Cyclo-oxygenase (COX) inhibitors for preventing preterm labour
Department of Obstetrics and Gynaecology, Khon Kaen Hospital, Srichan Road, Khon Kaen, Thailand, 40000.Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 10/2012; 10(10):CD007748. DOI: 10.1002/14651858.CD007748.pub2
Labour before full term in pregnancy can lead to preterm birth of the baby. Preterm labour describes frequent uterine contractions (at least four in 20 minutes or eight in 60 minutes) and progressive changes in the cervix. If preterm labour is not managed properly, active labour can occur and result in preterm birth, before 37 completed weeks' gestation. Preterm birth is the leading cause of low birthweight, illness and death for newborn babies. Substances called prostaglandins play an important role in the contraction of the muscle of the womb and are important during labour and birth. They are produced by cyclo-oxygenase (COX), which is an enzyme that increases the level of prostaglandins. Giving COX inhibitors to pregnant women at risk of preterm labour might stop contraction of the womb and allow them to reach full term. We included one small randomised trial (involving 98 women) that involved the drug rofecoxib, which is one type of COX inhibitor. The included study did not report any information about prevention of labour before full-term pregnancy. However, use of this COX inhibitor was associated with an increased risk of the baby being born before full term. We found insufficient data to make any recommendation about using COX inhibitors for preventing preterm labour. Future research should include the follow-up of babies to examine the short- and longer-term effects associated with using COX inhibitors during pregnancy.
- [Show abstract] [Hide abstract]
ABSTRACT: Surfactant complex and its individual components decrease surface tension, silence inflammatory responses, bind and destroy air-borne microbes, facilitate phagocytosis by alveolar macrophages and bind endogenous and exogenous molecules. Surfactant components generally decrease harmful inflammatory responses. New exogenous surfactants and new indications for surfactant therapy remain to be studied. At term the pool of human surfactant from developing airways extends to the amniotic cavity and to the gastrointestinal tract. Preterm labor-inducing inflammatory ligands (interleukin-1 or lipopolysaccharide) cause a robust induction of surfactant complex and lower the risk of respiratory distress syndrome (RDS). The effect of antenatal glucocorticoid therapy is complementary. According to transgenic experiments or genetic evidence in humans, surfactant proteins A, D or C (SP-A, SP-D, SP-C), expressed in fetal tissue, influence the onset of term or preterm labor. After birth, the surface tension-reducing and the inflammation-silencing effects of exogenous and endogenous surfactant are complementary. Surfactant proteins influence the genetic predisposition of RDS, bronchopulmonary dysplasia (BPD) and airway infections in early infancy. Moderate to severe BPD has a strong genetic predisposition. Deleterious mutations of SP-B, ABCA3 or SP-C cause congenital interstitial lung disease that mimics the phenotype of established severe BPD. I propose that lung surfactant protects both the fetus and the newborn. Surfactant ameliorates inflammatory responses that are harmful to the mother, fetus and infant. In chorioamnionitis, inflammatory ligands are carried from the fetal membranes to the alveolar space via amniotic fluid and developing airways. They induce surfactant synthesis and secretion. Surfactant ameliorates severe inflammatory responses in fetal compartments and promotes spontaneous preterm birth.
- [Show abstract] [Hide abstract]
ABSTRACT: To evaluate the efficacy and safety of transdermal nitroglycerin as tocolytic agent in women with preterm labor. Systematic review and meta-analysis of randomized controlled trials. Thirteen studies (1302 women) were included. Two studies evaluated transdermal nitroglycerin versus placebo (N=186), 9 evaluated transdermal nitroglycerin versus β2-adrenergic-receptor agonists (N=1024), and 1 each evaluated transdermal nitroglycerin versus nifedipine (N=50) and transdermal nitroglycerin versus magnesium sulfate (N=42). There were no significant differences between transdermal nitroglycerin and placebo for delivery within 48 hours of initiation of treatment or before 28, 34 or 37 weeks' gestation, adverse neonatal outcomes, and neurodevelopmental status at 24 months of age. Nevertheless, one study found a marginally significant reduction in the risk of a composite outcome of significant neonatal morbidity and perinatal mortality (3/74 [4.1%] versus 11/79 [13.9%]; relative risk 0.29, 95% confidence interval 0.08-1.00). When compared with β2-adrenergic-receptor agonists, transdermal nitroglycerin was associated with a significant reduction in the risk of preterm birth <34 and <37 weeks' gestation, admission to the neonatal intensive care unit, use of mechanical ventilation, and maternal side effects. There were no significant differences between transdermal nitroglycerin and nifedipine and magnesium sulfate in delivery within 48 hours of treatment and pregnancy prolongation, respectively. Overall, women receiving transdermal nitroglycerin had a higher risk of headache. Although transdermal nitroglycerin appears to be more effective than β2-adrenergic-receptor agonists, the current evidence does not support its routine use as tocolytic agent for the treatment of preterm labor. Further additional double-blind placebo-controlled trials are needed.
- [Show abstract] [Hide abstract]
ABSTRACT: Introduction: In developed countries, preterm birth is the major cause of perinatal morbidity, mortality and the most important public health problem in the obstetric field. In the past decades, an increasing trend has been observed regardless of the great efforts focussed on the improvement of our understanding of the physiopathological mechanisms behind preterm labour (PTL) and the improvement in the use of tocolytic drugs. Areas covered: In this review, the authors focus on some points of the physiopathology of labour in order to understand the rationality behind the different management approaches developed for the PTL syndrome. Expert opinion: There is a need to develop new tools for the treatment of patients with PTL. Research focussed on improving tocolysis, the physiology of labour and pathological processes involved in PTL would afford new approaches for the treatment of PTL, allowing clinicians to provide integrative solutions for this multifactorial disease. Recently, the prophylactic use of progesterone pessary and cerclage in women with high risk of premature labour has been reported to reduce the incidence of premature births and improve neonatal outcomes. These results highlight the importance of prediction models in order to establish preventative strategies early in pregnancy.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.