Premature births: how to manage tocolysis
Objective. To elaborate a pathogenetic approach to tocolytic therapy.Belousova V.S., Strizhakov A.N., Timokhina E.V., Bogomazova I.M., Pirskhelauri E.G., Emelyanova E.S.
Subjects and methods. A total of 146 patients with clinical presentations of preterm labor at 24 to 34 weeks’ gestation were examined.
Results. In 71.9% of pregnant women, tocolysis with atosiban could prolong pregnancy for 48 hours or more. Pregnancy could be prolonged for an average of 13.1±3.5 days. Further examination revealed cervical canal infection in 71.2% of women. In addition, the study showed that the expression of toll-like receptor (TLR) in the cervical canal epithelium was enhanced in women without cervical infection.
Conclusion. Our investigations have demonstrated that cyclooxygenase inhibitors should be the leading tocolytic agents and it is necessary to use antibacterial therapy to enhance the efficiency of tocolysis.
Keywords
preterm labor
tocolysis
toll-like receptor
cyclooxygenase inhibitor
atosiban
References
- Mandy G.T. Incidence and mortality of preterm infant. UptoDate; 2017. Available at: https://www.uptodate.com/contents/incidence-and-mortality-of-the-preterm-infant?search=Incidence%20and%20mortality%20of%20preterm%20infant&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- Simhan H.N., Caritis S. Inhibition of acute preterm labor. UptoDate; 2019. Available at: https://www.uptodate.com/contents/inhibition-of-acute-preterm-labor?search=Inhibition%20of%20acute%20preterm%20labor&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- WHO Recommendations on interventions to improve preterm birth outcomes. World Health Organization; 2015. Available at: https://apps.who.int/iris/bitstream/handle/10665/183037/?sequence=1
- Flenady V., Reinebrant H.E., Liley H.G., Tambimuttu E.G., Papatsonis D.N. Oxytocin receptor antagonists for inhibiting preterm labour. Cochrane Database Syst. Rev. 2014; (6): CD004452. https://dx.doi.org/10.1002/14651858.CD004452.pub3.
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Сommittee Opinion No. 573: Magnesium sulfate use in obstetrics. Obstet. Gynecol. 2013; 122(3): 727-8. https://dx.doi.org/10.1097/01.AOG.0000433994.46087.85.
- Crowther C.A., Brown J., McKinlay C.J., Middleton P. Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database Syst. Rev. 2014; (8): CD001060. https://dx.doi.org/10.1002/14651858.CD001060.pub2.
- Yallampalli C., Dong Y.L., Gangula P.R., Fang L. Role and regulation of nitric oxide in the uterus during pregnancy and parturition. J. Soc. Gynecol. Investig. 1998; 5(2): 58-67. https://dx.doi.org/10.1016/S1071-5576(97)00106-8.
- Smith G.N., Walker M.C., McGrath M.J. Randomised, double-blind, placebo controlled pilot study assessing nitroglycerin as a tocolytic. Br. J. Obstet. Gynaecol. 1999; 106(7): 736-9.
- Lees C.C., Lojacono A., Thompson C., Danti L., Black R.S., Tanzi P. et al. Glyceryl trinitrate and ritodrine in tocolysis: an international multicenter randomized study. GTN Preterm Labour Investigation Group. Obstet. Gynecol. 1999; 94(3): 403-8.
- Баев О.Р., Васильченко О.Н., Карапетян А.О., Тетруашвили Н.К., Ходжаева З.С. Сравнение токолиза нифедипином и атозибаном при преждевременных родах. Акушерство и гинекология. 2018; 5: 50-6. https://dx.doi.org/10.18565/aig.2018.5.50-5 [Bayev O. R., Vasil'chenko, O. N., Karapetyan A. A., Tetruashvili N. K..To., Khodzhaeva Z. S. A comparison of tocolysis with nifedipine or atosiban in preterm labor. Obstetrics and gynecology. 2018; 5: 50-6. https://dx.doi.org/10.18565/aig.2018.5.50-5].
- Баев О.Р., Васильченко О.Н., Карапетян А.О., Тетруашвили Н.К., Ходжаева З.С. Сравнение токолиза гексопреналином и атозибаном. Медицинский совет. 2017; 2: 57-61.[ Bayev O. R., Vasil'chenko, O. N., Karapetyan A. A., Tetruashvili N. K..To., Khodzhaeva Z. S. A comparison of tocolysis with hexoprenaline and atosiban. Medical Council. 2017; 2: 57-61].
- Romero R., Miranda J., Chaiworapongsa T., Korzeniewski S.J., Chaemsaithong P., Gotsch F. et al. Prevalence and clinical significance of sterile intra-amniotic inflammation in patients with preterm labor and intact membranes. Am. J. Reprod. Immunol. 2014; 72(5): 458-74. https://dx.doi.org/10.1111/aji.12296.
- Feldman N., Rotter-Maskowitz A., Okun E. DAMPs as mediators of sterile inflammation in aging-related pathologies. Ageing Res. Rev. 2015; 24(Pt A): 29-39. https://dx.doi.org/10.1016/j.arr.2015.01.003.
Received 19.04.2019
Accepted 26.04.2019
About the Authors
Belousova Vera S., corresponding author-Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology at the Medical Faculty of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Address: 119991, Moscow, Bolshaya Pirogovskaya street, 2/4. Phone: +7 (903) 715-45-02. E-mail: desdemosha@mal.ruStrizhakov Alexander N., Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology at the Medical Faculty of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Address: 119991, Moscow, Bolshaya Pirogovskaya street, 2/4.Phone: +7 (916) 194-99-91.
E-mail: kafedra-agp@mail.ru
Timokhina Elena Vladimirovna, Doctor of Medical Sciences, Professor of the Department of Obstetrics, Gynecology and Perinatology at the Medical Faculty of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Address: 119991, Moscow, Bolshaya Pirogovskaya street, 2/4. Phone: +7 (916) 607-45-34. E-mail: elena.timokhina@mail.ru
Bogomazova Irina Mikhailovna, Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology at the Medical Faculty of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Address: 119991, Moscow, Bolshaya Pirogovskaya street, 2/4. Phone: +7 (926) 305-04-03. E-mail: Irinka.bogomazova@mail.ru
Pitskhelauri Elena Germanovna, Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology at the Medical Faculty of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University). Address: 119991, Moscow, Bolshaya Pirogovskaya street, 2/4. Phone: +7 (916) 334-00-89. E-mail: elena-doc@rambler.ru
Yemelyanova Elena Sergeevna, a student of the medical faculty of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).
Address: 119991, Moscow, Trubetskaya street, 8/2. Phone: +7 (499) 782-3045. e-mail: kafedra-agp@mail.ru
For citations: Belousova V.S., Strizhakov A.N., Timokhina E.V., Bogomazova I.M., Pirskhelauri E.G., EmelyanovA E.S. Premature births: how to manage tocolysis. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2019; (6): (in Russian)
http://dx.doi.org/10.18565/aig.2019.6:102-107
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