Preterm labour is indicated by regular contractions of the uterus and changes in the cervix (the opening of the womb) before 37 weeks of pregnancy. Preterm labour and birth may be associated with illness or death of the baby, and often place a substantial emotional burden on families. Preterm birth may also result in childhood disability. Even a short-term prolongation of pregnancy after the onset of threatened or actual preterm labour can allow the administration of corticosteroids to the mother to hasten fetal lung maturation and transfer of the mother to a centre with neonatal intensive care facilities. A range of drugs (tocolytic) are used to suppress labour. The oxytocin antagonist atosiban is one of these. Once the episode of threatened preterm labour settles, maintenance treatment with a tocolytic can then be used to try to prevent any reoccurrence. This has to be balanced against potential adverse outcomes such as intrauterine infection, fetal death, an increase in severe disability for survivors, and side-effects of the drugs. This review identified only one good quality multicentre controlled trial which showed that subcutaneously administered atosiban as maintenance therapy did not reduce the incidence of preterm birth or improve neonatal outcomes when compared with placebo treatment. The trial randomised 513 women in whom preterm labour (with intact membranes and limited cervical dilatation) ceased following intravenous treatment with atosiban. The mean gestation at enrolment was around 31 weeks and the proportion of multiple births was similar in the two groups. Atosiban infused at 6 mL/hr (30 µg/min) did not reduce preterm birth before 28, 32, or 37 weeks. Women on maintenance therapy were discharged home with a continuous subcutaneous infusion pump and daily nursing contact. There was an increase in injection site reaction for the atosiban group. There is insufficient evidence of benefit to justify this intervention.
"The pathogenesis of preterm birth is still under debate; in fact preterm labour might be the result of the early idiopathic activation of the normal labour process or the consequence of pathological insults (Papatsonis et al. 2009). In industrialized countries, the incidence of the preterm delivery is generally 5–9% (Goldenberg et al. 2008) and it represents one of the serious problems in perinatal medicine representing the most important cause of perinatal morbidity and mortality after congenital anomalies (Papatsonis et al. 2009). The preterm birth rate has increased by 33% in the last 25 years, almost entirely due to the rise in late preterm births defined as births between 34 0/7 and 36 6/7 weeks of gestation (Committee on Obstetric Practice 2008). "
[Show abstract][Hide abstract] ABSTRACT: Purpose
Late-preterm births are considered functionally mature but, several line of evidences suggest that, compared with term neonates, they have a higher risk of complications. The aim of this study was to compare the incidence of maior clinical complications of late preterm infants born in our division, compared to those born at term.
We retrospectively analysed late preterm deliveries occurred in a twenty-months period. Late preterms were divided in 3 sub-groups according to gestational age at delivery: 34 0/6 , 35 0/6 , 36 0/6 weeks of gestation. The incidence of maior clinical complications was evaluated. Statistical analysis was performed by using the Z- test.
Among term deliveries 17.24% were admitted to the neonatal intensive care unit and 69.01% presented one major adverse outcome: 25.35% jaundice, 25.35% hypoglycemia , 11.26% RDS , 4.22% intraventricular hemorrhage (IVH), 4,22% anemia. The incidence of IVH was significantly higher only at 340/6 weeks of gestation compared to term infants. The incidence of anemia and RDS was significantly higher at 34 0/6 and 35 0/6 weeks of gestation, but it was not significantly different at 36 weeks of gestation, compared to full-term infants. Finally, the incidence of hypoglycemia and jaundice results significantly higher in all the 3 sub groups of late preterms, compared to full term infants.
Results demostrated an increased risk of morbidity in the late preterm period. Results also showed that the gestational age at delivery of late preterms can influence the risk of adverse neonatal outcomes.
"Considerable debate remains as to whether maintenance tocolysis is appropriate after initial tocolysis for spontaneous preterm labor. Various drugs with different dosage schedules and routes have been used for maintenance tocolysis (β-agonists, calcium-channel blockers, magnesium, and atosiban) but no significant prolongation of pregnancy or improved perinatal outcome has been noted    . Progesterone has been widely used as a uterine sedative in the prevention of preterm labor but it has not been investigated thoroughly for maintenance tocolysis. "
[Show abstract][Hide abstract] ABSTRACT: Objective
To evaluate the efficacy of maintenance therapy with oral micronized progesterone (OMP) for prolongation of pregnancy in cases of arrested preterm labor.
Ninety women at 24–34 weeks of singleton pregnancy with intact membranes and arrested preterm labor were randomly allocated to receive OMP (n = 45) or placebo (n = 45) daily until 37 weeks or delivery, whichever was earlier. Outcome parameters were compared using Student t test, χ2 test, Fisher exact test, and log-rank χ2 test.
OMP significantly prolonged the latency period (33.29 ± 22.16 vs 23.07 ± 15.42 days; P = 0.013). Log-rank analysis revealed a significant difference in mean time to delivery between the 2 groups (P = 0.014). There were significantly fewer preterm births (33% vs 58%; P = 0.034) and low birth weight neonates (37% vs 64%; P = 0.017), and significantly higher mean birth weight (2.44 ± 0.58 vs 2.14 ± 0.47 kg; P = 0.009) in the OMP group. Perinatal outcomes and adverse effects were similar in the 2 groups.
Maintenance tocolysis with OMP significantly prolonged pregnancy and decreased the number of preterm births.
Clinical Trial Registry of India: CTRI/2011/10/002043.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 07/2014; 126(1). DOI:10.1016/j.ijgo.2014.01.019 · 1.54 Impact Factor
"In a study in which a total of 513 women were randomized to receive either atosiban or placebo administered with a subcutaneous infusion pump in order to prevent recurrence of preterm birth, atosiban compared to placebo did not reduce the incidence of preterm birth before 37 weeks (RR 0.89; 95% CI 0.71 to 1.12), 32 weeks (RR 0.85; 95% CI 0.47 to 1.55), or 28 weeks (RR 0.75; 95% CI 0.28 to 2.01). Outcomes were also similar for both groups with respect to birth weight, respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, and intraventricular hemorrhage (Papatsonis et al., 2009). "
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