Nifedipine (N=20): 10 mg orally. Taherian AA, Dehdar P. Comparison of efficacy and safety of nifedipine versus magnesium sulfate in treatment of preterm labor. It can be an anxious time when youre wondering whether youre pregnant. No data on maintenance therapy. It was initiated after discontinuation of acute IV tocolysis. Acute tocolysis: Sensitivity analysis including only studies with high methodological quality (modified Jadad score 6). This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Maintenance treatment of preterm labor with the oxytocin antagonist atosiban. Ritodrine and magnesium sulfate in nifedipine group and magnesium sulfate in ritodrine group. According to one study, CCBs can delay delivery for several days, depending on how far a womans cervix is dilated when starting medication. A case series study reported that six out of seven cases of nifedipine-associated severe maternal dyspnea occurred in women with twin pregnancies and recommended caution when administering nifedipine to patients with compromised cardiovascular function, mainly those with a twin gestation, cardiac disease, maternal hypertension, and intrauterine infection.57 A recent multicenter prospective cohort study from the Netherlands and Belgium, in which an independent panel evaluated the recorded adverse events without knowledge of the type of tocolytic used, reported that among 542 women treated with nifedipine, five (0.9%) had a serious adverse side effect and six (1.1%) had a mild adverse side effect.61 In our review, nifedipine was associated with a significant decreased risk in maternal adverse effects when compared with 2-adrenergic-receptor agonists and magnesium sulfate, and a significant reduction in discontinuation of treatment because of adverse effects when compared with 2-adrenergic-receptor agonists. Nifedipine (N=100): 10 mg sublingually every 20 min for three doses total, followed by 20 mg orally every 46 h until at least 12 h of uterine quiescence occurred within the first 48 h. Maintenance therapy with nifedipine in 42% of women. The tour begins on Aug. 3 in Sterling . We assessed publication and related biases visually by examining the symmetry of funnel plots and statistically by using the Egger test.25 The larger the deviation of the intercept of the regression line from zero, the greater was the asymmetry and the more likely it was that the metaanalysis would yield biased estimates of effect. Kashanian M, Akbarian AR, Soltanzadeh M. Atosiban and nifedipin for the treatment of preterm labor. Read MD, Wellby DE. Verify dates using clinical history and ultrasonography, History of leaking fluid: observed leakage or pooling of fluid from cervical os on sterile speculum examination, Arborization or ferning of fluid on microscopy, Positive amniotic protein test result (e.g., placental alpha microglobulin-1 [Amnisure]), Ultrasound assessment shows low amniotic fluid, Ultrasound-guided transabdominal instillation of indigo carmine dye into the amniotic sac, if available, shows dye outside of the amniotic sac, Observe for regular contractions accompanied by progressive dilation and cervical effacement, Evaluate for group B streptococcus carrier status, urinary tract infection, bacterial vaginosis, and sexually transmitted infections (trichomoniasis, gonorrhea, or chlamydia); treat as appropriate. There were no statistically significant differences between nifedipine-treated and ritodrine-treated groups for delivery within 48 hours and 7 days of initiation of treatment, and preterm birth before 34 and 36 weeks of gestation. Valenzuela GJ, Sanchez-Ramos L, Romero R, et al. Prevention of preterm delivery. But the use of tocolytics is controversial. Cararach V, Palacio M, Martnez S, et al. People arent more likely to contract chlamydia during pregnancy. This topic will discuss the use of tocolytic drugs for inhibition . Analyses were performed with the Review Manager (RevMan) software version 5.0.23 (The Nordic Cochrane Centre, Denmark), StatsDirect version 2.7.8 (StatsDirect Ltd, United Kingdom), and Stata, version 10.0 (StataCorp, College Station, Texas). Gaunekar NN, Crowther CA. If contractions persisted, this dose was repeated every 1520 minutes up to a maximal total dose of 40 mg during the first hour of treatment. AU TGA pregnancy category: C. US FDA pregnancy category: -Immediate-release capsules: C. -Extended-release tablets: Not assigned. A course of corticosteroids is the only antenatal intervention that has been shown to improve postdelivery neonatal outcomes, including a reduction in neonatal mortality, intracranial hemorrhage, necrotizing enterocolitis, and neonatal infection. Maintenance dose Contractions should cease after the initial dose of 20-40 mg PO. Nifedipine tocolysis associated atrial fibrillation responds to DC cardioversion. Research Highlights: Pregnant women with severe preeclampsia who took a daily dose of extended-release nifedipine (an oral, once-daily pill) when labor was induced had better blood pressure control during labor and were less likely to need fast-acting medicine including intravenous medicine to lower very high blood pressure, compared to those who got a placebo. Beck S, Wojdyla D, Say L, et al. There was no overall difference between nifedipine and magnesium sulfate for delivery within 48 hours of treatment, or before 34 or 37 weeks of gestation, gestational age at birth or in time from trial entry to delivery (Table 4). All but 5 studies35,38,43,45,51 had adequate generation of allocation sequence. Nifedipine has no side effects for your baby. Cervical cerclage, an encircling suture placed around the cervix before or during pregnancy, has been used to help correct structural defects or cervical weakening in high-risk women with a shortened cervix. Nifedipine (N=95): 10 mg sublingually. No data on membranes status. In preterm labor with cervical dilatation, the efficacy of tocolytic drugs has been proven to prolong pregnancy. Nifedipine (N=37): 20 mg orally every 6 h until 37 weeks. Inclusion: women with singleton pregnancy in preterm labor irrespective of the membranes status. Then 20 mg orally every 6 h for at least 24 h. No data on maintenance therapy. Hayes E, Moroz L, Pizzi L, Baxter J. Recently, Khan et al.62 published a systematic review and meta-regression analysis of randomized controlled trials, observational studies, and case series which evaluated the feto-maternal safety of calcium channel blockers when used in pregnancy, no just for the treatment of preterm labor but also for use in the treatment of hypertension in pregnancy. Tocolytics, such as prostaglandin inhibitors and calcium channel blockers, should be used to prolong the time to delivery so that antenatal corticosteroids and potentially magnesium sulfate can be administered, and the mother can be transferred to a tertiary facility with a neonatal intensive care unit. Khan K, Zamora J, Lamont RF, et al. Extended-release tablets: Initial dose: 30 to 60 mg orally once a day. This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus. Koks CA, Brlmann HA, de Kleine MJ, Manger PA. A randomized comparison of nifedipine and ritodrine for suppression of preterm labor. It appears in cervical secretions before the onset of labor. Hypotension was defined as a decrease in systolic or diastolic blood pressure of 15 mmHg or more. There were no significant differences between children exposed in utero to either nifedipine or 2-adrenergic-receptor agonists in neurodevelopmental status at 2 years of age or psychosocial and motor functioning at 912 years of age. A significant increase in gestational age at birth (weighted mean difference [WMD] 0.7 weeks; 95% CI, 0.31.2; I2=0.0%), interval between trial entry and delivery (WMD, 5.8 days; 95% CI, 1.410.2; I2=63.0%), and birth weight (WMD, 178.8 gm; 95% CI, 84.1273.6; I2=31.0%) was also shown. Read this post to know about the safety of using Nifedipine during pregnancy, when and how to use it, and its potential side effects. Epidemiology of late preterm (near-term) births. Methods We identified the following subjects from a computerized, hospital database: 58 singleton and 32 twin pregnancies that were between 24 and 34 weeks of gestation, admitted for spontaneous preterm labor without rupture of the . What is the likelihood that the patient will deliver prematurely? Al-Qattan F, Omu AE, Labeeb N. A prospective randomized study comparing nifedipine versus ritodrine for the suppression of preterm labour. Myocardial infarction during nifedipine therapy for preterm labor. 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). Clinical management guidelines for obstetrician-gynecologist. Nifedipine versus ritodrine for suppression of preterm labor. Two reviewers (A.C.-A. Nifedipine (N=32): 10 mg sublingually. Several agents have been used for the inhibition of preterm labor but, unfortunately, it is still no clear what the first-line tocolytic agent should be:6 1) 2-adrenergic-receptor agonists reduce the risk of delivery within 48 hours of initiation of treatment.7 Nevertheless, there is no evidence that this delay in the timing of birth leads to improvements in neonatal outcomes, and maternal adverse events are substantial;7 2) magnesium sulfate is ineffective in delaying birth or preventing preterm birth, and its use could be associated with an increased risk of fetal, neonatal and infant mortality;8 3) there is not enough evidence of whether prostaglandin-synthesis inhibitors reduce the risk of preterm birth because studies have limited sample size;9 4) the oxytocin receptor antagonist, atosiban, was found to increase the proportion of patients remaining undelivered and not requiring an alternate tocolytic at 7 days when compared with placebo; yet, this was not associated with an improvement in neonatal outcomes which has been attributed to the complex design and interpretation of trials of tocolysis that involve a rescue maneuver.10 Yet, this agent has become the agent of choice in many European countries based on the results of comparative trials with beta-adrenergic agents. Anti-inflammatory. Preterm labor leading to preterm birth is a significant cause of morbidity and mortality in infants. There have been attempts to design a stratification tool to determine the risk of preterm delivery based on risk factors (Table 17 ). Table 2 shows quality assessment of included studies. A prospective, randomized trial of nifedipine vs. ritodrine in threatened preterm labor. Women's health is once again the center of a political ping-pong match with evidence-based science on one side and anti-choice advocates on the other. Tests for amniotic proteins, such as placental alpha microglobulin-1 (Amnisure), have high reported sensitivity for premature rupture of membranes.29 Other methods for confirming premature rupture of membranes include ultrasound assessment of low amniotic fluid levels and ultrasound-guided transabdominal instillation of indigo carmine dye into the amniotic sac. Most trials included women between 24 and 34 weeks of gestation. A sterile speculum examination should be performed for further risk stratification, including evaluation for cervical dilation, vaginal infections, bleeding, and rupture of membranes. Nifedipine trials: effectiveness and safety aspects. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. If you are at risk for preterm labor, several screening tests can help you and your doctor determine the extent of your risk. These authors reported that adverse events were highest among women who received more than 60 mg total dose of nifedipine (odds ratio, 3.78; 95% CI, 1.2711.2) and in reports from case series compared to controlled studies (odds ratio, 2.45; 95% CI, 1.175.15). Romero R, Sibai BM, Sanchez-Ramos L, et al. Moreover, nifedipine was less likely than 2-adrenergic-receptor agonists and magnesium sulfate to cause maternal adverse events, and its use was associated with a significant decrease in discontinuation of treatment because of adverse events when compared with 2-adrenergic-receptor agonists. 12 mg intramuscularly every 24 hours for 2 doses Dexamethasone (Decadron ) Corticosteroid. Thus, the total score ranged from 0 (lowest quality) to 8 (highest quality). Mean gestational age at trial entry varied from 29.1 to 32.4 weeks. Simhan HN, Caritis SN. As a library, NLM provides access to scientific literature. Sixteen studies2830,3234,37,39,4144,47,49,50,52 reported adequate concealment of allocation. C. US FDA pregnancy category: -Immediate-release capsules: C. US FDA pregnancy category: -Immediate-release capsules: -Extended-release. 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