Miscellaneous Drugs during Pregnancy
“Bert” Bertis Britt Little in 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.
The diagnosis and management of preterm labor with intact membranes
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
The basic premise behind the use of tocolytic treatment is that the administration of pharmacologic agents can inhibit myometrial contractions, prolong pregnancy, and reduce the rate of neonatal morbidity and mortality. Intravenous alcohol was the first agent introduced to delay preterm delivery (297). Its use was accompanied by an unacceptable rate of maternal complications. Since that time, multiple pharmacologic agents have been used, including beta-adrenergic agents, magnesium sulfate, oxytocin receptor antagonists, calcium-channel blockers, nitroglycerin, and prostaglandin synthase inhibitors. Decades of research indicate that tocolysis can prolong pregnancy for 48 hours to 7 days (298–301). This prolongation of gestation is considered beneficial, because it allows the transfer of patients to a tertiary care facility and, importantly, the administration of corticosteroids. The hope that the use of tocolysis would reduce the rate of preterm birth has not been realized. It is possible that the ideal agent has not been identified. Alternatively, it is possible that tocolysis, as a strategy, would not succeed if a serious pathologic process which has led to activation of the myometrium and other components of the common pathway of parturition is not treated. For example, the administration of beta-adrenergic agents in patients with documented intrauterine infection is not effective in prolonging pregnancy and may result in an increased rate of maternal pulmonary edema (205,242,243). Therefore, many studies of tocolysis are confounded by including patients who will not benefit from inhibition of uterine contractility.
Antepartum haemorrhage
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Tocolysis for the treatment of uterine activity has been used to good effect in some studies [C].9 It appears to be safe to use, gaining on average 13 days when compared to women in whom it was not used. It must be used judiciously to settle uterine activity that is causing bleeding. It must never be considered in women who show signs of cardiovascular instability or where there is evidence of fetal compromise. Studies have mainly used beta-sympathomimetics, which have a physiological disadvantage. Where tocolysis is considered agents other than beta-agonists should be considered first. Given the lack of cardiovascular side effects, an oxytocic antagonist would probably be the first choice.
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.
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).
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).
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