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Tocolytic

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81. 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. WHO recommendations on interventions to improve preterm birth outcomes

not occur within 7 days after the initial dose, and a subsequent clinical assessment demonstrates that there is a high risk of preterm birth in the next 7 days. Conditional recommendation based on moderate-quality evidence for newborn outcomes and low-quality evidence for maternal outcomes Tocolytics for inhibiting preterm labour 2.0. Tocolytic treatments (acute and maintenance treatments) are not recommended for women at risk of imminent preterm birth for the purpose of improving newborn outcomes

2015 World Health Organisation Guidelines

86. Point of care tests to exclude pre-term labour: Quantitative Fetal Fibronectin (fFN) testing for predicting pre-term labour

premature labour (tocolytics) and to promote fetal lung development (corticosteroids), both of which have potential side effects. It can also reduce unnecessary referral to a tertiary level hospital with adequate neonatal care. MSAC noted that this was particularly important for women in rural and remote communities where hospital admission may mean considerable travel away from family. MSAC noted the overlap between this application and Application 1335 for phosphorylated insulin-like growth factor (...) with fFN results known; 95%CI: 11% more admissions to 4% less admissions); ? use of tocolytics (rate difference = 2% fewer patients treated with fFN results known; 95%CI: 11% fewer patients treated to 7% more patients treated; N=192); or ? use of steroids (rate difference = 3% fewer patients treated with fFN results known; 95%CI: 13% fewer patients treated to 8% more patients treated; N=289). MSAC considered that a possible explanation for the lack of any effect on hospitalisations might be explained

2014 Medical Services Advisory Committee

87. Point of Care Tests to exclude preterm labour: Phosphorylated Insulin-like Growth Factor Binding Protein test

peptides. The presence of phIGFBP-1 is postulated to be predictive of pre-term labour. Identification of false labour can reduce the unnecessary use of therapies to delay premature labour (tocolytics) and to promote fetal lung development (corticosteroids), both of which have potential side effects. It can also reduce unnecessary referral to a tertiary level hospital with appropriate neonatal care facilities. MSAC noted that this was particularly important for women in rural and remote communities (...) , rather than assessing the phIGFBP-1 test result in isolation. It is probable that this test may improve accuracy compared with current clinical assessment, but with insufficient sensitivity to achieve acceptable thresholds to avoid misclassifying women and causing harm compared to a more risk-averse approach to clinical management. There were no data presented on the consequences of testing for subsequent clinical management, such as use of tocolytics and steroids, or referrals to hospital, nor

2014 Medical Services Advisory Committee

88. Cervical pessary for preventing preterm birth. Full Text available with Trip Pro

group (6% and 27% respectively, RR 0.24; 95% CI 0.13 to 0.43). Mean gestational age at delivery was 37.7 + 2 weeks in the pessary group and 34.9 + 4 weeks in the expectant group. Women in the pessary group used less tocolytics (RR 0.63; 95% CI 0.50 to 0.81) and corticosteroids (RR 0.66; 95% CI 0.54 to 0.81) than the expectant group. Vaginal discharge was more common in the pessary group (RR 2.18; 95% CI 1.87 to 2.54). Among the pessary group, 27 women needed pessary repositioning without removal

2013 Cochrane

89. Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour. Full Text available with Trip Pro

Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour. In some women, an episode of preterm labour settles and does not result in immediate preterm birth. Subsequent treatment with tocolytic agents such as oxytocin receptor antagonists may then have the potential to prevent the recurrence of preterm labour, prolonging gestation, and preventing the adverse consequences of prematurity for the infant.To assess the effects of maintenance therapy (...) with oxytocin antagonists administered by any route after an episode of preterm labour in order to delay or prevent preterm birth.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013), sought ongoing and unpublished trials by contacting experts in the field and searched the reference lists of relevant articles.Randomised controlled trials comparing oxytocin antagonists with any alternative tocolytic agent, placebo or no treatment, used for maintenance therapy after

2013 Cochrane

90. Umbilical Cord Prolapse

does not improve neonatal outcomes any further. 44 The knee–chest and head-down positions have not been evaluated for the management of cord prolapse independently of other interventions. Tocolysis has been used to reduce contractions and limit bradycardia, including in women with cord prolapse. 45–47 The suggested tocolytic regimen is terbutaline 0.25 mg subcutaneously. 38,39,48,49 4.6 What is the optimal mode of birth with cord prolapse? Caesarean section is the recommended mode of delivery

2014 Royal College of Obstetricians and Gynaecologists

91. Perinatal Management of Pregnant Women at the Threshold of Infant Viability? the Obstetric Perspective

already have a cervical cerclage in place will present with labour symptoms at extreme preterm gestations. The decision to remove the cerclage must be timed carefully to avoid unnecessary trauma to the cervix if the woman labours with the cerclage in situ. The evidence for use of tocolysis in preterm labour has recently been summarised. 15 Systematic reviews have not distinguished between tocolytic use at the threshold of viability ( = 26 weeks of gestation) and later preterm gestations. One (...) systematic review concluded that tocolytics were not associated with a significant reduction in births before 30 weeks of gestation 16 and another concluded that oxytocin receptor antagonists such as atosiban did not prevent preterm birth at 38ºC, foul–smelling amniotic fluid, leukocytes or bacteria in amniotic fluid, fetal tachycardia or meconium–stained amniotic fluid were identified as risk factors for early onset neonatal infection. It was recommended that intrapartum antibiotic prophylaxis using

2014 Royal College of Obstetricians and Gynaecologists

92. Inappropriate use of ritodrine hydrochloride for threatened preterm birth in Japan: a retrospective cohort study using a national inpatient database. Full Text available with Trip Pro

hydrochloride, a betamimetic, can be selected as the first-line tocolytic treatment in Japan. This study was performed to (i) examine the current status of long-term tocolytic treatment, particularly with intravenous infusion of betamimetics, for threatened preterm birth in Japan and (ii) clarify the association between long-term tocolytic treatment and maternal adverse effects.This retrospective cohort study was conducted using a national inpatient database for acute-care inpatients in Japan. Among all (...) . The proportion of maternal adverse effects was significantly higher among patients treated for ≥28 days than ≤48 h. A longer duration of tocolysis was significantly associated with increased maternal adverse effects.Long-term tocolysis was associated with an increased incidence of maternal adverse effects in the current study using real-world data. Japanese clinicians should adjust their tocolytic treatment practices in accordance with the latest scientific evidence or make efforts to verify

2019 BMC Pregnancy and Childbirth

93. Uterine hypertonus and fetal bradycardia occurred after combined spinal-epidural analgesia during induction of labor with oxytocin infusion: A case report. Full Text available with Trip Pro

lateral decubitus position and giving supplemental oxygen were attempted to resuscitating the baby. Because of suspicious fetal distress, the baby was rapidly delivered by emergency cesarean section.The Apgar score of the baby was 8 and 10 at 1 and 5 minutes after birth. Subsequent follow-up confirmed that both mother and baby were in good condition.The loss of the tocolytic effect of epinephrine after CSE analgesia and continuous oxytocin infusion may work together to form a totally synergistic

2019 Medicine

94. Cervico-vaginal placental alpha-microglobulin-1 (PAMG-1) combined with cervical length for the prediction of preterm birth in women with threatened preterm labor. (Abstract)

Cervico-vaginal placental alpha-microglobulin-1 (PAMG-1) combined with cervical length for the prediction of preterm birth in women with threatened preterm labor. Preterm birth is a major cause of neonatal morbidity and mortality. There is an urgent need to accurately predict imminent delivery to enable necessary interventions such as tocolytic, glucocorticoid and magnesium sulfate administration. We aimed to evaluate placental alpha macroglobulin-1 as a new diagnostic marker in the prediction

2019 Acta Obstetricia et Gynecologica Scandinavica

95. Progesterone - Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?: Critical Analysis of the Evidence. Full Text available with Trip Pro

Progesterone - Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?: Critical Analysis of the Evidence. Numerous experimental studies indicate that natural progesterone, through various mechanisms, exerts an inhibitory effect on uterine contractility and sensitises the myometrium for tocolytics. It was therefore appropriate to investigate the possible benefits of oral/vaginal progesterone and the synthetic progesterone derivative 17-α-hydroxyprogesterone caproate (...) , applied intramuscularly, in clinical studies on primary tocolysis, additively to established tocolytics ("adjunctive tocolysis") and as maintenance treatment after successful tocolysis in cases of threatened preterm birth. Three studies with a small number of cases do not yield any sufficient evidence for recommending progesterone/17-α-hydroxyprogesterone caproate as primary tocolysis in women with preterm labour. There is also no evidence that progesterone or 17-α-hydroxyprogesterone caproate

2019 Geburtshilfe Und Frauenheilkunde Controlled trial quality: predicted high

96. A comparative study on the efficacy of nifedipine and indomethacin for prevention of preterm birth as monotherapy and combination therapy: a randomized clinical trial. (Abstract)

A comparative study on the efficacy of nifedipine and indomethacin for prevention of preterm birth as monotherapy and combination therapy: a randomized clinical trial. Preterm delivery is an important issue in obstetrics, which is the most common cause of neonatal mortality and morbidity. Therefore, finding a way to prevent it is always under serious concern.The study aimed to compare the efficacy of two tocolytic agents, nifedipine and indomethacin, for inhibiting preterm uterine contractions

2019 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 Controlled trial quality: predicted high

97. The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: a randomized national multicenter trial. Full Text available with Trip Pro

methods needed, labor augmentation with oxytocin and/or amniotomy, use of tocolytics and adverse neonatal and maternal events.In the misoprostol vaginal insert group, median time to vaginal delivery was shorter (24.5 hours vs 44.2 hours, P < 0.001), whereas no difference was found in the cesarean section rate (33.8% vs 29.6%, odds ratio [OR] 1.21, 95% confidence interval [CI] 0.66-1.91, P = 0.67). Other induction methods and labor augmentation with oxytocin and/or amniotomy were less frequent

2019 Acta Obstetricia et Gynecologica Scandinavica Controlled trial quality: predicted high

98. Tocolysis: A Review of the Literature. (Abstract)

Tocolysis: A Review of the Literature. Preterm delivery represents an important cause of infant morbidity and mortality. Various tocolytics have been studied with the objective of stopping preterm labor, increasing gestational age at delivery, and preventing complications related to preterm birth.This review aims to summarize the major classes of tocolytics and review the evidence regarding use of each.A PubMed search of the following terms was performed to gather relevant data: "tocolytic

2019 Obstetrical & Gynecological Survey

99. Comparison of Nitroglycerin and Terbutaline for External Cephalic Version in Women Who Received Neuraxial Anesthesia: A Retrospective Analysis. (Abstract)

Comparison of Nitroglycerin and Terbutaline for External Cephalic Version in Women Who Received Neuraxial Anesthesia: A Retrospective Analysis. External cephalic version is a technique that decreases the need for cesarean delivery in patients with breech presentation. Several techniques exist to increase the success of external cephalic version; however, there are no studies comparing different tocolytics in patients who also received neuraxial anesthesia. We, therefore, performed a review (...) of 198 patients who presented for external cephalic version and compared their success rates based on the tocolytic medication utilized. The external cephalic version success rate for patients who received terbutaline was significantly higher than for those who received nitroglycerin (N [%]: 57 [65.6] terbutaline group versus 40 [36.0] nitroglycerin group; P < .001).

2019 Anesthesia and Analgesia

100. Single and repeat cervical length measurement in twin gestations with threatened preterm labour. (Abstract)

was measurement at the time of admission and several days later after cessation of the contractions. Treatment included administration of tocolytics (usually oral nifedipine) for no more than 48 hours, and administration of steroids if the cervical length is 25mm or less. The first cervical length measurements were clustered into five groups: measurements of less than 10 mm, between 10.0 and 14.9 mm, between 15.0 and 19.9 mm, between 20.0 and 24.9 mm, and 25 mm or greater. For each group, we calculated

2019 Ultrasound in Obstetrics and Gynecology

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