No abstract available.
Female ; Obstetric Labor, Premature* ; Pregnancy ; Ritodrine* ; Tocolytic Agents*

We describe a case of diamniotic dichorionic pregnancy at 23 weeks and 6 days of gestation with threatened preterm labor with rupture of membrane of twin one. After 10 days we delivered the first twin. We decided to retain the other one to allow improvement in the outcome for the second twin. The patient was treated with tocolytics, antibiotics, cervical cerclage, steroid and continously monitored. After 58 daysthere was increasing uterine contractility and we delivered the second twin.
Anti-Bacterial Agents ; Cerclage, Cervical ; Female ; Humans ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy, Multiple ; Rupture ; Tocolytic Agents ; Twins*

Premature labor remains one of the most intractable risk factors that contribute to perinatal morbidity and mortality. Tocolytics, antibiotics and corticosteroid have been used as the typical management for preterm labor. Various treatment of women with signs and symptoms of preterm labor has failed to decrease in the incidence of preterm births in the world. The management of preterm labor remains very controversial problems today. There are no clear "first-line" tocolytic drugs and antibiotics to prolong gestation period and improve perinatal outcome. But in Royal College of Obstetricians and gynecologists (RCOG) recommend that atosiban and nifedipine appear to be preferable as they have fewer side effects and seem to comparable effectiveness. So far there is insufficient evidence for any firm conclusions about whether or not maintenance tocolytic therapy following preterm labor is valuable. In conclusion, clinical circumstances and physician preferences should dictate treatment. Individual approach or combined treatment for preterm labor may be helpful in determining which treatment is suitable to each patient.
Anti-Bacterial Agents ; Female ; Humans ; Incidence ; Mortality ; Nifedipine ; Obstetric Labor, Premature* ; Pregnancy ; Premature Birth ; Risk Factors ; Tocolysis ; Tocolytic Agents

Morphine is known to inhibit nocturnal uterine contractions in several animal models, and oxytocin is known to be a primary causative factor of uterine contractions. The purpose of the present study was to determine the tocolytic effect of morphine in relation to the pharmacokinetics of oxytocin, after a bolus injection of oxytocin. The metabolism of oxytocin was investigated during the third trimester in baboons. Four animals were placed on a tether system with venous and arterial access, including continuous uterine monitoring. Plasma oxytocin levels were determined by radioimmunoassay after extraction with petroleum ether/acetone. Morphine consistently increased the metabolic clearance rate of oxytocin in all four animals (p < 0.05) and this was in accordance with suppressed uterine contractions. We conclude that morphine could be used as an inhibitor of nocturnal uterine contractions, and that this is caused by the morphine induced increased metabolic clearance rate of oxytocin.
Animal ; Female ; Metabolic Clearance Rate ; Morphine/*pharmacology ; Oxytocin/*pharmacokinetics ; Papio ; Pregnancy ; Tocolytic Agents/*pharmacology ; Uterine Contraction/drug effects

OBJECTIVE: The purpose of our study is to investigate the feasibility of the laparoscopy and compare perioperative outcomes between laparoscopy and laparotomy in pregnant women with non-malignant ovarian tumor. METHODS: Retrospective comparative analysis of 56 pregnant women who underwent laparoscopy or laparotomy due to non-malignant ovarian tumors at Samsung Medical Center, Seoul, Korea, between October 1994 and December 2010 were performed. RESULTS: Among 56 patients, 22 and 34 pregnant women underwent laparotomy and laparoscopy, respectively. There were no statistically significant differences between the two groups about general characteristics including age, gestational age, torsion, surgeon type, pain at diagnosis and clinical outcomes including tocolytics use, operation type, operation time, the ratio of normal full-term vaginal delivery, Apgar score. However, pathological longest tumor size was larger in laparotomy group than laparoscopy group (9.0 cm vs. 5.8 cm; p=0.001) and laparoscopy was related with significantly less estimated blood loss (200 vs. 50 mL; p=0.001) and short hospital days (7 vs. 4 days; p<0.001). CONCLUSION: Laparoscopy for the treatment of non-malignant ovarian tumors in pregnant women is feasible and has benefits such as less estimated blood loss during the surgery and hospital stays when compared with laparotomy. However, laparoscopic adnexal surgery for large tumor size may be still challenging in pregnant women.
Apgar Score ; Female ; Gestational Age ; Humans ; Korea ; Laparoscopy ; Laparotomy ; Length of Stay ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Tocolytic Agents

BACKGROUND: Preterm birth is a major cause of perinatal morbidity and mortality. Tocolytic drugs are used to suppress uterine contractions. The most widely used tocolytics in the Philippines are betamimetics, such as Terbutaline, which are known to have high incidence of maternal adverse effects. Nifedipine, a calcium channel blocker, is an alternative tocolytic with potentially similar efficacy and fewer maternal side effects than terbutaline.
CONCLUSION: Terbutaline and Nifedipine appeared to be equally effective tocolytic agents. However, nifedipine had tile advantage of lesser incidence of maternal adverse effects.

Human ; Tocolytic Agents ; Nifedipine ; Terbutaline ; Calcium Channel Blockers ; Uterine Contraction ; Adrenergic Beta-agonists ; Maternal Inheritance ; Iatrogenic Disease

BACKGROUND: The consequences of preterm birth not only for the baby but also for the mother has been well documented over the years. Numerous interventions have been tried and tested and yet it is still a significant problem to date. Progesterone has been documented to be an effective prophylactic drug against preterm labor for those considered at high risk for developing the condition. However, little is known its effectiveness when given in oral form as a maintenance tocolysis for those who already suffered from an acute episode or preterm labor.
OBJECTIVE:To evaluate the effectiveness of oral progesterone in the prevention of preterm birth after being diagnosed of preterm labor
DESIGN: Meta-analysis
SUBJECTS: The study population consisted of women with singleton gestation who were diagnosed with preterm labor, defined as having contractions associated with corresponding cervical dilatation, which were treated with oral progesterone as a maintenance tocolytic until delivery.
DATA COLLECTION: Journals were searched in different journal databases. Reviewers independently assessed the eligibility of the articles included in this study. Methodologic quality was reviewed using the Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). Data extracted were analysed using the Review Manager 5.3 Software (Revman 2014) and the Comprehensive Meta-Analysis Software (CMA3 2016).
RESULTS: No statistical difference was noted in terms of latency prolongation, gestational age at birth, occurrence of preterm birth, and on neonatal outcomes such as APGAR Score < 7 at birth, neonatal death between those who received progesterone and those who did not. However, babies in the progesterone group had a mean birthweight higher than their placebo counterparts.
CONCLUSION: The use of oral progesterone as a maintenance tocolysis after arrested preterm labor showed no statistically significant benefit except for higher birthweight in babies upon delivery.

Human ; Female ; Tocolysis ; Tocolytic Agents ; Gestational Age ; Premature Birth ; Progesterone ; Perinatal Death ; Obstetric Labor, Premature ; Birth Weight ; Delivery, Obstetric

OBJECTIVE: To determine the risk of postpartum hemorrhage among patients who were treated with nifedipine for tocolysis of preterm labor.

METHODS: A prospective cohort study was conducted with 66 pregnant women admitted for preterm labor. One group of women was given nifedipine to give time for the administration of corticosteroids for fetal lung maturity and/or control of preterm labor and another group was not given nifedipine as they were admitted in advanced stage of labor (ie, more than or equal to 4 cm cervical dilatation). Independent/paired sample t-test, Mann-Whitney U/Wilcoxon signed rank test, and Fisher's exact test were used to determine the difference of mean, median, and frequency between and within groups, respectively. STATA 12.0 was used for data analysis.

RESULTS: There was more blood loss during delivery, which was statistically significant, among those who received nifedipine compared to those who have not taken the medicine (350 mL versus 250 mL, p = 0.021). Furthermore, the decreases in hemoglobin and hematocrit were also lower among those who did not receive nifedipine compared to those who received nifedipine for tocolysis (8.5 mg/dL versus 16.0 mg/dL, p = 0.014 and 0.03 versus 0.05, p = 0.010), again, statistically significant.

CONCLUSION: Nifedipine used as tocolytic appear to increase blood loss during delivery, which was statistically significant. Greater amount of blood loss may be anticipated among those with nifedipine intake thus helping the obstetrician in preparing for active management of postpartum hemorrhage and preventing maternal morbidity and mortality.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Nifedipine ; Obstetric Labor, Premature ; Postpartum Hemorrhage ; Tocolytic Agents ; Nifedipine-adverse Effects

BACKGROUND: Nonobstertic surgery during pregnancy needs special considerations by the surgeon in relation to the maternal and the fetal outcomes. Although there are many studies about appendicitis in pregnant women, nonobstetric surgery, in general, during pregnancy has not been sufficiently analyzed. In this clinical study, we reviewed the incidences of nonobstetric surgical diseases during pregnancy and observed the maternal and the fetal outcomes of surgery, including the effects of anesthesia and antibiotics. METHODS: We retrospectively analyzed 80 patients who were pregnant at the time of operation and who had undergone operations during an 11-year period from March 1986 to April 1997 at Shinchon- and Inchon-Severance Hospital. The distributions of age, disease, and delivery history were analyzed, and the diagnostic characteristics, and the fetal and the maternal outcomes were observed with respect to anesthesia and antibiotic usage. RESULTS: The average age of the patients was 32, and 53% of the patients were over 30. The numbers of patients in the first, the second, and the third trimester were 24 (30%), 36 (45%) and 20 (25%), respectively. The most frequent surgical disease was appendicitis with 52 patients (65%). The average duration of hospitalization was 14.4 days. Twenty-two patients (27.5%) had postoperative preterm labor and were successfully managed with tocolytic agents except for one preterm delivery. The total number of preterm deliveries was 10 (12.5%), and still birth occurred in 3 cases (3.8%). The cases of still birth involved severe original diseases, such as rectal carcinomas, pancreatic carcinomas, and sepsis. Among the antibiotics that were used during surgical care, monotherapy with ampicillin was the most frequently used mode. The incidence frequencies of delivery complications according to the used antibiotics were not significantly different from each other. General endotracheal anesthesia was used in 40 cases, spinal and epidural anesthesia was inducted in 25 and 13 cases, respectively. The incidences of fetal complications according to the methods of was administering anesthesia were not significantly different. CONCLUSIONS: The maternal and the fetal risks of nonobstetric surgery during pregnancy depend on the risk of the original surgical disease of the patient. Modes of anesthesia or antibiotic usage do not increase the incidences of obstetric complications.
Ampicillin ; Anesthesia ; Anesthesia, Epidural ; Anti-Bacterial Agents ; Appendicitis ; Female ; Hospitalization ; Humans ; Incidence ; Obstetric Labor, Premature ; Parturition ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; Sepsis ; Tocolytic Agents

Preterm delivery is defined as delivering a fetus or fetuses before 37th gestational week. The incidence of preterm delivery has been reported to be 8-10% but is associated with 75% of perinatal mortality and morbidity, and long term sequelae such as cerebral palsy. The rates of preterm deliveries have actually increased in recent years for complex reasons despite widespread efforts to address the problem. A major drawback for the development of beneficial interventions of preterm delivery is the poor understanding of the normal physiology of human parturition. However, research efforts to elucidate this problem have risen substantially over the past decades, and there have been great advances in the understanding of the molecular and cellular pathways. This understanding has led to the development of several therapeutic strategies in terms of delaying the delivery and reducing the perinatal complications. Thus, we will discuss on the recent developments in therapeutic strategies in preterm labor and preterm premature rupture of membranes including antibiotics treatment, antenatal corticosteroid therapy and various tocolytic agents.
Anti-Bacterial Agents ; Cerebral Palsy ; Female ; Fetus ; Humans ; Incidence ; Membranes ; Obstetric Labor, Premature ; Parturition ; Perinatal Mortality ; Physiology ; Pregnancy ; Rupture ; Tocolytic Agents