The Effect of Oral Nifedipine versus Parenteral Magnesium Sulfate and Ritodrine for Tocolysis in Patients with Threatened Preterm Labor: A Randomized Controlled Trial

Background: Preterm labor is a serious cause of neonatal morbidity and mortality. This study aims to compare the effects of nifedipine, Magnesium sulfate and ritodrine as tocolytic drugs in patients presented with threatened preterm labor. Patients and Methods: The current study was randomized controlled trial conducted in Sohag Teaching Hospital between November 2015 and September 2016. Patients were divided into: Group A: 101 patients received intravenous ritodrine infusion;Group B: 101 patients received intravenous magnesium sulfate;Group C: 101 patients received oral nifedipine. Different maternal and neonatal outcomes were assessed. Results: The baseline criteria were homogenous among the study groups with no statistically significant differences. There is no difference between each other group regarding the need for additional tocolysis or the rate of recurrence of labour pains. Nifedipine was associated with the least length of hospital stay. There is no difference between all groups regarding the rate of preterm delivery before full steroid dose (p > 0.05). However, nifedipine group was the least one in the rate of occurrence of preterm delivery within 7 days from initiation of tocolytic therapy. Similarly, nifedipine group was associated with higher gestational age at delivery and significant prolongation of pregnancy than the other groups. Conclusion: Oral nifedipine use was associated with less recurrence of labor pains, less need for additional tocolysis, less duration of hospital stay, and more patient satisfaction in patients with threatened preterm labour.

Single versus combination therapy in acute tocolysis: A prospective randomized controlled trial

This is a prospective controlled randomized trial conducted in 92 women with singleton pregnancies in preterm labor. The tocolytic efficacy and safety of combination atosiban and nifedipine was compared with that of the single agent, atosiban. Both lines of intervention was administered for 48 hours. Progression of labor was assessed by the frequency of uterine contractions and cervical changes. For statistical purpose, intent-to-treat (ITT) analysis was used throughout. Efficacy, as determined by the proportion of women in each group who did not deliver after therapy initiation, was comparable with no significant differences, at 48 hrs (91.5% vs. 91.1%) and at 7 days (90.7% vs. 85.7%) for the atosiban and the combination groups respectively. Safety was assessed by the numbers of adverse events. Maternal side effects were reported more in the combination group (34% vs. 64%;P = 0.006). Perinatal outcomes were similar between the groups. We conclude that the addition of nifedipine did not substantially improve the clinical outcomes beyond that were achieved with atosiban alone. Moreover, it has increased maternal side effects. Future research could focus on combination of other tocolytics.

Efficacy of Magnesium and Alpha Lipoic Acid Supplementation in Reducing Premature Uterine Contractions

Objective: Premature uterine contractions represent one of the major symptoms related to preterm labor. So far, primary prevention of preterm labor is based on the early identification of symptoms and on pharmacological treatments which are prone of several secondary effects. In this double-blinded, randomized, placebo-controlled trial, the efficacy of a supplementation of magnesium and alpha-lipoic acid has been evaluated. Methods: Three hundred pregnant women at 14 - 34 weeks of gestation were enrolled and randomly divided to receive a daily single tablet containing a supplement of magnesium and alpha-lipoic acid (DAV®LoLiPharmasrl, Rome-Italy) or placebo until delivery. The incidence of episodes of preterm uterine contraction, associated or not with pain, as well as maternal need of hospitalization was evaluated. Results: Magnesium and lipoic acid supplementation was effective to significantly reduce the incidence of preterm uterine contractions compared to placebo. In particular, 52% of women who received the supplementation reported no symptoms of preterm uterine contractions throughout pregnancy, and persistent episodes of uterine contractions were significantly reduced compared to placebo (20% vs 60%, respectively). Furthermore, only 20% of subjects who received the supplementation required hospitalization, while it has been necessary for 40% of women who received placebo. Conclusions: Our findings suggest that supplementation with magnesium and lipoic acid is effective in reducing the incidence of premature uterine contraction and related episodes of hospitalization, compared to placebo. Nevertheless, further studies based on larger cohorts of patients are necessary to confirm the efficacy of these preliminary results.