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Tocolytic

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101. 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

102. 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

104. Multiple pregnancy: antenatal care for twin and triplet pregnancies

(CG129) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 20 of 421.5.2 1.5.2 Pre Prev venting preterm birth enting preterm birth 1.5.2.1 Do not use the following interventions (alone or in combination) routinely to prevent spontaneous preterm birth in twin or triplet pregnancies: bed rest at home or in hospital intramuscular or vaginal progesterone cervical cerclage oral tocolytics. 1.5.3 1.5.3 Untargeted (...) interventions aimed at preventing spontaneous preterm birth in women with twin and triplet pregnancies, including cervical cerclage, tocolytic drugs and sexual abstinence. The existing evidence for the effectiveness of cervical cerclage is of low quality (mostly originating from observational studies). The existing evidence in relation to tocolytics is also limited: there is evidence for the effectiveness of betamimetics, but no randomised controlled trials were identified for the effectiveness of ritodrine

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

106. Rapid fetal fibronectin testing to predict preterm birth in women with symptoms of premature labour: a systematic review and cost analysis

, with no testing. This included hospitalisation; medications, such as antenatal steroids and tocolytic agents; occasional in utero transfer; and preterm delivery. Location/setting UK/secondary care. Methods Analytical approach: A decision tree was used to assess the impact of the test on costs; effectiveness was not modelled as no significant differences in effectiveness were identified by a systematic review. The time horizon was from hospital admission to the time of delivery. The authors stated

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2014 NHS Economic Evaluation Database.

107. 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

108. 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

109. 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

110. 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

111. EQUIPTT: The Evaluation of the QUiPP app for Triage and Transfer protocol for a cluster randomised trial to evaluate the impact of the QUiPP app on inappropriate management for threatened preterm labour. (PubMed)

. Intervention "just-in-case" results in many avoidable admissions, women being transferred out of their local hospital unnecessarily and most women receiving unwarranted drugs, such as steroids and tocolytics. It also precludes appropriate transfers for others as neonatal cots are blocked pre-emptively, resulting in more dangerous ex-utero transfers. We have developed the QUiPP App which is a clinical decision-making aid based on previous outcomes of women, quantitative fetal fibronectin (qfFN) values

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2019 BMC Pregnancy and Childbirth

112. Tocolysis: A Review of the Literature. (PubMed)

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

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

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

114. The efficacy of misoprostol vaginal insert compared with oral misoprostol in the induction of labor of nulliparous women: a randomized national multicenter trial. (PubMed)

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

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

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

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

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

117. Relaxin for preventing preterm birth. (PubMed)

), and the reference lists of relevant papers.Randomised and quasi-randomised controlled trials assessing the effects of relaxin compared with no treatment, a placebo, or an alternative tocolytic, for preventing preterm birth for women in preterm labour. Primary review outcomes included birth within 28 hours of treatment, birth within seven days of treatment, perinatal mortality, and a serious neonatal adverse outcome composite.Two review authors independently assessed study eligibility, extracted data

2013 Cochrane

118. Cervical pessary for preventing preterm birth. (PubMed)

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

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2013 Cochrane

119. Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour. (PubMed)

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

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2013 Cochrane

120. 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

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