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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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Sebastian E, Bykersma C, Eggleston A, Eddy KE, Chim ST, Zahroh RI, Scott N, Chou D, Oladapo OT, Vogel JP. Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review. EClinicalMedicine 2022; 49:101496. [PMID: 35747187 PMCID: PMC9167884 DOI: 10.1016/j.eclinm.2022.101496] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Preterm birth is a leading cause of neonatal mortality and morbidity, and imposes high health and societal costs. Antenatal corticosteroids (ACS) to accelerate fetal lung maturation are commonly used in conjunction with tocolytics for arresting preterm labour in women at risk of imminent preterm birth. METHODS We conducted a systematic review on the cost-effectiveness of ACS and/or tocolytics as part of preterm birth management. We systematically searched MEDLINE and Embase (December 2021), as well as a maternal health economic evidence repository collated from NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo, with no date cutoff. Eligible studies were economic evaluations of ACS and/or tocolytics for preterm birth. Two reviewers independently screened citations, extracted data on cost-effectiveness and assessed study quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. FINDINGS 35 studies were included: 11 studies on ACS, eight on tocolytics to facilitate ACS administration, 12 on acute and maintenance tocolysis, and four studies on a combination of ACS and tocolytics. ACS was cost-effective prior to 34 weeks' gestation, but economic evidence on ACS use at 34-<37 weeks was conflicting. No single tocolytic was identified as the most cost-effective. Studies disagreed on whether ACS and tocolytic in combination were cost-saving when compared to no intervention. INTERPRETATION ACS use prior to 34 weeks' gestation appears cost-effective. Further studies are required to identify what (if any) tocolytic option is most cost-effective for facilitating ACS administration, and the economic consequences of ACS use in the late preterm period. FUNDING UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by WHO.
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Affiliation(s)
- Elizabeth Sebastian
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Chloe Bykersma
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alexander Eggleston
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Katherine E. Eddy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Sher Ting Chim
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rana Islamiah Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author at: Burnet Institute, Melbourne, Australia.
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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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Lamont CD, Jørgensen JS, Lamont RF. The safety of tocolytics used for the inhibition of preterm labour. Expert Opin Drug Saf 2016; 15:1163-73. [DOI: 10.1080/14740338.2016.1187128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Callum D. Lamont
- Department of Medical Education, Lincoln County Hospital, Lincoln, UK
| | - Jan Stener Jørgensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Ronald F. Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
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Haram K, Mortensen JHS, Morrison JC. Tocolysis for acute preterm labor: does anything work. J Matern Fetal Neonatal Med 2014; 28:371-8. [DOI: 10.3109/14767058.2014.918095] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Driul L, Londero AP, Adorati-Menegato A, Vogrig E, Bertozzi S, Fachechi G, Forzano L, Cacciaguerra G, Perin E, Miceli A, Marchesoni D. Therapy side-effects and predictive factors for preterm delivery in patients undergoing tocolysis with atosiban or ritodrine for threatened preterm labour. J OBSTET GYNAECOL 2014; 34:684-9. [DOI: 10.3109/01443615.2014.930094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Saleh SS, Al-Ramahi MQ, Al Kazaleh FA. Atosiban and nifedipine in the suppression of pre-term labour: a comparative study. J OBSTET GYNAECOL 2014; 33:43-5. [PMID: 23259877 DOI: 10.3109/01443615.2012.721822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This is a retrospective study comparing the efficacy and safety of atosiban and nifedipine in the suppression of pre-term labour. A total of 75 patients were included in this study; 34 received atosiban and 41 received nifedipine. There were no statistically significant differences in the baseline characteristics for both groups. A total of 68.3% of women in the atosiban group remained undelivered at 7 days or more, compared with 64.7% in the nifedipine group, which was not statistically significant. Average birth weight, admission to the neonatal intensive care unit and mode of delivery were similar in both groups. However, the gestational age at delivery was significantly higher in the nifedipine group. We concluded that atosiban and nifedipine are effective in delaying delivery for 7 days or more in women presenting with pre-term labour. They have the same efficacy and associated minor side-effects. However, flushing, palpitation and hypotension were significantly higher in the nifedipine group.
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Affiliation(s)
- S S Saleh
- Department of Obstetrics and Gynaecology, Jordan University Hospital, Amman, Jordan.
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9
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Prevention of preterm labour: 2011 update on tocolysis. J Pregnancy 2011; 2011:941057. [PMID: 22175022 PMCID: PMC3228310 DOI: 10.1155/2011/941057] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 09/27/2011] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper is to review available data about drugs for preventing preterm labour. Tocolytic therapy includes β adrenergic receptor agonists, NO donors, magnesium sulphate, prostaglandin-synthase inhibitors, oxytocin receptor antagonists, calcium-channel blockers, progesterone, 17-α-hydroxyprogesterone caproate, and antibiotics. Their specific effects on myometrial contractility, their safety, their efficiency, and side effects profile for the mother and the fetus are presented. The main question of why and for what reasons tocolysis should be administrated is discussed.
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Wex J, Abou-Setta AM, Clerici G, Di Renzo GC. Atosiban versus betamimetics in the treatment of preterm labour in Italy: clinical and economic importance of side-effects. Eur J Obstet Gynecol Reprod Biol 2011; 157:128-35. [DOI: 10.1016/j.ejogrb.2011.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/09/2011] [Accepted: 04/14/2011] [Indexed: 11/29/2022]
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Abstract
PURPOSE Animal models have confirmed high efficiency of combined tocolytic treatment in preterm labour. In humans, the recommended doses of tocolytic drugs prolong pregnancy in threatened preterm labour. The aim of the study was to evaluate the inhibitory effect of dual combinations of atosiban, nifedipine and celecoxib on human myometrial strips contractility on the in vitro model of preterm labour. MATERIAL/METHODS Two groups of patients who delivered by cesarean section were involved in the study: 36 patients who delivered preterm between the 24(th) and 34(th) week of pregnancy and 40 patients who delivered at term. Myometrial samples were obtained from the lower uterine segment during cesarean sections. Contractile activity was recorded with digital software for each drug combination: atosiban/nifedipine; atosiban/celecoxib, nifedipine/celecoxib. Tocolytic efficiency of the drug combinations was assessed using IC(50) parameter - a molar drug concentration inhibiting 50% of contractility. RESULTS The atosiban/nifedipine combination has shown additive tocolytic effect on myometrial strips contractility in preterm and term patients. The other combinations: atosiban/celecoxib and nifedipine/celecoxib presented only antagonistic effects in both studied groups. CONCLUSIONS The effect of the combined therapy on human myometrial contractility presented in the study could be a base for further in vivo clinical trials.
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The influence of tocolytic drugs on cardiac function, large arteries, and resistance vessels. Eur J Clin Pharmacol 2011; 67:573-80. [DOI: 10.1007/s00228-011-1040-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/18/2011] [Indexed: 10/18/2022]
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Fullerton GM, Black M, Shetty A, Bhattacharya S. Atosiban in the Management of Preterm Labour. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2011. [DOI: 10.4137/cmwh.s5125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this review was to look at the evidence available for the use of atosiban as a tocolytic in cases of threatened preterm labour. A Royal College of Obstetricians and Gynaecologists Green Top Guideline concluded that there was no clear evidence to show a benefit to tocolysis in reducing perinatal and neonatal morbidity and mortality. Using a systematic literature search, we summarise the evidence available on the use of atosiban for the prevention of preterm birth and compare it with other commonly used tocolytic agents in terms of efficacy, patient preference and drug safety. We conclude that although atosiban appears to be the tocolytic of choice, a clear benefit of using tocolysis in all cases of threatened preterm labour remains to be justified and clinical management should be tailored according to individual needs.
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Affiliation(s)
- Gail M Fullerton
- Obstetrics & Gynaecology, Division of Applied Health Sciences, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Mairead Black
- Obstetrics & Gynaecology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, UK
| | - Ashalatha Shetty
- Obstetrics & Gynaecology, Division of Applied Health Sciences, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Sohinee Bhattacharya
- Obstetric Epidemiology, University of Aberdeen, King's College, Aberdeen, AB24 3FX, UK
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Abstract
The current article covers some of the major themes that emerged in 2009 in the fields of obstetric anesthesiology, obstetrics, and perinatology, with a special emphasis on the implications for the obstetric anesthesiologist.
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Affiliation(s)
- J M Mhyre
- Department of Anesthesia, Division of Obstetric Anesthesia, Women's Hospital, University of Michigan Health System, Ann Arbor, MI 48109-5278, USA.
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Different effects of tocolytic medication on blood pressure and blood pressure amplification. Eur J Clin Pharmacol 2010; 67:11-7. [PMID: 21079937 DOI: 10.1007/s00228-010-0926-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The importance of tocolysis has been discussed extensively. Beta-2 adrenoceptor agonistic drugs like ritodrine have been the reference tocolytic drugs in most countries. Cardiovascular side-effects are frequent. Atosiban, a newer tocolytic drug, is a competitive antagonist of oxytocin and has fewer cardiovascular side effects. Although large studies exist, there is mainly subjective reporting of adverse reactions with a focus on blood pressure data. OBJECTIVES Evaluation of the acute effects of therapeutic doses of ritodrine and atosiban in comparison to placebo on central and peripheral blood pressures, central-to-peripheral blood pressure amplification and the augmentation index (AIx) in healthy non-pregnant female volunteers. METHODS A double-blind, randomized, crossover trial was carried out in 20 healthy non-pregnant female volunteers. Hemodynamic measurements were performed under standardized conditions. RESULTS At steady state, central and peripheral pressures did not differ from placebo in the atosiban group. During ritodrine -infusion, central SBP increased by 11% versus placebo (p = 0.012) and peripheral SBP by 10% (p = 0.004). In contrast to atosiban and placebo, blood pressure amplification was absent in the ritodrine group. While the AIx did not change in the atosiban group, with ritodrine, the AIx tended to decrease. CONCLUSIONS The present study shows the significant effects of ritodrine on the cardiovascular system. Atosiban has no significant effects and may be an appropriate alternative to tocolyticum, particularly in cardiovascularly complicated pregnancies.
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