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      Tocoliticos en la amenaza de parto prematuro Translated title: Tocolitics in premature labor

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          Abstract

          RESUMEN La amenaza de parto prematuro se considera hoy en día como una urgencia obstétrica en la que, si no se realiza alguna intervención desemboca en un parto prematuro. Por tanto, una vez confirmado el diagnóstico, el tratamiento consiste en la administración de tocolíticos, cuyo objetivo principal es el retraso del nacimiento ganando tiempo para administrar maduración pulmonar y neuroprotección con el fin de disminuir el síndrome de dificultad respiratoria y parálisis cerebral, así como lograr el traslado de la madre a un centro de referencia, si fuere el caso. La elección de un fármaco u otro debe basarse en una adecuada valoración riesgo-beneficio, una vez tenida en cuenta la situación clínica de cada gestante. El empleo de tocolíticos al inicio de este proceso es esencial y en esta revisión se analiza la información disponible sobre su uso en la amenaza de parto prematuro.

          Translated abstract

          ABSTRACT The preterm labour is now considered an obstetric emergency in which, if no intervention is performed, it leads to premature delivery. Therefore, once the diagnosis has been confirmed, the treatment consists of the administration of tocolytics, whose main objective is to delay the birth by gaining time to administer lung maturation and neuroprotection in order to reduce respiratory distress syndrome and cerebral palsy, as well as to achieve the transfer of the mother to a reference center, if necessary. The choice of one drug or another should be based on an adequate risk-benefit assessment, once the clinical situation of each pregnant woman has been taken into account. The use of tocolytics at the beginning of this process is essential and in this review the available information on their use in threatened preterm labor is analyzed.

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          Most cited references84

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          Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012.

          Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality.
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            Tocolytic therapy for preterm delivery: systematic review and network meta-analysis

            Objective To determine the most effective tocolytic agent at delaying delivery. Design Systematic review and network meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline, Medline In-Process, Embase, and CINAHL up to 17 February 2012. Study selection Randomised controlled trials of tocolytic therapy in women at risk of preterm delivery. Data extraction At least two reviewers extracted data on study design, characteristics, number of participants, and outcomes reported (neonatal and maternal). A network meta-analysis was done using a random effects model with drug class effect. Two sensitivity analyses were carried out for the primary outcome; restricted to studies at low risk of bias and restricted to studies excluding women at high risk of preterm delivery (those with multiple gestation and ruptured membranes). Results Of the 3263 titles initially identified, 95 randomized controlled trials of tocolytic therapy were reviewed. Compared with placebo, the probability of delivery being delayed by 48 hours was highest with prostaglandin inhibitors (odds ratio 5.39, 95% credible interval 2.14 to 12.34) followed by magnesium sulfate (2.76, 1.58 to 4.94), calcium channel blockers (2.71, 1.17 to 5.91), beta mimetics (2.41, 1.27 to 4.55), and the oxytocin receptor blocker atosiban (2.02, 1.10 to 3.80). No class of tocolytic was significantly superior to placebo in reducing neonatal respiratory distress syndrome. Compared with placebo, side effects requiring a change of medication were significantly higher for beta mimetics (22.68, 7.51 to 73.67), magnesium sulfate (8.15, 2.47 to 27.70), and calcium channel blockers (3.80, 1.02 to 16.92). Prostaglandin inhibitors and calcium channel blockers were the tocolytics with the best probability of being ranked in the top three medication classes for the outcomes of 48 hour delay in delivery, respiratory distress syndrome, neonatal mortality, and maternal side effects (all cause). Conclusions Prostaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving neonatal and maternal outcomes.
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              Oxytocin: its mechanism of action and receptor signalling in the myometrium.

              Oxytocin is a nonapeptide hormone that has a central role in the regulation of parturition and lactation. In this review, we address oxytocin receptor (OTR) signalling and its role in the myometrium during pregnancy and in labour. The OTR belongs to the rhodopsin-type (Class 1) of the G-protein coupled receptor superfamily and is regulated by changes in receptor expression, receptor desensitisation and local changes in oxytocin concentration. Receptor activation triggers a number of signalling events to stimulate contraction, primarily by elevating intracellular calcium (Ca(2+) ). This includes inositol-tris-phosphate-mediated store calcium release, store-operated Ca(2+) entry and voltage-operated Ca(2+) entry. We discuss each mechanism in turn and also discuss Ca(2+) -independent mechanisms such as Ca(2+) sensitisation. Because oxytocin induces contraction in the myometrium, both the activation and the inhibition of its receptor have long been targets in the management of dysfunctional and preterm labours, respectively. We discuss current and novel OTR agonists and antagonists and their use and potential benefit in obstetric practice. In this regard, we highlight three clinical scenarios: dysfunctional labour, postpartum haemorrhage and preterm birth.
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                Author and article information

                Journal
                anales
                Anales de la Facultad de Ciencias Médicas (Asunción)
                An. Fac. Cienc. Méd. (Asunción)
                EFACIM. Editorial de la Facultad de Ciencias Médicas - Universidad Nacional de Asunción (Asunción, Central, Paraguay )
                1816-8949
                December 2020
                : 53
                : 3
                : 115-130
                Affiliations
                [1] San Lorenzo Asunción orgnameUniversidad Nacional de Asunción orgdiv1Facultad de Ciencias Médicas orgdiv2Cátedra de Ginecología y Obstetricia Paraguay
                Article
                S1816-89492020000300115 S1816-8949(20)05300300115
                10.18004/anales/2020.053.03.115
                9a842a31-b938-4816-b3e8-9215a05c8d5d

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 02 November 2020
                : 30 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 85, Pages: 16
                Product

                SciELO Paraguay

                Categories
                Articulos de Revisión

                tratamiento.,preterm labor,tocolíticos,parto prematuro,tocolytics,treatment.

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