atosiban and Fetal-Membranes--Premature-Rupture

Pregnancies with extremely preterm premature rupture of membranes (EPPROM), especially before 20 weeks of gestation, are usually considered to be a termination of pregnancy. By improvement of obstetric and neonatal care, we can prolong the pregnancy across the threshold of survival by aggressive tocolysis.. Using intrauterine insemination, a 32-year-old woman became pregnant with twins (first pregnancy). Threatened abortion occured since 9 weeks of gestation and EPPROM of the upper twin was noted at 18 weeks. Massive vaginal bleeding and vigorous uterine contractions occurred at 22 weeks. Poor control of preterm labor occurred using ritodrine and MgSO(4). Atosiban was applied to calm uterine activities. After discontinuation of atosiban at 30 weeks, the uterine contractions became severe again and an emergency cesarean section was performed to deliver two live, premature babies weighing 1,518 g and 830 g, respectively. Twin A was healthy, weighing 2,030 g at 35 days after birth and subsequently discharged. The smaller twin B was dependent on continuous positive airway pressure and died of pulmonary infection 120 days after birth.. Comparing to other tocolytic agents, Atosiban has few side effects and assisted in prolonging a pregnancy involving twins that experienced EPPROM.

Topics: Adult; Female; Fetal Growth Retardation; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Magnesium Sulfate; Male; Pregnancy; Pregnancy, Multiple; Premature Birth; Reproductive Techniques, Assisted; Ritodrine; Tocolysis; Tocolytic Agents; Twins; Vasotocin

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Cerclage, Cervical; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Humans; Obstetric Labor, Premature; Pregnancy; Premature Birth; Prenatal Care; Tocolytic Agents; Vasotocin

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Cerclage, Cervical; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Humans; Obstetric Labor, Premature; Pregnancy; Premature Birth; Prenatal Care; Tocolytic Agents; Vasotocin

Preterm birth complicates >15 million pregnancies annually worldwide. In many countries, women who present with signs of preterm labour are treated with tocolytics for 48 hours. Although this delays birth, it has never been shown to improve neonatal outcome. In 2015, the WHO stated that the use of tocolytics should be reconsidered and that large placebo-controlled studies to evaluate the effectiveness of tocolytics are urgently needed.. We designed an international, multicentre, randomised, double-blinded, placebo-controlled clinical trial. Women with threatened preterm birth (gestational age 30-34 weeks), defined as uterine contractions with (1) a cervical length of < 15 mm or (2) a cervical length of 15-30 mm and a positive fibronectin test or (3) in centres where cervical length measurement is not part of the local protocol: a positive fibronectin test or insulin-like growth factor binding protein-1 (Actim-Partus test) or (4) ruptured membranes, will be randomly allocated to treatment with atosiban or placebo for 48 hours. The primary outcome is a composite of perinatal mortality and severe neonatal morbidity. Analysis will be by intention to treat. A sample size of 1514 participants (757 per group) will detect a reduction in adverse neonatal outcome from 10% to 6% (alpha 0.05, beta 0.2). A cost-effectiveness analysis will be performed from a societal perspective.. This study has been approved by the Research Ethics Committee (REC) of the Amsterdam University Medical Centres, location AMC, as well as the REC's in Dublin and the UK. The results will be presented at conferences and published in a peer-reviewed journal. Participants will be informed about the results.. Nederlands Trial Register (Trial NL6469).

Topics: Cervical Length Measurement; Double-Blind Method; Female; Fetal Membranes, Premature Rupture; Fibronectins; Gestational Age; Humans; Infant, Newborn; Insulin-Like Growth Factor Binding Protein 1; Internationality; Maternal Mortality; Multicenter Studies as Topic; Obstetric Labor, Premature; Perinatal Mortality; Pregnancy; Randomized Controlled Trials as Topic; Tocolysis; Tocolytic Agents; Vasotocin

To analyse the expression of 15 genes encoding receptors and enzymes associated with the molecular mechanism of the tocolytic drugs atosiban (oxytocin receptor antagonist), nifedipine (calcium channel blocker) and celecoxib (selective cyclo-oxygenase-2 inhibitor) in preterm labor patients with premature rupture of fetal membranes in relation to symptoms of intrauterine infection and preterm labor risk factors.. Experimental molecular study.. Tertiary obstetric care center.. Myometrial samples were obtained during cesarean sections from 35 patients who delivered preterm with unverified symptoms of intrauterine infection, 35 patients who delivered preterm without symptoms of intrauterine infection and 90 women who delivered at term.. The Micro Fluidic Profiling Card analytic system was used to evaluate mRNA expression of the genes of interest.. The relative quantification values for mRNA expression.. The median oxytocin receptor and cyclo-oxygenase-2 mRNA expression in preterm patients with clinical symptoms of intrauterine infection was significantly higher than in preterm patients without symptoms. The median mRNA expression of β(1) , β(3) and β(4) subunits of the L-type calcium channel and prostaglandin E(2) receptor was significantly higher in preterm patients compared with term patients.. The mRNA expression of hormones, enzymes and their receptors associated with tocolytic actions can differ in various clinical conditions. The expression of these genes is regulated at different levels and can be modified by inflammatory factors, which affect their functions.

Topics: Adult; Calcium Channel Blockers; Calcium Channels, L-Type; Celecoxib; Cyclooxygenase 2 Inhibitors; Dinoprostone; Endometritis; Female; Fetal Membranes, Premature Rupture; Gene Expression Profiling; Gene Expression Regulation, Developmental; Humans; Nifedipine; Obstetric Labor, Premature; Oxytocics; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Premature Birth; Pyrazoles; RNA, Messenger; Sulfonamides; Term Birth; Tocolytic Agents; Vasotocin

The purpose of this retrospective study is to evaluate the effects of atosiban (Tractocile available in Austria since February 2000) for routine treatment of women with threatened preterm delivery. The advantage of this drug compared to other tocolytic agents is its specific action on reproductive tissues without the accompanying severe side effects. Women (n = 208) were retrospectively evaluated. Diagnoses at admission were preterm labour (n = 117), preterm rupture of membranes (n = 65), incompetent cervix (n = 19) and vaginal bleeding (n = 7). Gestational age was between weeks 21 and 33 of pregnancy. Preterm labour was defined as >/=4 uterine contractions/30 min and cervical length <30 mm examined by vaginal ultrasound and/or detection of vaginal fetal fibronectin. Tocolytic effectiveness was determined as the number of women having a diagnosis of preterm labour who were still pregnant after 48 hours and after 7 days. The influence on the frequency of contractions before and 3-12 hours after the start of treatment was assessed. Maternal side effects, perinatal and neonatal morbidity and transfers to the NICU were also evaluated. The proportion of women who remained undelivered was 78.7% after 48 hours, and 64.3% after 7 days. Atosiban decreased the frequency of contractions from 5.4/30 min before treatment to 1.6 contractions/30 min after the start of treatment. At the initial bolus application, 20.2% of women presented drug-related side effects, such as nausea, vertigo and flush over a short period of 1-2 minutes. During infusion, side effects possibly related to atosiban could be detected in 6% of women. Mean length of stay was 11.8 days in the NICU and 30.9 days in intermediate care. Twenty-three children developed intraventricular haemorrhage (I-IV). In conclusion, atosiban is an effective tocolytic drug in the treatment of preterm labour and preterm rupture of the membranes. It has significantly less side effects due to its lack of cardiovascular activity.

Topics: Drug Evaluation; Female; Fetal Membranes, Premature Rupture; Humans; Length of Stay; Obstetric Labor, Premature; Pregnancy; Pregnancy Outcome; Retrospective Studies; Tocolytic Agents; Treatment Outcome; Vasotocin