Comparison of Tocolytic Treatment Protocols in Threatened Preterm Labor: A Prospective Observational Study

Öz

This prospective observational study included patients diagnosed with TPL between 24 and 37 weeks of gestation who received tocolytic therapy at a tertiary university hospital between June 2021 and January 2023. Patients were grouped according to the initiated tocolytic regimen. Treatment efficacy was evaluated based on delaying delivery for at least 48 hours and prolonging pregnancy until 37 weeks of gestation. A total of 201 patients were evaluated. Median gestational age at first contraction was significantly different between groups (p<0.001), being 231 days (171–257) in the nifedipine group, 184.5 days (156–219) in the indomethacin group, and 191.5 days (126–236) in the nifedipine + indomethacin group. Median duration of tocolytic use also differed significantly (p<0.001): 8 days (1–73), 34 days (5–112), and 32 days (2–113), respectively. Latency period until delivery showed a significant difference between groups (p=0.012). Pairwise analysis demonstrated longer prolongation with nifedipine + indomethacin compared with nifedipine alone (43 vs. 21 days, p=0.026). However, success rates for delaying delivery ≥48 hours and prolonging pregnancy to 37 weeks were similar among groups. Commonly used tocolytic agents demonstrated comparable success in delaying delivery and prolonging pregnancy. Indomethacin and nifedipine + indomethacin achieved the longest latency periods.

Anahtar Kelimeler

• preterm labor
• tocolysis
• nifedipine
• indomethacin

Erken Doğum Tehdidinde Tokolitik Tedavi Protokollerinin Karşılaştırılması: Prospektif Gözlemsel Bir Çalışma

Öz

Bu prospektif gözlemsel çalışmaya, Haziran 2021 ile Ocak 2023 tarihleri arasında üçüncü basamak bir üniversite hastanesinde tokolitik tedavi alan ve 24–37 gebelik haftaları arasında erken doğum tehdidi (EDT) tanısı konulan hastalar dahil edildi. Hastalar, başlanan tokolitik tedavi rejimine göre gruplandırıldı. Tedavi etkinliği; doğumun en az 48 saat geciktirilmesi ve gebeliğin 37. haftaya kadar uzatılması temel alınarak değerlendirildi. Toplam 201 hasta değerlendirildi. İlk kontraksiyon sırasındaki medyan gebelik haftası gruplar arasında anlamlı farklılık göstermekteydi (p<0,001); nifedipin grubunda 231 gün (171–257), indometazin grubunda 184,5 gün (156–219) ve nifedipin + indometazin grubunda 191,5 gün (126–236) olarak bulundu. Tokolitik kullanım süresi medyanı da gruplar arasında anlamlı farklılık göstermekteydi (p<0,001); sırasıyla 8 gün (1–73), 34 gün (5–112) ve 32 gün (2–113) olarak saptandı. Doğuma kadar geçen latent dönem açısından da gruplar arasında anlamlı fark vardı (p=0,012). İkili analizde, nifedipin + indometazin kombinasyonunun yalnızca nifedipine kıyasla gebeliği daha uzun süre uzattığı gösterildi (43 güne karşı 21 gün, p=0,026). Bununla birlikte, doğumun ≥48 saat geciktirilmesi ve gebeliğin 37. haftaya kadar uzatılması açısından başarı oranları gruplar arasında benzerdi. Yaygın olarak kullanılan tokolitik ajanların, doğumu geciktirme ve gebeliği uzatma açısından benzer başarı gösterdiği görüldü. En uzun latent dönemler indometazin ve nifedipin + indometazin gruplarında elde edildi.

Anahtar Kelimeler

• erken doğum,
• tokoliz
• nifedipin
• indometazin

Kaynakça

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