Tocolytic therapy safeness in various gestational terms
DOI:
https://doi.org/10.15574/HW.2024.4(173).2632Keywords:
tocolysis, hexoprenaline, nifedipine, hyperglycemia, neuroprotectionAbstract
Hexoprenaline and nifedipine, known for their side effects, are currently most often used for tocolysis. Duration of use and interactions with other drugs require further study.
Aim was to compare the clinical and laboratory manifestations and consequences of tocolysis with hexporenaline and nifedipine in neonates and mothers.
Materials and methods. The results of tocolysis with hexoprenaline and nifedipine for more or less than 48 hours before delivery time were compared in extremely premature terms of labor (EPP group - 22-27 weeks, 77 parturients) and in terms of moderate premature parturition (MPP group - 28-34 weeks, 73 parturients).
Results. 80.0% and 90.9% of newborns survived within a week in the EPP and MPP groups after tocolysis with hexoprenaline for more than 48 hours. After tocolysis with nifedipine - respectively 66.7% and 92.9%, survival after hexoprenaline is 80.0%, nifedipine is 66.7% in the EPP group. Survival after prolonged tocolysis is higher than the average for the group (63.6%), in the MPP group the difference was 90.9 and 92.9%, without tocolysis 90.0%, and the average for the group was 90.4%. Survival in the EPP group with short-term tocolysis with hexoprenaline (50.0%) and nifedipine (60.0%), close to that without tocolysis (55.2%) and less than the average the EPP group (63.6%). All newborns survived after nifedipine, after hexoprenaline 81.8%, without tocolysis 90.0% in the MPP group. Moderate hyperglycaemia (5.6±0.58 mmol/L and 5.3±0.69 mmol/L) was observed after hexaprenaline and nifedipine, 4.2±0.37 mmol/L without tocolysis.
Conclusions. The lower survival rate of extremely preterm infants does not depend on the tocolysis type or its absence and is associated with immaturity in accordance with the term, and not with effectivelessness of therapeutic influences. Survival of moderately preterm infants after tocolysis with nifedipine showed a better outcome. A side effect of tocolysis with both drugs studied was an excess up to 30% of the mean glycemic value. It is desirable to give preference to hexoprenaline at 22-27 weeks, and tocolysis with nifedipine is more appropriate for MPP (28-34 weeks term).
The study was carried out in accordance with the Helsinki Declaration principles. The study protocol was adopted by the Local Ethics Committee of the Bohomolets NMU. Informed consent from the women for the study was obtained.
Authors declare no conflict of interest.
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