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Zhao LR, Lu SJ, Liu Q, Yu YC, Xiao L. Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery. J OBSTET GYNAECOL 2023; 43:2128997. [PMID: 36205080 DOI: 10.1080/01443615.2022.2128997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We evaluated the impact of cervical cerclage combined with one or more uterine contraction inhibitors in persistent inhibition of uterine contraction for the treatment of late abortion and premature delivery. This retrospective case series study analysed the medical data of 58 patients who underwent cervical cerclage for cervical insufficiency and simultaneously received one or more uterine contraction inhibitors (indomethacin, ritodrine, and atosiban) and magnesium sulphate at the Zibo Maternal and Child Health Hospital between January 2019 and December 2020.Patients are normal pregnancy who received cervical cerclage without complications. The rate of successful treatment was 74.14% (43/58). The prolonged gestation duration was 16.42 ± 7.84 weeks, and the average delivery gestational age was 35.91 ± 5.16 weeks. The longest duration of treatment with a uterine contraction inhibitor or inhibitors in combination or with magnesium sulphate alone was 15.34 ± 13.16 days, and nine cases developed adverse reactions. Persistent uterine contraction inhibition after cervical cerclage could prolong pregnancy and improve pregnancy outcomes.Impact statementWhat is already known on this subject? A crucial reason for treatment failure of cervical cerclage is that uterine contraction was not effectively inhibited.What do the results of this study add? Persistent inhibition of uterine contraction after cervical cerclage prolonged pregnancy duration, increased gestational age at delivery, and improved pregnancy outcomes.What are the implications of these findings for clinical practice and/or further research? This study may provide a clinical basis for prolonging gestational age, preventing late abortion and premature delivery, and improving the survival rate and quality of life of premature infants.
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Affiliation(s)
- Li-Rong Zhao
- Department of Obstetric, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Shu-Jing Lu
- Department of Obstetric, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Qing Liu
- Department of Obstetric, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Ying-Chun Yu
- Department of Obstetric, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Li Xiao
- Department of Obstetric, Maternal and Child Health Care of Shandong Province Affiliated to Shandong University, Jinan, China
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2
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Shynlova O, Nadeem L, Lye S. Progesterone control of myometrial contractility. J Steroid Biochem Mol Biol 2023; 234:106397. [PMID: 37683774 DOI: 10.1016/j.jsbmb.2023.106397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
During pregnancy, the primary function of the uterus is to be quiescent and not contract, which allows the growing fetus to develop and mature. A uterine muscle layer, myometrium, is composed of smooth muscle cells (SMCs). Before the onset of labor contractions, the uterine SMCs experience a complex biochemical and molecular transformation involving the expression of contraction-associated proteins. Labor is initiated when genes in SMCs are activated in response to a combination of hormonal, inflammatory and mechanical signals. In this review, we provide an overview of molecular mechanisms regulating the process of parturition in humans, focusing on the hormonal control of the myometrium, particularly the steroid hormone progesterone. The primary reason for discussing the regulation of myometrial contractility by progesterone is the importance of the clinical problem of preterm birth. It is thought that the hormonal mechanisms regulating premature uterine contractions represent an untimely triggering of the normal events occurring during term parturition. Yet, our knowledge of the complex and redundant hormonal pathways controlling uterine contractile activity leading to delivery of the neonate remains incomplete. Finally, we introduce recent animal studies using a novel class of drugs, Selective Progesterone Receptor Modulators, targeting progesterone signaling to prevent premature myometrial contractions.
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Affiliation(s)
- Oksana Shynlova
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto M5G 1X5, Canada; Department of Physiology, University of Toronto, M5S 1A1, Canada; Department of Obstetrics & Gynecology, University of Toronto, M5S 1A1, Canada.
| | - Lubna Nadeem
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto M5G 1X5, Canada
| | - Stephen Lye
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto M5G 1X5, Canada; Department of Physiology, University of Toronto, M5S 1A1, Canada; Department of Obstetrics & Gynecology, University of Toronto, M5S 1A1, Canada
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3
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Murata T, Isogami H, Imaizumi K, Fukuda T, Kyozuka H, Yasuda S, Yamaguchi A, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Tocolytic treatment and maternal characteristics, obstetric outcomes, and offspring childhood outcomes among births at and after 37 weeks of gestation: the Japan environment and children's study. Arch Gynecol Obstet 2023:10.1007/s00404-023-07203-5. [PMID: 37831176 DOI: 10.1007/s00404-023-07203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To evaluate differences in maternal characteristics and obstetric and offspring childhood outcomes between births at and after 37 weeks of gestation (referred to as term and post-term births) according to the use of tocolytic treatment. METHODS Data for 63,409 women with singleton births at and after 37 weeks of gestation were analyzed using data from the Japan Environment and Children's Study (JECS). We compared maternal characteristics, obstetric outcomes, and offspring childhood outcomes between term and post-term births exposed and not exposed to tocolytic treatment. Additionally, multivariable logistic regression models were used to calculate adjusted odds ratios for offspring childhood outcomes with significant between-group differences in the univariable analysis, with term and post-term births without tocolytic agents as the reference group. RESULTS We observed differences in maternal characteristics and obstetric outcomes between term and post-term births exposed and not exposed to tocolytic treatment. The incidence of offspring childhood developmental disorders showed no significant between-group differences. However, participants exposed to tocolytic agents had higher incidence of offspring childhood allergic disorders. The adjusted odds ratio for any of the offspring childhood allergic disorders in term and post-term births with tocolytic agents was 1.08 (95% confidence interval, 1.03-1.13). CONCLUSION This study found no significant difference in the incidence of offspring developmental disorders between term and post-term births exposed and not exposed to tocolytic treatment. However, tocolytic treatment was associated with differences in maternal characteristics and obstetric outcomes, along with a marginal increase in the incidence of childhood allergic disorders in offspring.
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Affiliation(s)
- Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Hirotaka Isogami
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Karin Imaizumi
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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4
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Maxey AP, Travis JM, McCain ML. Regulation of oxytocin-induced calcium transients and gene expression in engineered myometrial tissues by tissue architecture and matrix rigidity. Curr Res Physiol 2023; 6:100108. [PMID: 38107790 PMCID: PMC10724203 DOI: 10.1016/j.crphys.2023.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023] Open
Abstract
The uterus is susceptible to benign tumors known as fibroids, which have been associated with many pregnancy complications, including preterm labor. However, the impact of fibrotic tissue remodeling on the physiology of the myometrium, the smooth muscle layer of the uterus, is poorly understood, in large part due to a lack of model systems. In this study, we engineered healthy-like and fibrotic-like myometrium by culturing human myometrial smooth muscle cells on polyacrylamide hydrogels micropatterned with fibronectin to independently tune matrix rigidity and tissue alignment, respectively. We then evaluated calcium transients in response to oxytocin stimulation. Isotropic myometrial tissues on stiff substrates (representing fibrotic myometrium) had shorter calcium transients due to shorter decay time compared to aligned myometrial tissues on soft substrates (representing healthy myometrium). Calcium transients in aligned tissues had longer response times and longer decay times than isotropic tissues, irrespective of substrate stiffness. The amplitude of calcium transients was also higher on soft substrates compared to stiff substrates, irrespective of tissue alignment. We also performed RNA sequencing to detect differentially expressed genes between healthy- and fibrotic-like tissues, which revealed that a bitter taste receptor shown to induce smooth muscle relaxation, TAS2R31, was down-regulated in fibrotic-like tissues. Finally, we measured oxytocin-induced calcium transients in response to pre-treatment with progesterone, caffeine, thrombin, and nifedipine to demonstrate applications for our model system in drug screening. Both progesterone and caffeine caused a decrease in calcium transient duration, as expected, while thrombin and nifedipine had less impact. Collectively, our engineered model of the myometrium enables new insights into myometrial mechanobiology and can be extended to identify or screen novel drug targets.
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Affiliation(s)
- Antonina P. Maxey
- Laboratory for Living Systems Engineering, Alfred E. Mann Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jaya M. Travis
- Laboratory for Living Systems Engineering, Alfred E. Mann Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Megan L. McCain
- Laboratory for Living Systems Engineering, Alfred E. Mann Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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5
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Walker AR, Larsen CB, Kundu S, Stavrinidis C, Kim SH, Inoue A, Woodward DF, Lee YS, Migale R, MacIntyre DA, Terzidou V, Fanelli F, Khanjani S, Bennett PR, Hanyaloglu AC. Functional rewiring of G protein-coupled receptor signaling in human labor. Cell Rep 2022; 40:111318. [PMID: 36070698 PMCID: PMC9638024 DOI: 10.1016/j.celrep.2022.111318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/21/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Current strategies to manage preterm labor center around inhibition of uterine myometrial contractions, yet do not improve neonatal outcomes as they do not address activation of inflammation. Here, we identify that during human labor, activated oxytocin receptor (OTR) reprograms the prostaglandin E2 receptor, EP2, in the pregnant myometrium to suppress relaxatory/Gαs-cAMP signaling and promote pro-labor/inflammatory responses via altered coupling of EP2 from Gαq/11 to Gαi/o. The ability of EP2 to signal via Gαi/o is recapitulated with in vitro OT and only following OTR activation, suggesting direct EP2-OTR crosstalk. Super-resolution imaging with computational modeling reveals OT-dependent reorganization of EP2-OTR complexes to favor conformations for Gαi over Gαs activation. A selective EP2 ligand, PGN9856i, activates the relaxatory/Gαs-cAMP pathway but not the pro-labor/inflammatory responses in term-pregnant myometrium, even following OT. Our study reveals a mechanism, and provides a potential therapeutic solution, whereby EP2-OTR functional associations could be exploited to delay preterm labor. EP2 activity is reprogrammed toward pro-inflammatory pathways during human labor Oxytocin downregulates EP2-Gαs signaling and switches EP2-Gαq/11 signaling to Gαi/o EP2/OTR heterotetramers are reorganized by oxytocin to conformations favoring Gαi EP2 agonist PGN9856i does not activate pro-labor signals even after oxytocin treatment
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Affiliation(s)
- Abigail R Walker
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Camilla B Larsen
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Samit Kundu
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - Christina Stavrinidis
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Sung Hye Kim
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - Asuka Inoue
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - David F Woodward
- Department of Bioengineering, Imperial College London, London, UK
| | - Yun S Lee
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - Roberta Migale
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Stem Cell Biology and Developmental Genetics Laboratory, The Francis Crick Institute, London, UK
| | - David A MacIntyre
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - Vasso Terzidou
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK
| | - Francesca Fanelli
- Department Life Sciences, University of Modena and Reggio Emilia, via Campi 103, 41125 Modena, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, via Campi 287, 41125 Modena, Italy
| | - Shirin Khanjani
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Reproductive Medicine Unit, University College London Hospital, London, UK
| | - Phillip R Bennett
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK; March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK.
| | - Aylin C Hanyaloglu
- Institute of Reproductive and Developmental Biology, Department Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
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6
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Tang CL, Li QY, Chen FL, Cai CT, Dong YY, Wu YY, Yang JZ, Zhao M, Chi FL, Hong L, Ai A, Chen MX, Li KM, Teng XM, Chen ZQ. A randomized double blind comparison of atosiban in patients with recurrent implantation failure undergoing IVF treatment. Reprod Biol Endocrinol 2022; 20:124. [PMID: 35986323 PMCID: PMC9389813 DOI: 10.1186/s12958-022-00999-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients with recurrent implantation failure (RIF) may have more uterine contractions. Several observational studies suggested that atosiban administration around embryo transfer resulted in higher pregnancy rates in RIF patients. This study aimed to evaluate the effect of atosiban given before fresh embryo transfer on pregnancy outcomes of women with RIF. METHODS A prospective, randomized, double-blind controlled clinical trial was performed in IVF center of Shanghai First Maternity and Infant Hospital. According to a computer-generated randomization list, 194 infertile women with RIF received fresh embryo transfer between July 2017 and December 2019 were randomly allocated into the atosiban (n = 97) and the placebo (n = 97) groups. Women in the treatment group received atosiban intravenously about 30 min before embryo transfer with a bolus dose of 6.75 mg over one minute. Those in the placebo group received only normal saline infusion for the same duration. RESULTS There was no significant difference in the live birth rate between the atosiban and placebo groups (42.3% vs 35.1%, P = 0.302, RR = 1.206 (0.844-1.723)). No significant differences were found between the two groups in the positive pregnancy test, clinical pregnancy, ongoing pregnancy, miscarriage, multiple pregnancy, ectopic pregnancy and implantation rates. Similar results were found when stratified by the number of embryos previously transferred, number of previous failed embryo transfers, frequency of endometrial peristalsis on embryo transfer day (≥ 3 waves/min) or serum estradiol (E2) on the day of hCG above the median level. And, there was no correlation between the serum E2 level on the day of hCG and the frequency of endometrial peristalsis on embryo transfer day. The frequency of endometrial peristalsis on embryo transfer day, total FSH/HMG dosage and duration were the significant factors which independently predicted the likelihood of a live birth. CONCLUSIONS These results suggested that atosiban treatment before fresh embryo transfer might not improve the live birth rate in RIF patients. TRIAL REGISTRATION The study had been approved by the Institutional Review Board of the hospital (2017 ethics No.43) and was registered under Clinicaltrials.gov with an identifier NCT02893722.
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Affiliation(s)
- Chuan Ling Tang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Qi Yue Li
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Feng Lian Chen
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Chen Ting Cai
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yue Yan Dong
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yuan Yuan Wu
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jian Zhi Yang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Mei Zhao
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Feng Li Chi
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Ling Hong
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Ai Ai
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Miao Xin Chen
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Kun Ming Li
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiao Ming Teng
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhi Qin Chen
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Kirchhoff E, Schneider V, Pichler G, Reif P, Haas J, Joksch M, Mager C, Schmied C, Schöll W, Pichler-Stachl E, Gold D. Hexoprenaline Compared with Atosiban as Tocolytic Treatment for Preterm Labor. Geburtshilfe Frauenheilkd 2022; 82:852-858. [PMID: 35967742 PMCID: PMC9365465 DOI: 10.1055/a-1823-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/10/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction
Preterm birth is defined as a live birth before 37 weeks of gestation and is associated with increased neonatal morbidity and mortality. The aim of this study is to
compare the efficacy of hexoprenaline and atosiban for short- and long-term tocolysis and their effects on neonatal and maternal outcomes.
Methods
This retrospective cohort study included women with threatened preterm labor between 24 + 0 and 34 + 0 weeks of gestation without premature rupture of membranes. The
tocolytic efficacy of hexoprenaline and atosiban was compared in women receiving one of the two medications for short- and long-term tocolysis. Continuous variables were compared using
t-test or Mann–Whitney U test, as appropriate. Comparison of categorical variables between the two groups was done with χ
2
test after Pearsonʼs and Fisherʼs exact test.
Results
761 women were enrolled in this study; 387 women received atosiban and 374 women received hexoprenaline as their primary tocolytic agent. Atosiban showed a higher efficacy as
a primary tocolytic agent (p = 0.000) within 48 hours. As regards long-term tocolysis, there were no differences between the treatment groups (p = 0.466). Maternal side effects such as
tachycardia (p = 0.018) or palpitations (p = 0.000) occurred more frequently after the administration of hexoprenaline, while there were no differences between the two drugs administered
with regard to any other maternal or neonatal outcome parameter.
Conclusion
Our retrospective study shows a significantly higher efficacy of atosiban in the first 48 hours, especially when administered at an early gestational age. There were no
significant differences in terms of neonatal outcome but significantly more maternal adverse effects during the administration of hexoprenaline.
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Affiliation(s)
- Ebba Kirchhoff
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Verena Schneider
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Gerhard Pichler
- 2 Klinische Abteilung für Neonatologie der Med. Universität Graz, Graz, Austria
| | - Philipp Reif
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Josef Haas
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Maike Joksch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Corinna Mager
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Christian Schmied
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Wolfgang Schöll
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Elisabeth Pichler-Stachl
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
| | - Daniela Gold
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz, Graz, Austria
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Assessing the Potency of the Novel Tocolytics 2-APB, Glycyl-H-1152, and HC-067047 in Pregnant Human Myometrium. Reprod Sci 2022; 30:203-220. [PMID: 35715551 PMCID: PMC9810572 DOI: 10.1007/s43032-022-01000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/02/2022] [Indexed: 01/07/2023]
Abstract
The intracellular signaling pathways that regulate myometrial contractions can be targeted by drugs for tocolysis. The agents, 2-APB, glycyl-H-1152, and HC-067047, have been identified as inhibitors of uterine contractility and may have tocolytic potential. However, the contraction-blocking potency of these novel tocolytics was yet to be comprehensively assessed and compared to agents that have seen greater scrutiny, such as the phosphodiesterase inhibitors, aminophylline and rolipram, or the clinically used tocolytics, nifedipine and indomethacin. We determined the IC50 concentrations (inhibit 50% of baseline contractility) for 2-APB, glycyl-H-1152, HC-067047, aminophylline, rolipram, nifedipine, and indomethacin against spontaneous ex vivo contractions in pregnant human myometrium, and then compared their tocolytic potency. Myometrial strips obtained from term, not-in-labor women, were treated with cumulative concentrations of the contraction-blocking agents. Comprehensive dose-response curves were generated. The IC50 concentrations were 53 µM for 2-APB, 18.2 µM for glycyl-H-1152, 48 µM for HC-067047, 318.5 µM for aminophylline, 4.3 µM for rolipram, 10 nM for nifedipine, and 59.5 µM for indomethacin. A single treatment with each drug at the determined IC50 concentration was confirmed to reduce contraction performance (AUC) by approximately 50%. Of the three novel tocolytics examined, glycyl-H-1152 was the most potent inhibitor. However, of all the drugs examined, the overall order of contraction-blocking potency in decreasing order was nifedipine > rolipram > glycyl-H-1152 > HC-067047 > 2-APB > indomethacin > aminophylline. These data provide greater insight into the contraction-blocking properties of some novel tocolytics, with glycyl-H-1152, in particular, emerging as a potential novel tocolytic for preventing preterm birth.
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Jang EJ, Kim YJ, Hwang HS, Yee J, Gwak HS. Associations of GNAS and RGS Gene Polymorphisms with the Risk of Ritodrine-Induced Adverse Events in Korean Women with Preterm Labor: A Cohort Study. Pharmaceutics 2022; 14:pharmaceutics14061220. [PMID: 35745791 PMCID: PMC9227008 DOI: 10.3390/pharmaceutics14061220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Abstract
Ritodrine, a β2-adrenergic receptor agonist, is among most commonly prescribed tocolytic agents. This study aimed to evaluate the associations of single nucleotide polymorphisms in GNAS, RGS2, and RGS5 with the risk of ritodrine-induced adverse events (AEs) and develop a risk scoring system to identify high-risk patients. This is the prospective cohort study conducted at the Ewha Woman’s University Mokdong Hospital between January 2010 and October 2016. Pregnant women were included if they were treated with ritodrine for preterm labor with regular uterine contractions (at least 3 every 10 min) and cervical dilation. A total of 6, 3, and 5 single nucleotide polymorphisms (SNPs) of GNAS, RGS2, and RGS5 genes were genotyped and compared in patients with and without ritodrine-induced AEs. A total of 163 patients were included in this study. After adjusting confounders, GNAS rs3730168 (per-allele odds ratio (OR): 2.1; 95% confidence interval (95% CI): 1.0–4.3) and RGS2 rs1152746 (per-allele OR: 2.6, 95% CI: 1.1–6.5) were significantly associated with ritodrine-induced AEs. According to the constructed risk scoring models, patients with 0, 1, 2, 3, 4, and 5 points showed 0%, 13%, 19%, 31%, 46%, and 100% risks of AEs. This study suggested that GNAS and RGS2 polymorphisms could affect the risk of AEs in patients treated with ritodrine.
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Affiliation(s)
- Eun-Jeong Jang
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
| | - Young-Ju Kim
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul 07985, Korea;
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea;
| | - Jeong Yee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- Correspondence: (J.Y.); (H.-S.G.); Tel.: +82-2-3277-3052 (J.Y.); +82-2-3277-4376 (H.-S.G.); Fax: +82-2-3277-3051 (J.Y. & H.-S.G.)
| | - Hye-Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea;
- Correspondence: (J.Y.); (H.-S.G.); Tel.: +82-2-3277-3052 (J.Y.); +82-2-3277-4376 (H.-S.G.); Fax: +82-2-3277-3051 (J.Y. & H.-S.G.)
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10
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Murata T, Kyozuka H, Yasuda S, Fukuda T, Tanaka T, Fujimori K. Effects of maternal ritodrine hydrochloride administration on the heart rate of preterm fetal sheep with intraamniotic inflammation. PLoS One 2022; 17:e0265872. [PMID: 35358222 PMCID: PMC8970407 DOI: 10.1371/journal.pone.0265872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Ritodrine hydrochloride is used for pregnancy prolongation and intrauterine fetal resuscitation. However, its clinical significance in intraamniotic inflammation during preterm labor and intrauterine fetal distress is unclear. We investigated the effects of maternal ritodrine hydrochloride administration (MRA; 200 μg/min for 2 h, followed by 800 μg/min for 2 h after 24 h) on fetal physiological parameters. For this purpose, we used chronically instrumented pregnant sheep at 113–119 d (term = 145 d) of gestation without (Group 1, n = 5) and with (Group 2, n = 5) intraamniotic inflammation induced by lipopolysaccharide injection into the amniotic cavity. The changes in fetal heart rate (FHR) and short-term variability (STV) and long-term variability (LTV) in FHR, fetal blood pressure, and fetal arterial blood gas (FABG) values were measured before and at 1 and 2 h after initiating MRA. Before MRA, all parameters were similar between Groups 1 and 2; however, there was significantly higher STV in Group 2 than in Group 1 before MRA at 800 μg/min, significantly higher partial arterial pressure of carbon dioxide in FABG in Group 2 than in Group 1 before MRA at 200 μg/min, and significantly lower blood glucose (BG) in Group 2 than in Group 1 before MRA at 800 μg/min. One hour after MRA, the FHR, STV, and LTV were significantly higher at 800 μg/min than those at the baseline in Group 1, as determined by the Friedman test; however, no significant difference was observed in Group 2. Additionally, the FABG pH significantly decreased 1 h after MRA at 800 μg/min in Group 2, whereas FABG lactate and BG significantly increased 2 h after MRA at 800 μg/min in Groups 1 and 2. Thus, short-term MRA at 800 μg/min increased the FHR, STV, and LTV significantly; these values were further modified under intraamniotic inflammation.
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Affiliation(s)
- Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
- * E-mail:
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Teruyoshi Tanaka
- Department of Biomolecular Science, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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11
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Liu WY, Zhang JR, Xu XM, Ye TY. Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report. World J Clin Cases 2022; 10:1381-1387. [PMID: 35211573 PMCID: PMC8855204 DOI: 10.12998/wjcc.v10.i4.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/21/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preterm birth accounts for about 12% of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality. In order to avoid premature birth and prolong gestational age, tocolytics are the first and the best choice. Ritodrine is the most commonly used tocolytic medication. However, side effects such as pulmonary edema, hypokalemia, and hyperglycemia are known. Here we report a rare but serious side effect–toxic epidermal necrolysis (TEN)–caused by ritodrine.
CASE SUMMARY A woman (31 years, gravida 4, para 2) was hospitalized because of premature contractions at 27 + 6 wk of gestation. A skin rash with pruritus appeared at 32 + 3 wk of gestation after administration of ritodrine, indomethacin, and dexamethasone, and it spread throughout the whole body in 3 d, particularly the four limbs. After 11 d’ treatment, she was diagnosed with TEN. An emergency cesarean section was performed immediately to deliver the baby and intensive symptomatic treatment was promptly commenced after delivery. She recovered from the severe condition without any sequelae except for slight pigmentation after symptomatic treatment.
CONCLUSION When a skin rash appears during the administration of ritodrine, we are supposed to consider the risk of TEN.
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Affiliation(s)
- Wen-Yu Liu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Jia-Rong Zhang
- Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xian-Ming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Tian-Yi Ye
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
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12
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Murata T, Kyozuka H, Yasuda S, Fukuda T, Yamaguchi A, Maeda H, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Association between maternal ritodrine hydrochloride administration during pregnancy and childhood wheezing up to three years of age: The Japan environment and children's study. Pediatr Allergy Immunol 2021; 32:1455-1463. [PMID: 34013624 DOI: 10.1111/pai.13545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/25/2021] [Accepted: 05/13/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The effects of maternal ritodrine hydrochloride administration (MRA) during pregnancy on fetuses and offspring are not entirely clear. The present study aimed to evaluate the association between MRA and childhood wheezing using data from a nationwide Japanese birth cohort study. METHODS This study analyzed the data of the participants enrolled in the Japan Environment and Children's Study, a nationwide prospective birth cohort study, between 2011 and 2014. Data of women with singleton live births after 22 weeks of gestation were analyzed. The participants were divided according to MRA status. Considering childhood factors affecting the incidence of wheezing, including smoking environment and childhood viral infections, a logistic regression model was used to calculate odds ratios for "wheezing ever," diagnosis of asthma in the last 12 months, and "asthma ever" in women with MRA, with women who did not receive MRA as the reference. Additionally, participants were stratified by term births, and odds ratios for outcomes were calculated using a logistic regression model. RESULTS A total of 68,123 participants were analyzed. The adjusted odds ratio for wheezing was 1.17 (95% confidence interval, 1.12-1.22). The adjusted odds ratios for the other outcomes did not significantly increase after adjusting for childhood factors. The same tendency was confirmed after excluding women with preterm births. CONCLUSION MRA was associated with a slightly increased incidence of childhood wheezing up to three years, irrespective of term or preterm birth status. It is important that perinatal physicians consider the potential effects of MRA on the offspring's childhood health.
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Affiliation(s)
- Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hajime Maeda
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environment and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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13
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de Sousa ÍA, de Meneses GMS, Cardoso JVM, Lopes PQ, de Sousa JA, Cavalcanti SMPG, da Silva Cavalcanti PM, Filho FC. Inhibitory effect of Pyr6 (an Orai channel blocker) on agonist-induced contractions in rat uterus. J Obstet Gynaecol Res 2021; 47:4306-4318. [PMID: 34571573 DOI: 10.1111/jog.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
AIM Both human and rat myometrium express stromal interaction molecule (STIM) and Orai/ transient receptor potential canonical (TRPC) proteins, which are components of plasma membrane Ca2+ store-operated channels. There are reports that these proteins mediate agonist-induced Ca2+ influx in cultured myometrial cells. In this study, we aimed to determine the effects of Pyr6, an Orai channel blocker, on different agonist-induced contractions in isolated segments of rat uterus. MAIN FINDINGS In Ca2+ -free Tyrode's solution, Pyr6 (3 μM) promoted a reduction in both the magnitude and frequency of Ca2+ (1 mM)-induced uterine contractions after the addition of carbachol (CCh, 100 μM), but not after the addition of oxytocin (OT, 150 nM). In Ca2+ (0.18 mM)-Tyrode's solution, Pyr6 completely relaxed uterine contractions induced by both CCh and cloprostenol (300 nM), but not those induced by either KCI (40-80 mM) or OT. The addition of Pyr6 abolished the oscillatory uterine contractions induced by Ca2+ after the addition of cyclopiazonic acid (CPA, 10 μM). When pre-incubated (5 min), Pyr6 reduced the magnitude of both CCh-induced phasic and tonic contractions. The addition of Pyr2 (3 μM), an Orai and TRPC channel blocker, abolished uterine contractions induced by CCh or OT. CONCLUSION Considering Pyr6 as an Orai channel blocker and its inhibitory effect on uterine contractions induced by CCh, CPA, and cloprostenol, we suggest that Orai channels are required for the maintenance of contractions induced by these agonists in rat uterus.
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Affiliation(s)
- Ícaro Araújo de Sousa
- Biophysics and Physiology Department, Health Sciences Center, Federal University of Piauí, Ininga, Teresina, Brazil
| | | | - José Victor Miranda Cardoso
- Biophysics and Physiology Department, Health Sciences Center, Federal University of Piauí, Ininga, Teresina, Brazil
| | - Pablo Queiroz Lopes
- Pharmacological Sciences Department, Health Sciences Center, Federal University of Paraíba, Cidade Universitária - Campus I. Castelo Branco, João Pessoa, Brazil
| | - Joubert Aires de Sousa
- Physiotherapy Department, Health Sciences Center, University of the State of Piauí, Teresina, Brazil
| | | | - Paulo Marques da Silva Cavalcanti
- Pharmacological Sciences Department, Health Sciences Center, Federal University of Paraíba, Cidade Universitária - Campus I. Castelo Branco, João Pessoa, Brazil
| | - Francisco Chagas Filho
- Biophysics and Physiology Department, Health Sciences Center, Federal University of Piauí, Ininga, Teresina, Brazil
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14
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Marchand G, Blumrick R, Ruuska AD, Ware K, Masoud AT, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Ulibarri H, Sainz K. Novel oxytocin receptor antagonists for tocolysis: a systematic review and meta-analysis of the available data on the efficacy, safety, and tolerability of retosiban. Curr Med Res Opin 2021; 37:1677-1688. [PMID: 34134590 DOI: 10.1080/03007995.2021.1944076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the efficacy, safety, and tolerability of retosiban-a novel tocolytic unavailable in the US-in the management of preterm labor. METHODS We searched ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS, Web of Science, and the Cochrane Library for relevant clinical trials using the terms "retosiban" and "preterm labor" through 09/2020. We included all published randomized clinical trials (three) that compared retosiban to placebo for preterm labor, excluding conferences, books, reviews, posters, case reports, and animal studies. We analyzed homogeneous data under the fixed-effects model and heterogeneous data under the random-effects model. RESULTS We included all randomized clinical trials addressing this topic, which ultimately resulted in three trials with a total of 116 patients. There were no significant differences between retosiban and placebo in births at term (RR = 0.41, p = .02), births ≤7 days from the first study treatment (RR = 0.59, p = .23), or administration of rescue tocolytic (RR = 0.36, p = .07); the maternal adverse events of headache, anemia, constipation, or urinary tract infection (p > .05); or neonatal outcomes of Apgar score at 1 min (p = .88) or 5 min (p = .69), weight (p = .23), head circumference (p = .55), malnutrition (p = .27), hyperbilirubinemia (RR = 0.56, p = .21), jaundice (RR = 1.21, p = .84), respiratory distress (RR = 0.53, p = .49), or tachypnea (RR = 0.40, p = .42). CONCLUSION With the limited high quality evidence available, retosiban demonstrates no clear benefit over placebo in the management of preterm labor. Nevertheless, its favorable safety profile, oral bioavailability, and novel mechanism of action and the limited number of studies available for review warrant further analysis.
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Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Alexandra D Ruuska
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Kelly Ware
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- International University of Health Sciences, Basseterre, St. Kitts
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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15
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Murata T, Kyozuka H, Yasuda S, Fukuda T, Kanno A, Yamaguchi A, Jimbo M, Nishigori H, Fujimori K. Effects of acute tocolysis using ritodrine hydrochloride on foetal heart rate patterns in intrauterine foetal resuscitation: a retrospective, single-centre observational study. J OBSTET GYNAECOL 2021; 42:563-568. [PMID: 34396888 DOI: 10.1080/01443615.2021.1929111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
No consistent recommendations concerning the preferred tocolytic agents for intrauterine foetal resuscitation are available. We evaluated the effects of acute tocolysis (AT) using ritodrine hydrochloride on foetal heart rate (FHR) patterns and neonatal outcomes. We retrospectively analysed the data of patients undergoing emergency caesarean section because of non-reassuring foetal status indicated by foetal scalp electrodes. Patients were classified into AT (ritodrine hydrochloride approximately 500 µg/min) and control groups with 15 and 12 participants, respectively. FHR patterns, Apgar scores, umbilical arterial analysis, and neonatal admission were compared. All participants had FHR category II; decelerations disappeared in all foetuses in the AT group, with no significant difference in neonatal outcomes. The AT group had a higher baseline FHR and lower short-term FHR variability than the control group, indicating foetal autonomic responses. Further studies are needed to clarify the effects of AT on FHR patterns, neonatal outcomes, and foetal and neonatal autonomic responses.Impact statementWhat is already known on this subject? The usefulness of acute tocolysis using ritodrine hydrochloride has been well-documented in several studies; however, such an application often induces side effects, such as maternal tachycardia, palpitations, and tremors.What the results of this study add? The short-term administration of ritodrine hydrochloride eliminated decelerations, with no significant difference in neonatal outcomes in pregnant women with foetal heart rate category II. Meanwhile, there were higher foetal heart rate and lower short-term foetal heart rate variability in pregnant women administered with ritodrine hydrochloride, indicating foetal autonomic responses.What the implications are of these findings for clinical practice and/or further research? Ritodrine hydrochloride administration, even for short-term, appears to be associated with foetal autonomic responses. Further studies with stratification of patient groups based on the severity and aetiology of non-reassuring foetal status, including pregnant women with foetal category III, would elucidate the risk and benefit of acute tocolysis using ritodrine hydrochloride, based on foetal heart rate patterns, neonatal outcomes, and foetal and neonatal autonomic responses.
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Affiliation(s)
- Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Aya Kanno
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Yamaguchi
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masatoshi Jimbo
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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16
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Kodama Y, Tanaka I, Sato T, Hori K, Gen S, Morise M, Matsubara D, Sato M, Sekido Y, Hashimoto N. Oxytocin receptor is a promising therapeutic target of malignant mesothelioma. Cancer Sci 2021; 112:3520-3532. [PMID: 34115916 PMCID: PMC8409407 DOI: 10.1111/cas.15025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023] Open
Abstract
Malignant mesothelioma (MM) is one of the most aggressive tumors. We conducted bioinformatics analysis using Cancer Cell Line Encyclopedia (CCLE) datasets to identify new molecular markers in MM. Overexpression of oxytocin receptor (OXTR), which is a G‐protein–coupled receptor for the hormone and neurotransmitter oxytocin, mRNA was distinctively identified in MM cell lines. Therefore, we assessed the role of OXTR and its clinical relevance in MM. Kaplan‐Meier and Cox regression analyses were applied to assess the association between overall survival and OXTR mRNA expression using The Cancer Genome Atlas (TCGA) datasets. The function of OXTR and the efficacy of its antagonists were investigated in vitro and in vivo using MM cell lines. Consistent with the findings from CCLE datasets analysis, OXTR mRNA expression was highly increased in MM tissues compared with other cancer types in the TCGA datasets, and MM cases with high OXTR expression showed poor overall survival. Moreover, OXTR knockdown dramatically decreased MM cell proliferation in cells with high OXTR expression via tumor cell cycle disturbance, whereas oxytocin treatment significantly increased MM cell growth. OXTR antagonists, which have high selectivity for OXTR, inhibited the growth of MM cell lines with high OXTR expression, and oral administration of the OXTR antagonist, cligosiban, significantly suppressed MM tumor progression in a xenograft model. Our findings suggest that OXTR plays a crucial role in MM cell proliferation and is a promising therapeutic target that may broaden potential therapeutic options and could be a prognostic biomarker of MM.
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Affiliation(s)
- Yuta Kodama
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ichidai Tanaka
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuhiro Sato
- Division of Cancer Biology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Kazumi Hori
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soei Gen
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Matsubara
- Department of Diagnostic Pathology, Tsukuba University, Tsukuba, Japan
| | - Mitsuo Sato
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitaka Sekido
- Division of Cancer Biology, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Molecular and Cellular Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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Ibrahim MH, Elfaki T, Elhassan EM, Abdelrahiem SK, Adam I. The effectiveness of nifedipine/indomethacin combination therapy and nifedipine monotherapy for postponing preterm birth (25-34 weeks of gestation) in Sudanese women: a randomized clinical trial study protocol. BMC Pregnancy Childbirth 2021; 21:457. [PMID: 34187394 PMCID: PMC8244195 DOI: 10.1186/s12884-021-03951-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm birth is the most common cause of neonatal morbidity and mortality. Tocolytics are considered a standard treatment for women with threatened preterm delivery to allow time for maternal steroid administration and transfer to referral centers with neonatal intensive care units. However, there is controversy about the best tocolytic therapy to be considered as the first choice. The aim of this study is to compare the tocolytic effectiveness and tolerability of combination therapy with nifedipine and indomethacin versus nifedipine monotherapy among Sudanese women with preterm labor (PTL) as well as to compare the possible neonatal outcomes associated with each drug. METHODS/DESIGN This is a randomized controlled clinical trial to be conducted in the Medani Maternity Hospital, Sudan. Women aged 18-40 years that are diagnosed with preterm labor and have a gestational age between 25 and 34 weeks will be eligible to participate in this trial. The diagnosis of threatened PTL is defined as persistent uterine contractions "(four contractions every 20 min or eight contractions every 60 min)" with cervical changes "(cervical effacement ≤80% or cervical dilatation >two cm)". Patients will be eligible regardless of the presentation of the fetus. It will be randomly decided whether participants receive nifedipine/indomethacin combination therapy or nifedipine monotherapy. The primary outcome is the number of women who do not deliver and do not need alternative tocolytic drug (terbutaline). The secondary outcome is an estimated association with neonatal morbidity and mortality. The sample size will be 117 subjects in each arm of the study, according to a type I error of 0.05 and a study power of 80%. DISCUSSION We expect higher effectiveness of the combination indomethacin/nifedipine tocolytic therapy compared with nifedipine monotherapy. We plan to suggest this combination therapy as the best option for postponing PTL. TRIAL REGISTRATION Clinical trial registration: PACTR202004681537890 , date of registration: March 8, 2020.
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Affiliation(s)
- Mohammed H Ibrahim
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah City, Qassim Region, 51911, Saudi Arabia
| | - Tahani Elfaki
- Department of Obstetrics and Gynecology, University of Gezira, Medani, Sudan.
| | - Elhassan M Elhassan
- Department of Obstetrics and Gynecology, University of Gezira, Medani, Sudan
| | - Somia K Abdelrahiem
- Department of Obstetrics and Gynecology, University of Gezira, Medani, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
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18
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Maxey AP, McCain ML. Tools, techniques, and future opportunities for characterizing the mechanobiology of uterine myometrium. Exp Biol Med (Maywood) 2021; 246:1025-1035. [PMID: 33554648 DOI: 10.1177/1535370221989259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The myometrium is the smooth muscle layer of the uterus that generates the contractions that drive processes such as menstruation and childbirth. Aberrant contractions of the myometrium can result in preterm birth, insufficient progression of labor, or other difficulties that can lead to maternal or fetal complications or even death. To investigate the underlying mechanisms of these conditions, the most common model systems have conventionally been animal models and human tissue strips, which have limitations mostly related to relevance and scalability, respectively. Myometrial smooth muscle cells have also been isolated from patient biopsies and cultured in vitro as a more controlled experimental system. However, in vitro approaches have focused primarily on measuring the effects of biochemical stimuli and neglected biomechanical stimuli, despite the extensive evidence indicating that remodeling of tissue rigidity or excessive strain is associated with uterine disorders. In this review, we first describe the existing approaches for modeling human myometrium with animal models and human tissue strips and compare their advantages and disadvantages. Next, we introduce existing in vitro techniques and assays for assessing contractility and summarize their applications in elucidating the role of biochemical or biomechanical stimuli on human myometrium. Finally, we conclude by proposing the translation of "organ on chip" approaches to myometrial smooth muscle cells as new paradigms for establishing their fundamental mechanobiology and to serve as next-generation platforms for drug development.
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Affiliation(s)
- Antonina P Maxey
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Megan L McCain
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA.,Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA 90033, USA
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19
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Jaju PB. Effectiveness and Safety of Isoxsuprine Hydrochloride as Tocolytic Agent in Arresting Active/Threatened Preterm Labor and Its Role in Maintenance Tocolysis: A Prospective, Open-Label Study. Am J Perinatol 2021; 38:291-295. [PMID: 31550735 DOI: 10.1055/s-0039-1696720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the study is to obtain insights on the short and long-term safety and effectiveness of isoxsuprine hydrochloride as a tocolytic agent in the management of PTL. STUDY DESIGN In this prospective, single-center, noncomparative study, patients (with preterm labor at gestational age of 24-37 weeks) were administered intravenous (IV) infusion of 40-mg isoxsuprine hydrochloride until uterine quiescence, followed by intramuscular (IM) injection of isoxsuprine hydrochloride 10 mg/4-hourly for first 24 hours and maintained with retard 40-mg sustained release capsule (two times a day) till the time of delivery or 37 completed weeks of pregnancy. RESULTS All patients (n = 50) achieved successful tocolysis in 24 hours and 48 hours postadministration of isoxsuprine hydrochloride (IV/IM/oral). Mean (±SD) gestation age at the time of delivery was 39.8 ± 2.1 weeks, with latency period of 58.5 ± 18.7 days. Pregnancy outcomes were normal in all the patients and no congenital anomaly/fetal infection was reported. Mean (±SD) fetal birth weight was 2.7 ± 0.3 kg; mean (±SD) Apgar score at 1 and 5 minutes were 7.5 ± 0.6 and 9.2 ± 0.4, respectively. Maternal tachycardia and vomiting (8.0% each) were the commonly reported adverse drug reactions, which were resolved with dose adjustment. CONCLUSION Isoxsuprine was found to be an effective and well-tolerated tocolytic agent in arresting PTL, in turn resulting in the overall improvement in maternal and perinatal outcomes.
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Affiliation(s)
- Purushottam B Jaju
- Department of Obstetrics and Gynecology, B.M. Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, India
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20
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Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort). Sci Rep 2020; 10:9535. [PMID: 32533019 PMCID: PMC7293322 DOI: 10.1038/s41598-020-65201-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/29/2020] [Indexed: 11/09/2022] Open
Abstract
After preterm premature rupture of membranes (PPROM), antibiotics and antenatal steroids are effective evidence-based interventions, but the use of tocolysis is controversial. We investigated whether a unit policy of tocolysis use after PPROM is associated with prolonged gestation and improved outcomes for very preterm infants in units that systematically use these other evidence-based treatments. From the prospective, observational, population-based EPICE cohort study (all very preterm births in 19 regions from 11 European countries, 2011-2012), we included 607 women with a singleton pregnancy and PPROM at 24-29 weeks' gestation, of whom 101, 195 and 311 were respectively managed in 17, 32 and 45 units with no-use, restricted and liberal tocolysis policies for PPROM. The association between unit policies and outcomes (early-onset sepsis, survival at discharge, survival at discharge without severe morbidity and survival at two years without gross motor impairment) was investigated using three-level random-intercept logistic regression models, showing no differences in neonatal or two-year outcomes by unit policy. Moreover, there was no association between unit policies and prolongation of gestation in a multilevel survival analysis. Compared to a unit policy of no-use of tocolysis after PPROM, a liberal or restricted policy is not associated with improved obstetric, neonatal or two-year outcomes.
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21
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Lamont RF, Jørgensen JS. Safety and Efficacy of Tocolytics for the Treatment of Spontaneous Preterm Labour. Curr Pharm Des 2020; 25:577-592. [PMID: 30931850 DOI: 10.2174/1381612825666190329124214] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Attempts to reduce the burden may be proactive using biochemical or biophysical prediction and preventative measures. If these efforts fail, then the approach may have to be reactive using tocolytics to inhibit spontaneous preterm labour. OBJECTIVE We have reviewed the evidence concerning the safety and efficacy of various classes of tocolytic agents. RESULTS The evidence to support the use of magnesium sulfate or nitric oxide donors as a tocolytic is poor. Compared to placebo or no treatment, there is evidence to support the efficacy of calcium channel blockers (mainly nifedipine), prostaglandin synthetase inhibitors (mainly indomethacin and sulindac), oxytocin receptor antagonists (mainly atosiban) and β2-agonists (mainly ritodrine, terbutaline, salbutamol and fenoterol). Maternal safety concerns have reduced the use of β2-agonists. Fetal safety and gestational age restrictions have largely condemned prostaglandin synthetase inhibitors to second-line therapy. First-line therapy in Europe and other parts of the world outside the USA and Australia is limited to calcium channel blockers and oxytocin receptor antagonists. With respect to efficacy, atosiban and nifedipine are similar, but the robustness of the evidence favours atosiban. With respect to safety, atosiban is clearly the safest tocolytic as there are fetomaternal concerns with nifedipine, particularly in high daily doses. CONCLUSION The perfect tocolytic that is uniformly effective and safe does not exist. Cost, licensing and informed consent are considerations involved in the choice. Efforts continue to develop and introduce other or better agents, including novel compounds such as progesterone, PGF2α antagonists and statins.
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Affiliation(s)
- Ronald F Lamont
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Division of Surgery, Northwick Park Institute of Medical Research Campus, University College London, London, United Kingdom
| | - Jan S Jørgensen
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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22
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Muñoz-Pérez VM, Ortiz MI, Cariño-Cortés R, Fernández-Martínez E, Rocha-Zavaleta L, Bautista-Ávila M. Preterm Birth, Inflammation and Infection: New Alternative Strategies for their Prevention. Curr Pharm Biotechnol 2019; 20:354-365. [PMID: 30961490 DOI: 10.2174/1389201020666190408112013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Worldwide, the progress in reducing neonatal mortality has been very slow. The rate of preterm birth has increased over the last 20 years in low-income and middle-income countries. Its association with increased mortality and morbidity is based on experimental studies and neonatal outcomes from countries with socioeconomic differences, which have considered implementing alternative healthcare strategies to prevent and reduce preterm births. METHODS Currently, there is no widely effective strategy to prevent preterm birth. Pharmacological therapies are directed at inhibiting myometrial contractions to prolong parturition. Some drugs, medicinal plants and microorganisms possess myorelaxant, anti-inflammatory and immunomodulatory properties that have proved useful in preventing preterm birth associated with inflammation and infection. RESULTS This review focuses on the existing literature regarding the use of different drugs, medicinal plants, and microorganisms that show promising benefits for the prevention of preterm birth associated with inflammation and infection. New alternative strategies involving the use of PDE-4 inhibitors, medicinal plants and probiotics could have a great impact on improving prenatal and neonatal outcomes and give babies the best start in life, ensuring lifelong health benefits. CONCLUSION Despite promising results from well-documented cases, only a small number of these alternative strategies have been studied in clinical trials. The development of new drugs and the use of medicinal plants and probiotics for the treatment and/or prevention of preterm birth is an area of growing interest due to their potential therapeutic benefits in the field of gynecology and obstetrics.
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Affiliation(s)
- Víctor M Muñoz-Pérez
- Area Academica de Medicina, Instituto de Ciencias de la Salud, Universidad Autonoma del Estado de Hidalgo, Eliseo Ramirez Ulloa 400, Doctores Pachuca de soto, 42090, Mexico
| | - Mario I Ortiz
- Area Academica de Medicina, Instituto de Ciencias de la Salud, Universidad Autonoma del Estado de Hidalgo, Eliseo Ramirez Ulloa 400, Doctores Pachuca de soto, 42090, Mexico
| | - Raquel Cariño-Cortés
- Area Academica de Medicina, Instituto de Ciencias de la Salud, Universidad Autonoma del Estado de Hidalgo, Eliseo Ramirez Ulloa 400, Doctores Pachuca de soto, 42090, Mexico
| | - Eduardo Fernández-Martínez
- Area Academica de Medicina, Instituto de Ciencias de la Salud, Universidad Autonoma del Estado de Hidalgo, Eliseo Ramirez Ulloa 400, Doctores Pachuca de soto, 42090, Mexico
| | - Leticia Rocha-Zavaleta
- Instituto de Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico, Coyoacan, Ciudad de Mexico, Mexico
| | - Mirandeli Bautista-Ávila
- Area Academica de Farmacia, Instituto de Ciencias de la Salud, Universidad Autonoma del Estado de Hidalgo, Ex Hacienda la Concepcion s/n, ctra. Pachuca- Tilcuautla, Hidalgo 42060, Mexico
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23
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Oxytocin Receptor Antagonists, Atosiban and Nolasiban, Inhibit Prostaglandin F 2α-induced Contractions and Inflammatory Responses in Human Myometrium. Sci Rep 2019; 9:5792. [PMID: 30962532 PMCID: PMC6453954 DOI: 10.1038/s41598-019-42181-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/19/2019] [Indexed: 12/28/2022] Open
Abstract
Oxytocin receptor antagonists (OTR-A) have been developed as tocolytics for the management of preterm labour due to the significant role of oxytocin (OT) in the onset of both term and preterm labour. Similar to OT, prostaglandins (PGs) play key roles in myometrial contractility and cervical ripening. Inhibition of PG synthesis/activity is used to delay preterm birth. Thus, targeting the PG pathway in combination with an OTR-A may be an effective strategy for delaying preterm delivery. In this study, we examined the effects of atosiban and nolasiban on PGF2α-induced contractions and pro-inflammatory responses in human pregnant myometrium. Both OTR-As, atosiban and nolasiban, inhibited PGF2α-induced contractions in a dose-dependent manner (p < 0.001 and p < 0.01, respectively). These inhibitory effects involved the suppression of PGF2α-mediated increase in intracellular calcium levels. In addition, the OTR-As significantly suppressed PGF2α-induced activation of pro-inflammatory pathways such as NF-κB and mitogen activated protein kinases (MAPKs), and the subsequent expression of contraction-associated-protein, COX-2. We have demonstrated that atosiban and nolasiban not only inhibit contractions elicited by OT, but also inhibit contractions and inflammation induced by PGF2α. This suggests a possible crosstalk between OTR and PG receptor signalling and highlights the importance of understanding G protein-coupled receptor interactions/crosstalk in the development of future tocolytics.
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24
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Ali AA, Sayed AK, El Sherif L, Loutfi GO, Ahmed AMM, Mohamed HB, Anwar AT, Taha AS, Yahia RM, Elgebaly A, Abdel-Daim MM. Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor. Int J Gynaecol Obstet 2019; 145:139-148. [PMID: 30784056 DOI: 10.1002/ijgo.12793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/11/2018] [Accepted: 02/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Two tocolytic drugs-atosiban and nifedipine-are currently used for first-line treatment of preterm labor (PTL). OBJECTIVE To compare the efficacy and safety of atosiban with nifedipine for PTL treatment. SEARCH STRATEGY In May 2017, we searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Clinical Trials with search terms including "nifedipine", "atosiban", and "preterm labor". SELECTION CRITERIA Randomized controlled trials of women with PTL. DATA COLLECTION AND ANALYSIS Data were extracted for study design, patient characteristics, risk of bias domains, and study outcomes. A random-effects model was used to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS We included seven studies that enrolled 992 patients. There was no significant difference between atosiban and nifedipine for pregnancy prolongation of 48 hours or more regarding efficacy (RR 1.06, 95% CI 0.92-1.22; P=0.440) or effectiveness (0.93, 0.84-1.03; P=0.177). Pregnancy prolongation for 7 days or more also did not differ between groups for efficacy (RR 1.04, 95% CI 0.89-1.21; P=0.656) or effectiveness (0.91, 0.79-1.05; P=0.177). Atosiban-however-was associated with fewer maternal side-effects than nifedipine. CONCLUSION Atosiban resulted in fewer maternal side-effects than nifedipine, with no difference in pregnancy prolongation. PROSPERO registration: CRD42018090223.
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Affiliation(s)
- Aya Ashraf Ali
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Ahmed Kamal Sayed
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Loalo'a El Sherif
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Gihan Ossam Loutfi
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Abdullah Mahmoud Mohamed Ahmed
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Hajer Bassem Mohamed
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Ahmad Tareq Anwar
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Abdullah Salah Taha
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Reem Mohamed Yahia
- Faculty of Medicine, Minia University, Minia, Egypt.,Minia Medical Research Society (MMRS), Minia University, Minia, Egypt
| | - Ahmed Elgebaly
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Medical Research Education and Practice Association (MREP), Cairo, Egypt
| | - Mohamed M Abdel-Daim
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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25
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Ng KKL, Rozen G, Stewart T, Agresta F, Polyakov A. Does nifedipine improve outcomes of embryo transfer?: Interim analysis of a randomized, double blinded, placebo-controlled trial. Medicine (Baltimore) 2019; 98:e14251. [PMID: 30681617 PMCID: PMC6358362 DOI: 10.1097/md.0000000000014251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UC) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatments. Various pharmacological agents, with the exception of calcium channel blockers, have been investigated to improve ET outcomes by reducing UC. Thus, a double-blinded randomized, placebo-controlled trial was conducted to determine whether nifedipine, a calcium channel blocker with potent smooth muscle relaxing activity and an excellent safety profile, can improve the outcome of patients undergoing ET treatments. METHODS Ninety-three infertile women were recruited into 1 of 2 groups: placebo (n = 47) or nifedipine 20 mg (n = 46). Study participants were admitted 30 minutes prior to ET and given either tablet after their baseline vital signs were recorded. They then underwent ET and were observed for adverse events for another 30 minutes post-ET. Follow up of the participants' outcomes was conducted via electronic medical records. The primary outcomes are implantation and clinical pregnancy rates. Secondary outcomes include any maternal or fetal adverse events, miscarriage, pregnancy, live births, and neonatal outcomes. Resulting data were then analyzed using t test, Pearson chi-square test, and Fisher exact test to compare outcomes between the 2 groups. RESULTS No statistical differences in the implantation rate (42.6% vs 39.1%, P = .737, rate ratio 0.868, 95% confidence interval [CI]: 0.379-1.986) and the clinical pregnancy rate (23.4% vs 26.1%, P = .764, rate ratio 1.155, 95% CI: 0.450-2.966) were detected between the placebo and the treatment groups. In addition, no statistical significance between the placebo and the treatment groups for any secondary outcomes were detected. CONCLUSIONS This double blinded, randomized, and placebo-controlled trial demonstrated that the single use of 20 mg nifedipine given 30 minutes before embryo transfer did not improve the implantation rate or the clinical pregnancy rate of the infertility treatment. Further studies are required to demonstrate the clinical benefits and risks of nifedipine usage in embryo transfer.
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Affiliation(s)
| | - Genia Rozen
- Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | | | - Franca Agresta
- Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Alex Polyakov
- Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
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Pinto Cardoso G, Houivet E, Marchand-Martin L, Kayem G, Sentilhes L, Ancel PY, Lorthe E, Marret S. Association of Intraventricular Hemorrhage and Death With Tocolytic Exposure in Preterm Infants. JAMA Netw Open 2018; 1:e182355. [PMID: 30646165 PMCID: PMC6324618 DOI: 10.1001/jamanetworkopen.2018.2355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE No trials to date have demonstrated the benefits of tocolysis on death and/or neonatal morbidity in preterm infants; tocolytics may affect the fetal blood-brain barrier. OBJECTIVES To assess the risks associated with tocolysis in women delivering prematurely as measured by death and/or intraventricular hemorrhage (IVH) in preterm infants and to compare the association of calcium channel blockers (CCBs) nifedipine and nicardipine hydrochloride vs atosiban used for tocolysis with death and/or IVH. DESIGN, SETTINGS, AND PARTICIPANTS The French 2011 EPIPAGE-2 (Enquête Épidémiologique sur les Petits Âges Gestationnels) cohort was limited to mothers admitted for preterm labor without fever, who delivered from 24 to 31 weeks of gestation from April 1 through December 31, 2011. Groups of preterm infants with vs without tocolytic exposure and groups with atosiban vs CCB exposure were compared. Data analysis was performed from June 7, 2014, through September 3, 2017. EXPOSURES Tocolytics. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death and/or IVH in preterm infants. Secondary outcomes included death, IVH, and a composite of death and/or grades III to IV IVH. RESULTS A total of 1127 mothers (mean [SD] age, 25.5 [6.0] years) experienced preterm labor and gave birth to 1343 preterm infants with a male to female ratio of 1.23 and mean (SD) gestational age of 27 (2.5) weeks. Of these, 789 mothers (70.0%) received tocolytics; 314 (39.8%) received only atosiban, and 118 (15.0%) received only a CCB. In the first analysis, the primary outcome (death and/or IVH) was not significantly different in preterm infants with vs without tocolytic exposure (183 of 363 [50.4%] vs 207 of 363 [57.0%]; relative risk [RR], 0.88; 95% CI, 0.77-1.01; P = .07). The secondary outcome (death and/or grades III-IV IVH) was significantly lower in preterm infants with vs without tocolytic exposure (92 of 363 [25.3%] vs 118 of 363 [32.5%]; RR, 0.78; 95% CI, 0.62-0.98; P = .03). Other outcomes did not differ significantly. In the secondary analysis, death and/or IVH was not significantly different in preterm infants with atosiban vs CCB exposure (96 of 214 [44.9%] vs 62 of 121 [51.2%]; RR, 0.88; 95% CI, 0.70-1.10; P = .26), nor was IVH (77 of 197 [39.1%] vs 48 of 106 [45.3%]; RR, 0.86; 95% CI, 0.66-1.13; P = .29). CONCLUSIONS AND RELEVANCE In this population-based study, findings suggest that tocolytics were associated with a reduction of death and severe IVH. Other studies are necessary to compare perinatal outcomes after use of atosiban vs CCBs.
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Affiliation(s)
- Gaëlle Pinto Cardoso
- Department of Neonatal Pediatrics and Intensive Care, Neuropediatrics and Rehabilitation Center, Reference Centre for Learning Disabilities of the Child, Rehabilitation Centre, Rouen University Hospital–Charles Nicolle Hospital, Rouen, France
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1245, NEOVASC Team, Research and Biomedical Innovation Institute, Rouen Medical School, Normandy University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Laetitia Marchand-Martin
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris Descartes University France, Département Hospitalo-Universitaire Risk in Pregnancy, Paris, France
- Unité de Recherche Clinique, Centre d’Investigation Clinique P1419, Cochin Hotel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Gilles Kayem
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris Descartes University France, Département Hospitalo-Universitaire Risk in Pregnancy, Paris, France
- Department of Obstetrics and Gynecology, Armand Trousseau Hospital, Paris, France
- Sorbonne Universités, Université Pierre and Marie Curie Paris 06, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Pierre-Yves Ancel
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris Descartes University France, Département Hospitalo-Universitaire Risk in Pregnancy, Paris, France
- Unité de Recherche Clinique, Centre d’Investigation Clinique P1419, Cochin Hotel-Dieu Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Elsa Lorthe
- INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris Descartes University France, Département Hospitalo-Universitaire Risk in Pregnancy, Paris, France
| | - Stéphane Marret
- Department of Neonatal Pediatrics and Intensive Care, Neuropediatrics and Rehabilitation Center, Reference Centre for Learning Disabilities of the Child, Rehabilitation Centre, Rouen University Hospital–Charles Nicolle Hospital, Rouen, France
- Institut National de la Santé et de la Recherche Medicale (INSERM) U1245, NEOVASC Team, Research and Biomedical Innovation Institute, Rouen Medical School, Normandy University, Rouen, France
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S-Nitrosoglutathione Reductase Underlies the Dysfunctional Relaxation to Nitric Oxide in Preterm Labor. Sci Rep 2018; 8:5614. [PMID: 29618799 PMCID: PMC5884813 DOI: 10.1038/s41598-018-23371-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/06/2018] [Indexed: 12/11/2022] Open
Abstract
Tocolytics show limited efficacy to prevent preterm delivery. In uterine smooth muscle cGMP accumulation following addition of nitric oxide (NO) has little effect on relaxation suggesting a role for protein S-nitrosation. In human myometrial tissues from women in labor at term (TL), or spontaneously in labor preterm (sPTL), direct stimulation of soluble guanylyl cyclase (sGC) fails to relax myometrium, while the same treatment relaxes vascular smooth muscle completely. Unlike term myometrium, effects of NO are not only blunted in sPTL, but global protein S-nitrosation is also diminished, suggesting a dysfunctional response to NO-mediated protein S-nitrosation. Examination of the enzymatic regulator of endogenous S-nitrosoglutathione availability, S-nitrosoglutathione reductase, reveals increased expression of the reductase in preterm myometrium associated with decreased total protein S-nitrosation. Blockade of S-nitrosoglutathione reductase relaxes sPTL tissue. Addition of NO donor to the actin motility assay attenuates force. Failure of sGC activation to mediate relaxation in sPTL tissues, together with the ability of NO to relax TL, but not sPTL myometrium, suggests a unique pathway for NO-mediated relaxation in myometrium. Our results suggest that examining the action of S-nitrosation on critical contraction associated proteins central to the regulation of uterine smooth muscle contraction can reveal new tocolytic targets.
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López Gómez L, Marín Gabriel MA, Encinas B, de la Cruz Troca JJ, Rodríguez Marrodán B. Oxytocin Receptor Antagonist (Atosiban) in the Threat of Preterm Birth: Does It Have Any Effect on Breastfeeding in the Term Newborn? Breastfeed Med 2018; 13:123-128. [PMID: 29356563 DOI: 10.1089/bfm.2017.0206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Oxytocin is a hormone involved in the mechanism of breastfeeding, uterine contractions, and social relationships. Atosiban (competitive oxytocin antagonist) is one of the most commonly used tocolytics for the threat of preterm labor in Europe. The aim of this study is to determinate if the administration of atosiban has any influence in the type of feeding in the term newborn at discharge. The secondary objective is to verify its effectiveness for the prevention of preterm delivery and in the possibility of applying treatment to complete lung maturation. MATERIALS AND METHODS Retrospective cohort study carried out in a tertiary University Hospital distinguished by WHO-UNICEF as a Baby-Friendly Hospital Initiative. The analysis included 264 women exposed to atosiban during a period of 4 years. One hundred met inclusion criteria. Unexposed infants born right after and before the exposed ones were selected as the not exposed subgroup (n = 200). RESULTS Among women treated with atosiban, 82% maintained exclusively breastfed (EBF), 8% had mixed breastfeeding, and 10% had formula feeding at discharge. In the nonexposed group, 82% maintained EBF, 9.5% had mixed breastfeeding, and 8.5% had formula feeding at discharge (p = 0.84). 97.5% of pregnant women treated with atosiban received corticosteroid for lung maturation, and 49.5% completed gestation with term newborns. CONCLUSION There were no significant differences in the type of feeding at discharge between the atosiban group and the nonexposed group. In most cases, the administration of tocolytic therapy allowed to complete lung maturation.
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Affiliation(s)
| | - Miguel A Marín Gabriel
- 2 Department of Neonatology, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain .,3 Department of Pediatrics, Autónoma University , Madrid, Spain
| | - Begoña Encinas
- 4 Department of Obstetrics, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
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29
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Ng KKL, Rozen G, Stewart T, Agresta F, Polyakov A. A double-blinded, randomized, placebo-controlled trial assessing the effects of nifedipine on embryo transfer: Study protocol. Medicine (Baltimore) 2017; 96:e9194. [PMID: 29390463 PMCID: PMC5758165 DOI: 10.1097/md.0000000000009194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UCs) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatment. Various pharmacological agents, with the exception of calcium channel blocker (CCB), have been investigated to reduce UC. In this regard, we are presenting a proposal for a double-blind randomized placebo-controlled trial. The trial aims to determine whether nifedipine, a CCB with potent smooth muscle relaxing activity and an excellent safety profile, can improve the outcome of ET. METHODS AND ANALYSES We will recruit 100 infertile women into one of 2 groups: placebo (n = 50) and nifedipine 20 mg (n = 50). Study participants will be admitted 30 minutes prior to ET and given either tablet after their baseline vital signs have been recorded. They will then undergo ET and be observed for adverse events for another 30 minutes post-ET. The primary outcome will be implantation rate and clinical pregnancy rate. Secondary outcomes include adverse events, miscarriage and pregnancy, and neonatal outcomes. Resulting data will then be analyzed using t test, Chi-square test, and multivariate test to compare outcomes between the 2 groups for any statistical significance. This protocol has been designed in accordance with the SPIRIT 2013 Guidelines.
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Affiliation(s)
- Kelvin KL Ng
- Melbourne Medical School, University of Melbourne
| | - Genia Rozen
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Tanya Stewart
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Franca Agresta
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
| | - Alex Polyakov
- Department of Reproductive Services, Royal Women's Hospital, Parkville
- Melbourne IVF, East Melbourne, Victoria, Australia
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Gyamfi-Bannerman C, Menon R, Bonney EA, Dolan SM, Johnson M, Lamont RF, Mesiano S, Murtha AP, Myatt L, Mysorekar I, Williams SM, Zhong N, Helmer H. Novel thoughts on preterm birth research proceedings of the 13th annual preterm birth international collaborative (PREBIC) meeting. Semin Perinatol 2017; 41:438-441. [PMID: 29074002 DOI: 10.1053/j.semperi.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology Columbia University Medical Center, New York, NY.
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Perinatal Research, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Elizabeth A Bonney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Siobhan M Dolan
- Division of Reproductive and Medical Genetics, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Mark Johnson
- Academic Obstetrics and Gynaecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Rd, London SW10 9NH, UK
| | - Ronald F Lamont
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK; Odense University Hospital, Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, Odense, Denmark
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH
| | - Amy P Murtha
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Duke University Medical Center, University of Alabama at Birmingham, Birmingham, AL
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Indira Mysorekar
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110; Pathology and Immunology, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Nanbert Zhong
- New York State Institute for Basic Research in Developmental disabilities, Staten Island, NY
| | - Hanns Helmer
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Austria
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Kim SH, Bennett PR, Terzidou V. Advances in the role of oxytocin receptors in human parturition. Mol Cell Endocrinol 2017; 449:56-63. [PMID: 28119132 DOI: 10.1016/j.mce.2017.01.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/16/2017] [Accepted: 01/21/2017] [Indexed: 12/26/2022]
Abstract
Oxytocin (OT) is a neurohypophysial hormone which has been found to play a central role in the regulation of human parturition. The most established role of oxytocin/oxytocin receptor (OT/OTR) system in human parturition is the initiation of uterine contractions, however, recent evidence have demonstrated that it may have a more complex role including initiation of inflammation, regulation of miRNA expression, as well as mediation of other non-classical oxytocin actions via receptor crosstalk with other G protein-coupled receptors (GPCRs). In this review we highlight both established and newly emerging roles of OT/OTR system in human parturition and discuss the expanding potential for OTRs as pharmacological targets in the management of preterm labour.
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Affiliation(s)
- Sung Hye Kim
- Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, East Acton, London W12 0NN, UK
| | - Phillip R Bennett
- Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, East Acton, London W12 0NN, UK
| | - Vasso Terzidou
- Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, Du Cane Road, East Acton, London W12 0NN, UK; Academic Department of Obstetrics & Gynaecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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