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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].
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Tocolytic agents have been used to decrease uterine activity when preterm labour is likely. Various drugs have been used, including beta-mimetics [31], calcium channel blockers [32] and magnesium sulphate [33]. Beta-mimetics (such as ritrodrine) are effective in prolonging pregnancy for up to 48 hours but not longer [31]; this intervention may be beneficial to allow time for postnatal glucocorticoids to have effect [7] or to allow transfer to a tertiary perinatal centre for delivery. Calcium channel blockers appear to be more effective than beta-mimetics and they are effective in combination with prenatal glucocorticoids in reducing RDS (RR 0.63; 95% Cl 0.46–0.88) [32]. Magnesium sulphate, however is ineffective and also has the adverse effect of increased neonatal and paediatric mortality [33].
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).
The evaluation of maternal systemic thiol/disulphide homeostasis for the short-term prediction of preterm birth in women with threatened preterm labour: a pilot study
Published in Journal of Obstetrics and Gynaecology, 2022
Orkun Cetin, Erbil Karaman, Murat Alisik, Ozcan Erel, Ali Kolusari, Hanım Guler Sahin
All patients were managed at hospital and recommended bed rest. First, they treated with hydration. Tocolytic therapy was started after persistent uterine contractions or progressive shortening of cervix at least 2 h of intravenous hydration. Our clinic’s tocolitic protocol started after first step (nifedipine [10–30 mg oral daily] and 17-alpha-hydroxyprogesterone caproate [17OHP-C, 250 mg, i.m] once a week until 36 gestational weeks or until preterm delivery. Intramuscular betamethasone [two 12 mg at 24 h intervals] was performed to the patients for foetal lung maturity.) Foetal surveillance was followed by foetal movement count and non-stress test daily. Tocolytic therapy was stopped 48 h after the first dose of corticosteroids. Tocolysis and antenatal corticosteroid treatment were used untill 34 weeks of pregnancy. Route and timing of delivery was planned on a case-by-case basis, and caesarean operation was made only for obstetric indication.
Myomectomy during pregnancy; diagnostical dilemmas: two case reports and a systematic review of the literature
Published in Journal of Obstetrics and Gynaecology, 2022
Michail Diakosavvas, Kyveli Angelou, Zacharias Fasoulakis, Nikolaos Kathopoulis, Dimitris Zacharakis, Nikolaos Blontzos, Panos Antsaklis, Dimitrios Haidopoulos, George Daskalakis, Alexandros Rodolakis, Marianna Theodora
As previously mentioned, in most of the cases a laparotomy was performed. On the other hand, laparoscopy, once considered a contraindication in pregnancy, has recently been employed, safely, in more and more cases (Gadacz and Talamini 1991). As far as our review is concerned, the maternal complication rate as well as the obstetrical outcomes of cases treated via laparoscopy is not inferior to the ones from patients undergoing a laparotomy. Given the current lack of evidence-based guidelines concerning the route of myomectomy during pregnancy, laparoscopic approach should be preferred on the grounds of an adequately trained and experienced team (Saccardi et al. 2015). Even so, certain limitations of laparoscopy should be taken into consideration when choosing the approach of surgery, such as the feasibility of the procedure in a giant myoma in a gravid uterus (Fanfani et al. 2010). Regardless of the procedure, it should be highlighted that every safety measure possible must be employed when performing such an operation in a pregnant woman, such as minimal manipulation of the uterus and possibly tocolytic therapy during and postoperatively.