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      Management of preterm labor: atosiban or nifedipine?

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          Abstract

          Preterm birth is strongly associated with neonatal death and long-term neurological morbidity. The purpose of tocolytic drug administration is to postpone threatening preterm delivery for 48 hours to allow maximal effect of antenatal corticosteroids and maternal transportation to a center with specialized neonatal care facilities. There is uncertainty about the value of atosiban (oxytocin receptor antagonist) and nifedipine (calcium channel blocker) as first-line tocolytic drugs in the management of preterm labor. For nifedipine, concerns have been raised about unproven safety, lack of placebo-controlled trials, and its off-label use. The tocolytic efficacy of atosiban has also been questioned because of a lack of reduction in neonatal morbidity. This review discusses the available evidence, the pros and cons of either drug and aims to provide information to support a balanced choice of first-line tocolytic drug: atosiban or nifedipine?

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          Most cited references55

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          The fetal inflammatory response syndrome.

          The objective of this study was to determine the frequency and clinical significance of a systemic inflammatory response as defined by an elevated plasma interleukin-6 concentration in fetuses with preterm labor or preterm premature rupture of membranes. Amniocenteses and cordocenteses were performed in 157 patients with preterm labor and preterm premature rupture of membranes. Written informed consent and multi-institutional review board approvals were obtained. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as mycoplasmas. Amniotic fluid and fetal plasma interleukin-6 concentrations were measured with a sensitive and specific immunoassay. Statistical analyses included contingency tables, receiver operating characteristic curve analysis, and multiple logistic regression. One hundred five patients with preterm labor and 52 patients with preterm premature rupture of membranes were included in this study. The overall prevalence of severe neonatal morbidity (defined as the presence of respiratory distress syndrome, suspected or proved neonatal sepsis, pneumonia, bronchopulmonary dysplasia. intraventricular hemorrhage, periventricular leukomalacia, or necrotizing enterocolitis) among survivors was 34.8% (54/155). Neonates in whom severe neonatal morbidity developed had higher concentrations of fetal plasma interleukin-6 than fetuses without development of severe neonatal morbidity (median 14.0 pg/mL, range 0.5 to 900 vs median 5.2 pg/mL, range 0.3 to 900, respectively; P 11 pg/mL was 49.3% (36/73). Fetuses with fetal plasma interleukin-6 concentrations > 11 pg/mL had a higher rate of severe neonatal morbidity than did those with fetal plasma interleukin-6 levels < or = 11 pg/mL (77.8% [28/36] vs 29.7% [11/37], respectively; P < .001). Stepwise logistic regression analysis demonstrated that the fetal plasma interleukin-6 concentration was an independent predictor of the occurrence of severe neonatal morbidity (odds ratio 4.3, 95% confidence interval 1 to 18.5) when adjusted for gestational age at delivery, the cause of preterm delivery (preterm labor or preterm premature rupture of membranes), clinical chorioamnionitis, the cordocentesis-to-delivery interval, amniotic fluid culture, and amniotic fluid interleukin-6 results. A systemic fetal inflammatory response, as determined by an elevated fetal plasma interleukin-6 value, is an independent risk factor for the occurrence of severe neonatal morbidity.
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            Preterm delivery.

            Preterm delivery and its short-term and long-term sequelae constitute a serious problem in terms of mortality, disability, and cost to society. The incidence of preterm delivery, which has increased in recent years, is associated with various epidemiological and clinical risk factors. Results of randomised controlled trials suggest that attempts to reduce these risk factors by use of drugs are limited by side-effects and poor efficacy. An improved understanding of the physiological pathways that regulate uterine contraction and relaxation in animals and people has, however, helped to define the complex processes that underlie parturition (term and preterm), and has led to new scientific approaches for myometrial modulation. The continuing elucidation of the mechanisms that regulate preterm labour, combined with rigorous clinical assessment, offer hope for future solutions.
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              The impact of preterm birth on hospital inpatient admissions and costs during the first 5 years of life.

              To compare the cumulative use and cost of hospital inpatient services to 5 years of age by individuals divided into 4 subgroups by gestational age at birth. Costs applied to the hospital service utilization profile of each infant born in 2 areas covered by the Oxford Record Linkage Study during 1970-1993. Oxfordshire and West Berkshire, southern United Kingdom. 239 694 individuals divided into 4 subgroups by gestational age at birth: or=37 weeks. Number and duration of hospital admissions during the first 5 years of life and costs, expressed in pound sterling and valued at 1998-1999 prices, of hospital inpatient services. The total duration of hospital admissions for infants born at <28 and at 28 to 31 gestational weeks was 85 and 16 times that for term infants, respectively, once duration of life had been taken into account. Hospital inpatient service costs were significantly higher for preterm infants than for term infants, with the cost differences persisting throughout infancy and early and mid-childhood. Over the first 5 years of life, the adjusted mean cost difference was estimated at pound 14,614 ( 22,798 US dollars) when infants born at <28 weeks gestational age were compared with term infants and pound 11,958 ( 18,654 US dollars) when infants born at 28 to 31 weeks gestational age were compared with term infants. Independent contributions to total cost came from being born: small for gestational age, a multiple, during the 1970s and early 1980s, to a woman of extreme maternal age or who was hospitalized antenatally, and from experiencing extended survival or childhood disease. However, preterm birth remained the strongest predictor of high cost. Preterm birth is a major predictor of how much an individual will cost hospital service providers during the first 5 years of life.
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                Author and article information

                Journal
                Int J Womens Health
                International Journal of Women's Health
                International Journal of Women's Health
                Dove Medical Press
                1179-1411
                9 August 2010
                2010
                : 2
                : 137-142
                Affiliations
                Department of Woman and Baby, University Medical Centre Utrecht, The Netherlands
                Author notes
                Correspondence: Roel de Heus, Department of Woman and Baby, University Medical Centre Utrecht, KJ.02.507.0/PO Box 85090, 3508 AB Utrecht, The Netherlands, Tel +31 624732630, Fax +31 30 2505320, Email r.deheus-2@ 123456umcutrecht.nl
                Article
                ijwh-2-137
                2971730
                21072306
                9a1997db-acc5-4ff5-87d7-9f030f6021f6
                © 2010 de Heus et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                : 14 May 2010
                Categories
                Review

                Obstetrics & Gynecology
                preterm labor,atosiban,preterm birth,oxytocin receptor antagonist,calcium channel blocker,tocolytic drugs,nifedipine

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