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Miscellaneous Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
In 2014, 3.99 million women delivered infants in the USA, of whom 9.61 percent were preterm (Hamilton et al., 2021). In 2020 during the COVID-19 pandemic, 3.61 million babies were delivered in the US. Approximately 10.1 percent of women delivered prematurely (Hamilton et al., 2021). No tocolytic agent is universally effective, although more than 100,000 pregnancies receive tocolysis therapy annually. Physicians do not universally accept efficacy of tocolytic agents. Gravidas treated with tocolytics are at increased risk for serious cardiopulmonary complications directly attributable to the tocolytic drug. Tocolytic therapy invariably occurs outside embryogenesis, therefore, risk of congenital anomalies is not an issue. With tocolysis, the primary concern is adverse maternal, fetal, and neonatal effects (Sanchez-Ramos et al., 2000). Three main indications for tocolysis in the treatment of preterm labor are (1) prophylaxis, (2) acute therapy, and (3) maintenance.
Placental Abruption
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Tocolytic use is generally discouraged due to maternal safety concerns. Multiple retrospective studies have evaluated tocolytic use (mostly magnesium sulfate) in the setting of placental abruption, without suggestion of increased maternal risk and possible pregnancy prolongation [79–82].
Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
Tocolysis for preterm labor may not be advisable in all cases. Pre-eclampsia may develop in up to 50% of cases, adding another factor to consider when defining the time of delivery. Again, delivery at a tertiary care center is recommended.
Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery
Published in Journal of Obstetrics and Gynaecology, 2023
Li-Rong Zhao, Shu-Jing Lu, Qing Liu, Ying-Chun Yu, Li Xiao
Liu et al. reported that both prophylactic cervical cerclage and therapeutic cervical cerclage distinctly extended the length of the pregnancy (Liu et al. 2018). Moreover, Li et al. concluded that cerclage placement could effectively reduce the incidence of preterm birth (Li et al. 2019). Vaginal cerclage can be used to treat cervical insufficiency. However, it can be ineffective in some cases (Joal et al. 2020). Tocolytic drugs are often used to postpone preterm delivery (Rovers et al. 2021). Both reasonable and in-time cervical cerclage and persistent uterine contraction inhibition are essential for effectively treating such patients. Therefore, we retrospectively analysed the medical data at our hospital and found that persistent uterine contraction inhibition after cervical cerclage could prolong gestational age. Cervical cerclage combined with persistent uterine contraction inhibition is an effective method for treating late pregnancy abortion and premature delivery caused by cervical insufficiency, and for prolonging the gestational age. This combined strategy of pregnancy management can reduce the number of preterm deliveries (Barinov et al. 2021).
Ovarian cysts in pregnancy: a narrative review
Published in Journal of Obstetrics and Gynaecology, 2021
Sachintha Senarath, Alex Ades, Pavitra Nanayakkara
Any surgery during a pregnancy warrants consideration of the wellbeing of the fetal. Preoperative, intraoperative and postoperative fetal monitoring is recommended in abdominal surgery in a mother with a viable foetus (Pearl et al. 2017). Prior to 26 weeks of gestation, Doppler auscultation is adequate, however, after 26 weeks a cardiotocograph is usually performed but this is centre-dependent. Although this has not been found to improve mortality, it does allow for early identification of fetal problems (Juhasz-Böss et al. 2014). Tocolytics should not be used prophylactically in pregnant women undergoing surgery but should be considered perioperatively when signs of preterm labour are present or other risk factors for this exist (Pearl et al. 2017). Furthermore, antibiotics should be prescribed as for non-pregnant patients with the exception of teratogenic agents. Maternal corticosteroids for fetal lung maturation for surgery between 24 to 34 weeks should be provided if time permitting (Juhasz-Böss et al. 2014; Naqvi and Kaimal 2015).
Formulation, development, and in-vitro/ex-vivo evaluation of vaginal bioadhesive salbutamol sulfate tablets for preterm labor
Published in Pharmaceutical Development and Technology, 2020
Amal S. M. Abu El-Enin, Asmaa M. Elbakry, Rania El Hosary, Marwa Ahmed Fouad Lotfy
Africa showed minimal progress to overcome this problem. Egypt is ranked 144 amongst 162 countries with prematurity-related deaths comprising about 28.5% of all under-5 deaths in Egypt (Liu et al. 2012; Lawn et al. 2013). Tocolytic drugs function by prolonging pregnancy in case of preterm labor, allowing the fetus to be more mature in the uterus before being born (Roberts et al. 2017). β2 agonists as salbutamol sulfate and terbutaline sulfate have been used for the treatment of preterm labor in hospitals since 1980. They are given as intravenous infusion then treatment maintained via oral tablets. Parenteral and oral salbutamol may cause some side effects, such as tachycardia, anxiety, and chill. It has also a short half-life 4–6 h (Zulfiqar and Iftikhar 2016). It suffers from first-pass effect in the liver and gut wall. Salbutamol sulfate is a class I drug according to biopharmaceutical classification, it is a highly water-soluble drug with a pKa of 9.2 and a log p value of 0.11 (Prasanth et al. 2011).