoring for detecting preterm labour. To reduce the morbidity and mortality associated with preterm birth, home uterine activity monitoring aims for early detection of increased contraction frequency, and early intervention with tocolytic drugs to inhibit labour and prolong pregnancy. However, the effectiveness of such monitoring is disputed.To determine whether home uterine activity monitoring is effective in improving the outcomes for women and their infants considered (...) only high quality studies were included (RR 0.86; 95% CI 0.74 to 1.01; one study, n = 1292). Women using home uterine monitoring made more unscheduled antenatal visits (mean difference (MD) 0.49; 95% CI 0.39 to 0.62; two studies, n = 3707) (GRADE moderate). Women using home uterine monitoring were also more likely to have prophylactic tocolytic drug therapy (average RR 1.21; 95% CI 1.01 to 1.45; seven studies, n = 4316; random-effects. T² = 0.03, I² = 62%) but this difference was no longer

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2015 Cochrane

97. Calcium channel blockers for inhibiting preterm labour and birth. (PubMed)

Calcium channel blockers for inhibiting preterm labour and birth. Preterm birth is a major contributor to perinatal mortality and morbidity, affecting around 9% of births in high-income countries and an estimated 13% of births in low- and middle-income countries. Tocolytics are drugs used to suppress uterine contractions for women in preterm labour. The most widely used tocolytic are the betamimetics, however, these are associated with a high frequency of unpleasant and sometimes severe (...) maternal side effects. Calcium channel blockers (CCBs) (such as nifedipine) may have similar tocolytic efficacy with less side effects than betamimetics. Oxytocin receptor antagonists (ORAs) (e.g. atosiban) also have a low side-effect profile.To assess the effects on maternal, fetal and neonatal outcomes of CCBs, administered as a tocolytic agent, to women in preterm labour.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 November 2013).All published and unpublished

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2014 Cochrane

98. Magnesium sulphate for preventing preterm birth in threatened preterm labour. (PubMed)

Magnesium sulphate for preventing preterm birth in threatened preterm labour. Magnesium sulphate has been used in some settings as a tocolytic agent to inhibit uterine activity in women in preterm labour with the aim of preventing preterm birth.To assess the effects of magnesium sulphate therapy given to women in threatened preterm labour with the aim of preventing preterm birth and its sequelae.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (last searched 31 January (...) 2014).Randomised controlled trials of magnesium sulphate as the only tocolytic, administered by any route, compared with either placebo, no treatment or alternative tocolytic therapy (not magnesium sulphate) to women considered to be in preterm labour.At least two review authors assessed trial eligibility and risk of bias and undertook data extraction independently.The 37 included trials (total of 3571 women and over 3600 babies) were generally of moderate to high risk of bias. Antenatal magnesium

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2014 Cochrane

99. Nitric oxide donors for treating preterm labour. (PubMed)

Nitric oxide donors for treating preterm labour. A number of tocolytics have been advocated for the treatment of threatened preterm labour in order to delay birth. The rationale is that a delay in birth may be associated with improved neonatal morbidity or mortality. Nitric oxide donors, such as nitroglycerin, have been used to relax the uterus. This review addresses their efficacy, adverse effects and influence on neonatal outcome.To determine whether nitric oxide donors administered (...) was mixed; trials comparing nitric oxide donors with other types of tocolytics were not blinded and this may have had an impact on findings.Three studies compared nitric oxide donors (glyceryl trinitrate (GTN)) with placebo. There was no significant evidence that nitric oxide donors prolonged pregnancy beyond 48 hours (average risk ratio (RR) 1.19, 95% confidence interval (CI) 0.74 to 1.90, two studies, 186 women), and although for most adverse effects there was no significant difference between groups

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2014 Cochrane

100. Progestational agents for treating threatened or established preterm labour. (PubMed)

Progestational agents for treating threatened or established preterm labour. Prematurity is not only the leading cause of perinatal morbidity and mortality but is associated with long-term impairment. Studies of various tocolytic agents have shown mixed results with little effect in improving pregnancy duration and insufficient data to confirm a definite beneficial effect on neonatal morbidity or mortality. Progesterone is known to have an inhibitory effect on uterine contractility (...) studies to identify any additional studies and communicated with authors and the pharmaceutical industry.Randomised controlled trials that compared progestational agents, given either alone or in combination with other tocolytics, with a control group receiving another tocolytic, placebo or no treatment, for the treatment of preterm labour.Two review authors independently extracted data and assessed trial quality.Eight studies were included in this review, involving 563 women, but only seven studies

2014 Cochrane

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