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Introduction: Nitric oxide donors in the form of nitroglycerine and ß-mimetic drugs (Isoxsuprine hydrochloride) are commonly used in managing preterm labour. It is one of the most challenging obstetric complications encountered by obstetricians, as well as preterm neonates for paediatricians. Preterm labour refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of the cervix between 20 and 37 weeks of gestation. Aim: To compare the effects of transdermal Glyceryl Trinitrate (GTN) with Isoxsuprine in terms of maternal complications, perinatal outcomes, and their tocolytic effectiveness. Materials and Methods: A hospital-based longitudinal study was conducted in the Department of Obstetrics and Gynaecology at JNU Medical College and Research Centre, Jaipur, Rajasthan, India. The study duration of the study was one year, from March 2022 to February 2023. A total number of 100 cases of preterm labour were enrolled and equally divided into two groups: Groups A (GTN patch) and group B (Isoxsuprine) with a defined dosing schedule. Singleton pregnancies with intact membranes and gestational age of 26-36 weeks were included in the study, metting the diagnostic criteria for preterm labour. Both the groups received pharmacological intervention, and outcome measures such as success rate of treatment (i.e., prolongation of labour), maternal side effects, and foetal outcomes (Neonatal Intensive Care Unit (NICU) admission and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score) were measured and evaluated. Predefined parameters and other data were tabulated in Microsoft Excel and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test was applied to identify significant differences. Results: The incidence of preterm labour was highest in the age group of 21-30 years (76% in Group A and 70% in Group B) among patients treated with nitroglycerine and isoxsuprine, respectively. The mean prolongation of pregnancy in the nitroglycerine group was 21.42 days, and in the isoxsuprine group, it was 16.22 days (p=0.042). The most common side effect in the nitroglycerine group was headache (60%), while in the isoxsuprine group, it was maternal hypotension (24%). The mean APGAR score in Group A and Group B was 8.18 and 8.06, respectively. It was observed that 24% of newborns in the nitroglycerine group and 36% in the isoxsuprine group required NICU admission. The success rate was 90% in the nitroglycerine group and 80% in the isoxsuprine group. Conclusion: Both drugs were effective in prolonging pregnancy for the first 48 hours, but nitroglycerine was found to be slightly better in terms of success rate. Nitroglycerin was more acceptable to patients with preterm labour, as it did not have to be administered through painful injections. [ABSTRACT FROM AUTHOR]

Among the total number of newborns, about 11% face hypoxia problems. It is hypoxia that becomes the main cause of premature birth, fetal and newborn mortality, as well as various pathologies. Fetal respiration passes through the placenta with the participation of the erythrocytes. Thus, fetal respiration is affected by the rate of passage of erythrocytes through small blood capillaries. Ultimately, the elasticity, area, and permeability of the erythrocyte membrane have a direct impact on the quality of fetal intrauterine respiration. This article discusses the main methods of studying the dynamic characteristics of erythrocytes and also analyzes the number of anion exchangers on the erythrocyte membrane. The experiment involved 4 pregnant women, two of whom have a risk of premature birth. These patients undergo tocolytic therapy, the purpose of which is to reduce the risk of premature birth. As a result of the study, the dynamics of changes in the ratio of dynamic strength to the elasticity of the erythrocyte membrane, the amount of band 3 protein, as well as the dynamics of the CO2-O2 exchange rate during tocolytic therapy of pregnant patients are determined. [ABSTRACT FROM AUTHOR]

The leading cause of newborn mortality and deaths in children under the age of five is complications from premature birth. Those preterm infants who live have a higher risk of developing major illnesses as children. Preterm birth must be addressed urgently if global efforts to lower infant and child morbidity & mortality are to succeed. When the Executive Guideline Steering Group (GSG) for maternal and perinatal health guidelines was established in 2021 by the World Health Organization (WHO), updating the WHO recommendations on the use of tocolytic treatment for enhancing preterm birth outcomes was given priority. This choice was made in light of recent information regarding the effectiveness of tocolytic therapy. Thus, the advice in this publication replaces the equivalent tocolytic proposal in the 2015 WHO recommendations on therapies to enhance preterm birth outcomes. [ABSTRACT FROM AUTHOR]

The efficacy of maintenance tocolytic therapy after successful arrest of preterm labor remains controversial. The purpose of this study was to evaluate the efficacy of 400 mg of daily vaginal progesterone (cyclogest) after successful parenteral tocolysis to increase latency period and improvement of neonatal outcomes in women with threatened preterm labor. In this randomized, double-blind, placebo-controlled trial, 85 participants were randomly allocated to either 400 mg daily of vaginal progesterone (n = 45) or placebo (n = 40) until 34 weeks of gestation. The primary outcomes were the time until delivery (latency period) and cervical length after 1 week of treatment. Secondary outcome were GA on delivery, type of delivery, incidence of low birth weight, perinatal morbidity and mortality. Longer mean latency until delivery (53.6 ± 16.8 versus 34.5 ± 12.9) days p =.0001; longer mean of gestational age on delivery (37.5 ± 2.2 versus 34.2 ± 2.1) weeks p =.0001; cervical length after 1 week of treatment (27.5 ± 5.5 versus 20.7 ± 3.1) mm p =.0001; low birth weight 12 (29.3%) versus 19 (57.6%) p =.01; and NICU admission 9 (22%) versus 15 (45.5%), were significantly different between the two groups. No significant differences were found between neonatal death 1 (2.4%) versus 2 (6.1%), p =.43; RDS 5 (12.2%) versus 8 (24.2%), p =.17; and need to mechanical ventilator 2 (5.4%) versus 6 (18.2%) p =.136, for the progesterone and placebo groups, respectively. Daily administration of 400 mg vaginal progesterone after successful parenteral tocolysis may increase latency preceding delivery and improves cervical shortening and neonatal outcome in women with preterm labor. Further confirmatory studies are warranted. [ABSTRACT FROM AUTHOR]

Background: The rate of preterm labor is higher in the developing countries and it is the main cause of neonatal mortality and morbidity. The prevention of preterm labor has become one of the major objectives of perinatal medicine. The causes of P.T.L in most cases remains unclear. Additionally, despite the identification of P.T.L risk factors; to date, no intervention has been associated with decrease in P.T.L rates,thus early detection women at high risk of P.T.L, and prophylactic treatment could be one of the best ways to prevent P.T.L. AIM of the Study: The aim of this study was to verify if vagianl progesterone maintenance therapy after a successfully treated episode of preterm labor could increase latency period. Patients and Methods: This prospective randomized trial was conducted in the Department of Obstetrics and Gynecology, Zagazig University Hospitals during the period from March 2021 to October 2021. It included 72 pregnant women at high risk for preterm labor. All patients received a single course of dexamethasone, consisting of two injections of 12mg dexamethasone during the first 24 hours after admission. After stoppage uterine contraction the women were divided into 2 groups: The first group (study group) comprised 36 patients. Women were given natural progesterone (prontogest) 200 mg vaginal suppository daily. The second group (control group) comprised 36 patients. Women were not given any drugs and follow up and instructed to limit their physical activity. Results: We found that progestional agents, reduce the risk of delivery less than 37 weeks of gestation for women at increased risk of spontaneous preterm labour, but their effect in spontaneous abortion or perinatal mortality, or measures of neonatal morbidity is uncertain. Conclusion: prophylactic administration of 200 mg vaginal progesterone suppositories is associated with a longer latency to delivery and better fetal outcome. [ABSTRACT FROM AUTHOR]

Objective: To study the tocolytic action of nifedipine combined with sildenafil citrate (SC) and if the combination is superior to nifedipine alone in inhibiting threatened preterm labour (PTL).Design: Prospective randomised study.Setting: An Egyptian university hospital.Population: Women with threatened PTL who received either nifedipine with SC or nifedipine alone.Methods: Patients were randomly allocated to receive either (1) nifedipine 20 mg orally (stat dose), followed by 10 mg orally every 6-8 hours at the same time as vaginal administration of SC (25 mg at 8-hourly intervals) or (2) nifedipine alone. Medications were continued for 48-72 hours.Main Outcome Measures: The percentage of women who remained undelivered during hospitalisation.Results: From January 2015 to November 2016, 239 women were randomised. The baseline characteristics of participants were similar. Nifedipine combined with SC was associated with more women remaining undelivered (81.8 versus 68.6%; P = 0.018) during hospitalisation. Regarding secondary outcomes, the addition of SC was also associated with fewer deliveries within 7 days of admission (9.1 versus 20.3%; P = 0.014), prolonged latency (29 versus 7 days; P = 0.002), fewer admissions to neonatal intensive care units (31.4 versus 44.1%; P = 0.043), fewer very preterm deliveries (from 28 to <32 weeks, 20.7 versus 38.1%; P = 0.043), and increased neonatal birthweight (1900 versus 1500 g; P = 0.018).Conclusions: Vaginal SC combined with nifedipine is an effective option for tocolytic therapy during threatened PTL.Tweetable Abstract: Vaginal SC enhances the tocolytic effect of nifedipine. [ABSTRACT FROM AUTHOR]

As one of the main aims of obstetrics is to be able to detect imminent delivery in patients with threatened preterm labor, the techniques currently used in clinical practice have serious limitations in this respect. The electrohysterogram (EHG) has now emerged as an alternative technique, providing relevant information about labor onset when recorded in controlled checkups without administration of tocolytic drugs. The studies published to date mainly focus on EHG-burst analysis and, to a lesser extent, on whole EHG window analysis. The study described here assessed the ability of EHG signals to discriminate imminent labor (< 7 days) in women with threatened preterm labor undergoing tocolytic therapy, using both EHG-burst and whole EHG window analyses, by calculating temporal, spectral, and non-linear parameters. Only two non-linear EHG-burst parameters and four whole EHG window analysis parameters were able to distinguish the women who delivered < 7 days from the others, showing that EHG can provide relevant information on the approach of labor, even in women with threatened preterm labor under the effects of tocolytic therapy. The whole EHG window outperformed the EHG-burst analysis and is seen as a step forward in the development of real-time EHG systems able to predict imminent labor in clinical praxis. Graphical abstract The ability of EHG recordings to predict imminent labor (< 7 days) was analyzed in preterm threatened patients undergoing tocolytic therapies by means of EHG-burst and whole EHG window analysis. The non-linear features were found to have better performance than the temporal and spectral parameters in separating women who delivered in less than 7 days from those who did not. [ABSTRACT FROM AUTHOR]

Introduction: Tocolytics may cause changes in fetal heart rate (HR) pattern, while fetal heart rate variability (HRV) is an important marker of fetal well-being. We aim to systematically review the literature on how tocolytic drugs affect fetal HRV.Materials and Methods: We searched CENTRAL, PubMed and EMBASE up to June 2016. Studies published in English, using computerized or visual analysis to describe the effect of tocolytics on HRV in human fetuses were included. Studies describing tocolytics during labor, external cephalic version, pre-eclampsia and infection were excluded. Eventually, we included six studies, describing 169 pregnant women.Results: Nifedipine, atosiban and indomethacin administration show no clinically important effect on fetal HRV. Following administration of magnesium sulfate decreased variability and cases of bradycardia are described. Fenoterol administration results in a slight increase in fetal HR with no changes in variability. After ritodrine administration increased fetal HR and decreased variability is seen. The effect of co-administration of corticosteroids should be taken into account.Conclusion: In order to prevent iatrogenic preterm labor, the effects of tocolytic drugs on fetal HRV should be taken into account when monitoring these fetuses. [ABSTRACT FROM AUTHOR]

Aim: The present observational study aimed to clarify the effects of sleep disorders on threatened premature delivery, especially preterm uterine contraction. Methods: The participants included 122 healthy singleton pregnant women. The Pittsburgh sleep quality index was used to evaluate the quality of sleep during the previous month at the initial examination and at 16, 24, and 32 weeks of gestation; scores > 5 indicate poor sleep. Threatened premature delivery was defined as preterm uterine contraction > 6 times/h and requiring tocolytic therapy before 37 weeks of gestation. We analyzed the relationship between poor sleep and threatened premature delivery. Results: Poor sleep affected 27% (n = 33) at the initial examination, 34% (n = 41) at 16 weeks, 37% (n = 45) at 24 weeks, and 41% (n = 50) at 32 weeks of gestation. There were 23 patients (19%) with threatened premature delivery. Poor sleep affected 35% and 25% of patients with threatened and non-threatened premature delivery at the initial examination, respectively, 52% and 29% at 16 weeks, 48% and 34% at 24 weeks, and 43% and 40% at 32 weeks of gestation. Conclusions: Sleep disorders at 16 weeks of gestation were the most significantly associated with threatened premature delivery. [ABSTRACT FROM AUTHOR]

Organized uterine contractions, including those necessary for parturition, are dependent on calcium entry through voltage-gated calcium channels in myometrial smooth muscle cells. Recent evidence suggests that small-conductance Ca2+-activated potassium channels (KCa2), specifically isoforms KCa2.2 and 2.3, may control these contractions through negative feedback regulation of Ca2+ entry. We tested whether selective pharmacologic activation of KCa2.2/2.3 channels might depress uterine contractions, providing a new strategy for preterm labor intervention. Western blot analysis and immunofluorescence microscopy revealed expression of both KCa2.2 and KCa2.3 in the myometrium of nonpregnant (NP) and pregnant (gestation day 10 and 16; D10 and D16, respectively) mice. Spontaneous phasic contractions of isolated NP, D10, and D16 uterine strips were all suppressed by the KCa2.2/2.3-selective activator CyPPA in a concentration-dependent manner. This effect was antagonized by the selective KCa2 inhibitor apamin. Whereas CyPPA sensitivity was reduced in D10 and D16 versus NP strips (pIC50 5.33 ± 0.09, 4.64 ± 0.03, 4.72 ± 0.10, respectively), all contractions were abolished between 30 and 60 μM. Blunted contractions were associated with CyPPA depression of spontaneous Ca2+ events in myometrial smooth muscle bundles. Augmentation of uterine contractions with oxytocin or prostaglandin F2α did not reduce CyPPA sensitivity or efficacy. Finally, in an RU486-induced preterm labor model, CyPPA significantly delayed time to delivery by 3.4 h and caused a 2.5-fold increase in pup retention. These data indicate that pharmacologic stimulation of myometrial KCa2.2/2.3 channels effectively suppresses Ca2+-mediated uterine contractions and delays preterm birth in mice, supporting the potential utility of this approach in tocolytic therapies. [ABSTRACT FROM AUTHOR]

Aim: The effectiveness of the management of preterm birth remains an important health care issue, especially when considering that more than two thirds of singleton neonatal death occurs in preterm labor. The purpose of this study was to compare oral celecoxib with intravenous magnesium sulfate as tocolytic. Methods: This was a randomized study of patients who were between 24 and 34 weeks of gestation with preterm labor. One hundred and four pregnant women with preterm labor were randomly assigned to receive celecoxib 100 mg b.i.d. for 48 h or intravenous magnesium sulfate (MgSO4) for maximum of 48 h. Outcome variables included delay of delivery for 48 h and the incidence of side-effects. Data was analyzed using the Student t-test and the χ2 test. Results: There was no difference between the groups over the course of the study in demographic characteristics, cervical examination and amniotic fluid index. Labor was arrested for 48 h was in 42 (81%) and 45 (87%) of the patients in the celecoxib and magnesium sulfate groups, respectively (p-0.298). There were no severe maternal or neonatal complications in either group. Conclusion: Celecoxib is as effective as magnesium sulfate for primary tocolysis. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of atosiban with usual management of threatened preterm labor. Methods: In this prospective, open-label, randomized controlled trial, women admitted to the hospital in threatened preterm labor (between 24 and 34 weeks' gestation) were randomized to receive atosiban or usual care (β-agonists, calcium channel blockers, magnesium sulphate, or any other tocolytic, alone or in combination, and/or bed rest). Results: In women randomized to receive atosiban (n=295) or usual care (n=290), significantly more women receiving atosiban remained undelivered at 48 h with no alternative tocolytic compared with usual care (77.6% vs. 56.6%; P<0.001). The proportion of women remaining undelivered after 48 h was comparable between the treatment groups. However, more women in the atosiban group required no additional tocolytics (85.1% vs. 62.8%; P<0.001). Maternal and fetal safety was significantly superior with atosiban. Neonatal safety was comparable. Conclusions: These findings support the use of atosiban to delay preterm birth and are consistent with previously conducted, randomized, controlled trials. Atosiban was associated with fewer maternal and fetal adverse events compared with other tocolytics, and presented no safety concerns for either the mother or the unborn baby. [ABSTRACT FROM AUTHOR]

The article focuses on the use of tocolytic therapy in the conservative management of preterm premature rupture of the membranes. Data suggests that prophylactic and therapeutic tocolysis may increase short-term latency. Brief initial tocolytic therapy increases initial latency to allow more time for antenatal corticosteroid and antibiotic administration.

Abstract: A 28-year-old primigravida who had taken oral ritodrine for 5 months to stop premature uterine contractions and was admitted in labor in the 33rd week of pregnancy developed acute pulmonary edema after cesarean section. Although parenteral ritodrine is the beta-adrenergic agent used most extensively to treat premature labor, only 1 case of pulmonary edema associated with long-term use of oral ritodrine had been reported so far. The present report presents for the first time computed tomograpic findings of acute pulmonary edema secondary to tocolytic therapy. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study is to estimate the relations between ionized and total Mg levels during MgSO4 administration in patients with preterm labor and preeclampsia. Methods: Forty-three pregnant patients who were candidates for MgSO4 were studied (preterm labor, 27; preeclampsia, 16). The administration method was intravenous injection of MgSO4 4g over 30min followed by 1–2g/h. Ionized Mg was measured by the selective ion electrode method at bedside, and compared it with total Mg levels. Results: Significant correlation was existed between levels of ionized and total Mg throughout therapy for both preterm labor (ionized Mg=0.19×total Mg+0.19; r =0.61, p <0.001) and preeclampsia (ionized Mg=0.20×total Mg+0.14; r =0.60, p <0.001). Conclusion: There are correlations between ionized and total Mg levels during administration of MgSO4 for both preterm labor and preeclampsia. [Copyright &y& Elsevier]

Preterm birth is the leading cause of death in newborns and the survivors are prone to health complications. Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy. The current methods used in clinical practice to diagnose preterm labor, the Bishop score or cervical length, have high negative predictive values but not positive ones. In this work we analyzed the performance of computationally efficient classification algorithms, based on electrohysterographic recordings (EHG), such as random forest (RF), extreme learning machine (ELM) and K-nearest neighbors (KNN) for imminent labor (<7 days) prediction in women with TPL, using the 50th or 10th–90th percentiles of temporal, spectral and nonlinear EHG parameters with and without obstetric data inputs. Two criteria were assessed for the classifier design: F1-score and sensitivity. RFF1_2 and ELMF1_2 provided the highest F1-score values in the validation dataset, (88.17 ± 8.34% and 90.2 ± 4.43%) with the 50th percentile of EHG and obstetric inputs. ELMF1_2 outperformed RFF1_2 in sensitivity, being similar to those of ELMSens (sensitivity optimization). The 10th–90th percentiles did not provide a significant improvement over the 50th percentile. KNN performance was highly sensitive to the input dataset, with a high generalization capability. [ABSTRACT FROM AUTHOR]

Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy and entails high costs for health systems. Currently, no reliable labor proximity prediction techniques are available for clinical use. Regular checks by uterine electrohysterogram (EHG) for predicting preterm labor have been widely studied. The aim of the present study was to assess the feasibility of predicting labor with a 7- and 14-day time horizon in TPL women, who may be under tocolytic treatment, using EHG and/or obstetric data. Based on 140 EHG recordings, artificial neural networks were used to develop prediction models. Non-linear EHG parameters were found to be more reliable than linear for differentiating labor in under and over 7/14 days. Using EHG and obstetric data, the <7- and <14-day labor prediction models achieved an AUC in the test group of 87.1 ± 4.3% and 76.2 ± 5.8%, respectively. These results suggest that EHG can be reliable for predicting imminent labor in TPL women, regardless of the tocolytic therapy stage. This paves the way for the development of diagnostic tools to help obstetricians make better decisions on treatments, hospital stays and admitting TPL women, and can therefore reduce costs and improve maternal and fetal wellbeing. [ABSTRACT FROM AUTHOR]