The efficacy of oral maintenance treatment with ritodrine in threatened preterm labor

Abstract

Objective: This study was undertaken to determine, in a prospective study, the effect of oral Ritodrine after successful intravenous tocolysis on averaged gestational age at delivery, latency period, averaged so: birth weight, neonatal length of stay in intensive care unit, neonatal mortality and morbidity. Materials and Methods: A total of 124 pregnant women threatened with preterm labor between 27 and 36 weeks of gestation were randomized as group treated with Ritodrine (5 mg orally, every 2 hours in the 24 hours and followed by 5 mg orally, every 4 hours until 36th week) or plasebo group. The patients, who had recurrent preterm delivery threat, had been retreated with IV Tocolysis. Results: Of the 124 patient who had been randomized, 24 were excluded from study because of various complications and lost to follow up, leaving for 50 patients for each group. Averaged gestational age at delivery (34,94+2,78 vs 34,32±2,25, p=0,28), latency period ( 19,15± vs 18,7±17,03, p=0,89), averaged birth weight (2480,2±662,3 gr vs 2338,4+537,5 gr p=0,24) neonatal length of stay in intensive care unit (9,92±5,69 vs 12,66±11,25, p=0,42). No statistical difference were documented between the groups. Conclusion: Use of oral Ritodrine after successful parenteral tocolysis during 27th to 34th weeks of gestation had no extra beneficial effect.

Keywords

• Morbidity,Mortality,Prospective Studies,Ritodrine,Tocolytic Agents,Administration, Oral,Injections, Intravenous

Erken doğum tehdidi olgularında ritodrin ile idame oral tokolitik tedavinin etkinliği

Öz

Arnaç: İntravenöz Ritodrin ile başarılı bir şekilde tedavi edilen hastalarda oral Ritodrin ile idame tokolitik tedavinin, ortalama doğum haftası, latent period, ortalama yenidoğan ağırlığı, yoğunbakımda kalma süresi ve neonatal mortalite ve morbidite üzerindeki etkilerini araştırmak. Materyal ve metod: Başarılı İntravenöz tokolitik tedavi sonrası, 27- 36. gebelik haftalarındaki 124 olgu Ritodrin alan (ilk 24 saat boyunca 12x1 oral 5mg Ritodrin ve 36. gebelik haftasına kadar günde 6x1 oral 5mg Ritodrin) ve almayan kontrol grubu olarak randomize edildi. Rekürren preterm eylemler IV Ritodrin ile tedavi edildi.. Bulgular: Gebelik sonuçları 100 olguda değerlendirildi. İki grup arasında doğumdaki ortalama gebelik haftası (34,942±2,78 ve 34,325±2,25 p=0,28), latent period (19,15+16,85 ve 18,7 ±17,03 p=0,89), rekürren preterm eylem (3 ve 16 p= 0,46 ), doğum ağırlığı ( 2480,2±662,36gr ve 2338,4±537,55 gr p=0,24 ), yeni doğan yoğun bakımında kalış süresi (9,92+5,69 ve 12,66±11,25, p=0,42) olarak bulundu. Karşılaştırılan tüm veriler açısından iki grup arasında istatistiksel olarak anlamlı bir fark tesbit edilmedi. Sonuç: Erken doğum tehdidinin İntravenöz Ritodrin ile tedavi edilmesinden sonra oral Ritodrin tedavisi ilave bir fayda sağlamamaktadır.

Anahtar Kelimeler

• Hastalık oranı,Ölüm oranı,İleriye dönük çalışma,Ritodrin,Tokolitik ajanlar,İlaç uygulama, oral,Enjeksiyon, ven içi

Kaynakça

1. 1. Rush R.W., Davey DA, Segall ML. The effect of preterm \l delivery on perinatal mortality. Br J Obstet Gynaecol. UJ 1978 ;85:806-ll y 2. 2. Lamont R.F., Dunlop P.O., Crowley P, Elder M.G
2. Spontaneous preterm labour and delivery at under 34 weeks' A: gestation. Br. Med. J. (Clin Res Ed). 1983 ;286:454-7 i 3. Kats V. L., Farmer R. M: Controversies in Tocolytic Therapy. J Clinical Obstetrics and Gynecology 1999;42: 802-8019 j 4. Hueston WJ. Prevention and treatment of preterm labor. Am.Fam. Physician 1989;40:139-146 5. McCormick M.C. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med * I985;312:82-9O 6. Dyson D.C. .-Monitoring women at risk for preterm labor. New i Engl.J. Med. 1998;338:15-19 7. Ehrenhaft P.M., Wagner J.L., Herdman R.C. Changing prog- nosis for very low birth weight infants. Obstet Gynecol 1989 ;74:528-35 8. Mastrobattısta J.M.: Therapeutic Agents in Preterm Labor Steroids: Clinical Obstetrics And Gynecology 2000;43:802-808 9. Macones G.A., Berlin M., Berlin J. A.: Efficacy of oral beta agonist maintenance Therapy in preterm labor: A meta-analysis .Obstet Gynecol 1995;85:313-7 10. Meirowitz N.B., Ananth C.V., Smulin J.C.,Vintzileus A.M
3. Value of maintanence therapy with oral tocolytics: A systematic Review . The journal of Maternal -Fetal Medicine 1999 :8:177-183 11. Gyetvai K., Hannah M. E., Hoddnet E. D., Ohlsson Â.: Tocolytics for preterm labor: A systematic review. Obstet Gynecol 1999 ;94-.869-877 12. DeVeciana M, Porto M, Major CA, Barke JI . Tocolysis in advanced preterm labor: impact on neonatal outcome. Am J Perinatal 1995;12:294-8. "v 13. Creasy R.K., Golbus M.S., Laws R.K., Parer J.T., Roberts J.M.: Oral Ritodrine maintenence in the treatment of preterm labor. Am J Obstet Gynecol 1980; 137: 212-216 14. The Canadian Preterm Labor investigators Group: Treatment of preterm labor with the beta-adrenergic agonist Ritodrine The New England Journal Of Medicine 1992;327:308-12 15. Sanchez - Ramos L, Kaunitz A.M., Gaudier F.L., Delke 1.: Efficacy of maintenance therapy after acute tocolysis: A meta- analysis. Am J Obstet Gynecol 1999 ; 181: 484-90 16. Lewis R., Mercer B.M., Salama M.,Walsh M.A.,Sibai B.M.,: Oral terbutaline after parenteral tocolysis: A randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 1996; 175:834-7 17. Leveno J.K., Klein V.R., Young V.R., William M.L.,Guzick D.S., Hankins G.D. .Single- centre randomised trial of Ritodrine hydrocloride for preterm labor. The Lancet 1986; 1293-1295 18. Ricci J.M.,Harriharan S., Helfgott A.,Reed K.,O'Sullivan M.J.: Oral tocolysis with magnesium chloride :A randomized controlled prospective clinical trial. Am. J Obstet Gynecol 1991 ;165:603-610 19. Can D. B., Clark A. L., Kernek K., Spinnato J. A.: Maintenance oral nifedipine for preterm labor: A randomized clinical trial. Am J Obstet Gynecol 1999; 181: 822-7 20. Parilla B.V., Dooley S.L.,Minogue J.P.,Socol ML: The efficasy of oral terbutaline after intravenous tocolysis. Am. J Obstet Gynecol 1993; 169:965-9 21. Larsen J.F., Eldon K., Lange A.P., Leegaard M., Osier M.,Olsen J.S., Permin M.: Ritodrine in the treatment of preterm labor : second danish multicenter study /Obstet Gynecol 1986;67:607-613 22. Rust O.A., Bofill J.A., Arriola R.M., Andrew ME., Morrison J.C. The clinical efficacy of tocolytic therapy . Am J Obstet Gvnecol 1996; 175: 838-42