No abstract available.
C-Reactive Protein* ; Tocolysis*

A clinical trial was performed to evaluate the tocolytic possibility of nifedipin and to propose a treatment regimen for preterm labor in the National Hospital of Gynecol-Obstet from July 2003 to December 2003. There were 40 cases of preterm labor with gestational age 31 weeks and 3 uterine contractions per minute on average. Patients received a 10 mg sublingual loading dose every 20 minutes (maximum dose 40mg), and followed by 20 mg oral dose every 6- 8 hours. Result: the effectiveness in tocolysis of nifedipin is very fast. It took 60-80 minutes to arrest uterine contraction (70- 80%) (including contractions of high frequency and intensity), especially in urgent tocolysis. The lower the frequency and intensity is, the higher and sooner the effectiveness is. 92.5% of delivery were delayed for 48 hours. 82.85% were postponed until 36 weeks, and the mean time of prolonged pregnacy was 39 days. Side-effects were mild and transient and in normotensive pregnant women blood pressure was almost unaffected. This treatment regimen of nifedipin showed the effectiveness in preterm labor. In brief, nifedipin is an effective, safe, convenient and economic tocolytic agent. It may well represent the best suitable tocolytic alternative currently available and can be used widely in Viet Nam.
Obstetric Labor, Premature, Nifedipine, Tocolysis

No abstract available.
Blood Glucose* ; Glucose* ; Humans ; Infant, Newborn* ; Insulin* ; Tocolysis*

No abstract available.
C-Reactive Protein* ; Female ; Obstetric Labor, Premature* ; Pregnancy ; Tocolysis*

OBJECTIVE: This study was conducted to compare the efficacy and safety of oral nicardipine in acute therapy for preterm labor with those of parenteral ritodrine hydrochloride. METHODS: Patients between 24 and 34 weeks' gestation with documented preterm labor were randomly assigned to receive oral nicardipine (n=31) or intravenous ritodrine (n=32) as initial tocolytic therapy. Patients in the nicardipine group received a 40-mg loading dose and then 20 mg every 2 hours as needed to stop contractions (total 80 mg). Patients in the ritodrine group received a 0.05 mg/min as initial dose. The dose was increased at 15-minute intervals until uterine contractions were inhibited or side effects became intolerable. The maximum recommended dose was 0.35 mg/min. Patients could be switched to another tocolytic regimen if they continued to have contractions after 6 hours of therapy. The main outcome variables examined were failure of tocolysis, time to uterine contractions equal or less than 5 times per hour, time to uterine quiescence, time gained in utero, and frequency of adverse medication effects. RESULTS: There were no significant differences in maternal demographic characteristics between the groups. Successful tocolysis, defined as cessation of uterine contractons less than 6 hours from initial dose, was observed in 58.1% in the nicardipine group and 65.6% in the ritodrine group (P=.544). Among patients with successful tocolysis who responded with uterine quiescence within 6 hours, there was no significant difference in the time to uterine quiescence in the ritodrine group (P=.087). Time to uterine contractions equal or less than 5 times per hour from initial treatment showed no significant difference between the two groups with successful tocolysis (P=.097). The patients in the ritodrine hydrochloride group had more adverse side effects, mainly maternal tachycardia (P=.013) and nausea and/or vomiting (P=.006). CONCLUSION: Oral nicardipine was effective, safe, and well-tolerated tocolytic agent. Patients who received ritodrine hydrochloride were more likely to have adverse medication effects.
Female ; Humans ; Nausea ; Nicardipine* ; Obstetric Labor, Premature* ; Pregnancy ; Ritodrine* ; Tachycardia ; Tocolysis ; Uterine Contraction ; Vomiting

Preterm birth (PTB) remains a major cause of neonatal mortality and morbidity, despite improvements in tocolytic treatment and neonatal care. Progesterone (17a-hydroxyprogesterone) produced naturally or synthetically can prevent PTB when applied vaginally and orally. Progesterone use may be a safe and cost-effective option in cases of singleton pregnancy with prior PTB, asymptomatically short cervix and arrested preterm labor.
Cervix Uteri ; Female ; Humans ; Infant ; Infant Mortality ; Obstetric Labor, Premature ; Pregnancy ; Premature Birth ; Progesterone ; Tocolysis

OBJECTIVES: The aim of this study was to compare the efficacy and safety of magnesium sulfate, ritodrine hydrochloride and nifedipine in the management of preterm labor. MATERIALS AND METHODS: 180 women with documented preterm labor were randomly assigned to receive magnesium sulfate (n=60), ritodrine hydrochloride (n=60) and nifedipine (n=60) as initial tocolytic therapy. 30 women with documented preterm labor were allocated to administer fluid only and bed rest as control group. Patient could be switched to another tocolytic regimen if they continued to have contractions or side effects. The main outcome variables examined were days gain in utero, success rate, side effects and neonatal outcome. RESULTS: There were no significant differences in maternal characteristics between the groups. The days gain in utero was no statistically different in the three groups(magnesium sulfate, ritodrine hydrochloride and nifedipine) but markedly longer in the three groups than the control group (p<.01). The total success rate was similar in the three groups, but side effects were much more in the magnesium sulfate and ritodrine group than the nifedipine group (p<.05). The respiratory distress syndrome in neonate was decreased in the three groups than the control group without statistical significance. CONCLUSION: Nifedipine is an effective, safe, and well-tolerated tocolytic agent. In this retrospective study, total success rate of controlling preterm labor was similar in the three groups, but patients who received nifedipine were less side effects than magnesium sulfate or ritodrine group.
Bed Rest ; Female ; Humans ; Infant, Newborn ; Magnesium Sulfate ; Magnesium* ; Nifedipine ; Obstetric Labor, Premature* ; Pregnancy ; Retrospective Studies ; Ritodrine* ; Tocolysis

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

OBJECTIVE: This study is performed to assess whether detection of phosphorylated insulin like growth factor binding protein-1 (phIGFBP-1) in cervical secretions by a bed side test could be used to prediction preterm delivery in patient with regular uterine contraction. METHODS: In our prospective study, 42 women between 20.2 and 36.4 weeks gestation with regular, persistent contraction (2-3/min for 30 min). and 27 women between 22.0 and 37.0 weeks of gestation without symptoms of preterm labor were assessed for presence of cervical phIGFBP-1. Dacron swabs were applied to the cervix and assayed in 5min by using immunochromatography, actim partus test (Medix Biochemica). RESULTS: Of the 42 patients with regular uterine contractions, 22 had a positive actim partus test and 20 had a negative test. Among the 22 patients with positive test, 5 delivered preterm and other 17 patients delivered term (<37 weeks). Among the the 20 women with a negative test, 2 delivered preterm (NS). The mean concentration of phIGFBP-1 in 22 positive patients is 83.8+/-86.5 microgram/L and that in 20 negative patients is 2.1+/-5.0 microgram/L (P<0.0001) (Table 4). Sensitivity, specificity, false positive, false negative, positive predictive, and negative predictive values were 18.5, 59.6, 40.3, 28.6, 16.7, and 94.9%, respectively. CONCLUSION: The absence of cervical phIGFBP-1 is seems to be a valuable test in excluding preterm delivery in patients who have regular uterine contractions. The high negative predictive value in this study may enable physicians to prevent over treatment of patients with uterine contractions. Therefore, many unwanted side-effects and complications of potentially hazardous tocolytic therapy can be prevented.
Cervix Uteri ; Female ; Humans ; Immunochromatography ; Insulin ; Obstetric Labor, Premature ; Polyethylene Terephthalates ; Pregnancy ; Prospective Studies ; Sensitivity and Specificity ; Tocolysis ; Uterine Contraction

The incidence of multifetal pregnancies has significantly increased because of progress of assisted reproductive technologies. Preterm delivery is the most common and significant obstetrical problem in multifetal pregnancies. When the first twin of mutifetal pregnancy is prematurely delivered at previable gestational age, the success of delayed interval delivery of the second twin can improve the neonatal outcome for the remaining fetus. The optimal management of delayed interval delivery is not defined. Tocolysis, prophylactic antibiotics, and cervical cerclage are generally used. I present a case of delayed interval delivery in twin pregnancy with an interval of 89 days. The first twin was delivered at 21.3 weeks of gestation and delayed delivery of the second twin was succeeded by conservative treatment without cervical cerclage. This case is the longest interval case in Korea.
Anti-Bacterial Agents ; Cerclage, Cervical ; Fetus ; Gestational Age ; Humans ; Incidence ; Korea ; Pregnancy ; Pregnancy, Twin ; Reproductive Techniques, Assisted ; Tocolysis