Abstract
ÖZET
Amaç: Preterm eylem tedavisinde tokolitik olarak nifedipin kullanılan hastaların sonuçları incelenerek nifedipinin etkinliği ve doğumun geciktirilmesinde katkısı olabilecek faktörleri belirlemeyi amaçladık. Gereç ve Yöntemler: Çalısmaya Ocak 2007- Aralık 2011 tarihleri arasında Süleymaniye Doğum ve Ka- dın Hastalıkları Eğitim Hastanesi’nde preterm eylem tanısıyla hospitalize edilen ve nifedipin ile tokolitik tedavi alan, 24-37 haftalar arasındaki 112 gebe dahil edildi. Çalışmaya dahil edilen hastalar doğumun geciktirildiği gün sayısına göre 7 gün veya daha az geciktirilenler ve 7 günden daha fazla geciktirilenler olmak üzere iki gruba ayrılarak her iki grup demografik özellikler ile perinatal, neonatal ve maternal sonuçlar açısından karşılaştırıldı.
Bulgular: Her iki grup arasında yaş, vücut kitle indeksi, gravida, parite, başvuru anındaki servikal kanal uzunluğu, Bishop skoru, tanı anındaki ortalama gebelik haftaları açısından istatistiksel olarak anlam- lı farklılık gözlenmedi (p<0.05). Hastaların %69,7’de doğum 7 günden daha fazla geciktirilmiş olup 34 haftadan önce doğum yapan hasta sayısı 32’dir ve bu hastaların 21(%65,6)’i 7 gün ve daha az doğumun geciktirilebildiği grupta izlendi (p=0,021). Doğum şekilleri açısından, kazanılan gün sayısı >7 gün olan grupta, sezaryen doğum oranı istatistiksel olarak anlamlı derecede daha düşük olarak bulundu (%61,8
& %34,6, p=0,008). Neonatal komplikasyonlar açısında gruplar karşılaştırıldığında 7 gün ve daha az do- ğumun geciktirildiği grupta respiratuar distres sendromu ve yoğun bakım ihtiyacı istatistiksel olarak an- lamlı derecede daha yüksek olarak tespit edildi (sırasıyla p=0,017; p=0,036).
Sonuç: Ciddi maternal ve fetal yan etkilerinin olmaması ve oral kullanıma uygun olması nedeniyle to- kolitik olarak nifedipinlerin kullanımı giderek artmıştır. Ancak nifedipinlerin etkinliğine yönelik yeterli plasebo kontrollü klinik çalışmalar ve ideal rejim bulunmamaktadır.
Anahtar kelimeler: Tokoliz; Nifedipin; Preterm eylem
ABSTRACT
Objective: Our aim is to determine the effectiveness of nifedipine as a tocolytic in woman with preterm labor and to determine the factors to prolong pregnancy.
Material and Methods: 112 woman in 24-37 weeks’ gestation who were admitted to Suleymaniye Birth And Women Health Education And Research Hospital and hospitalized to take nifedipine as tocolytic from january 2007 to 2011 december were added to our study. Partisipants were diveded into two groups according to their delay in timing of birth: Less than seven days and lonfer than seven days. These groups were compared on the basis of their demographical feature,nenotal and maternal follow- up results.
Results: There were no statistically difference in between two groups for age, body mass index, gravidity, parity, cervical lenght at time of admission, Bishop score and the mean gestational age (p< 0,05). In 69,7% of patients delivery was prolonged for longer than 7 days and 32 patients gave birth before 34 weeks. 21 of these 32 patients (65,6%) was in the first group in which delivery was prolonged for 7 days or less (p: 0,021). In the other group as compared for mode of delivery cesarean section was statistically low (61,8% vs 34,6% p: 0,008). Neonatal complications as respiratory distress syndrome need for intensive care unit was statistically high in less than 7 days prolonged for gestation group (p: 0,017, p: 0,036 respectively).
Conclusion: Use of nifedipine is pervaded as a tocolytic since it has minimal adverse effects on fetal and maternal systems with its simple oral usage, but there is no satisfactory placebo clinical trials on ideal medication.
Keywords: Tocolizis; Nifedipine; Preterm labor
Keywords
References
- van Vliet EO, Schuit E, Heida KY, Opmeer BC, Kok M, Gyselaers W, et al. Nifedipine versus atosiban in the treatment of threatened preterm labour (Assessment of Perinatal Outcome after Specific Tocolysis in Early Labour: APOSTEL III-Trial). BMC Pregnancy Childbirth. 2014 Mar 3;14: doi: 10.1186/1471-2393-14-93.
- Kara M, Yılmaz E, Avcı İ, Öge T. Comparison of nifedipine with magnesium sulphate plus terbutaline for treatment of preterm labor. J Turk Soc Obstet Gynecol. 2009; 6(4): 250- 6.
- Haas DM, Caldwell DM, Kirkpatrick P, McIntosh JJ, Welton NJ. Tocolytic therapy for preterm delivery: systematic review and network metaanalysis. BMJ. 2012 Oct 9;345:e6226. doi: 1136/bmj.e6226.
- Conde-Agudelo A, Romero R, Kusanovic JP. Nifedipine in the management of preterm labor: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011 Feb;204(2):134. e1- doi: 10.1016/j.ajog.2010.11.038.
- King JF, Flenady VJ, Papatsonis DN, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting preterm labour. Cochrane Database Syst Rev. 2003;(1):2255.
- Ferguson JE, Schutz T, Pershe R, Stevenson DK, Blaschke T. Nifedipine pharmacokinetics during preterm labor tocolysis. Am J Obstet Gynecol. 1989;161(6):1485-90.
- Papatsonis D, Flenady V, Liley H. Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour. Cochrane Database Syst Rev. 2009;21(1):5938.
- Anotayanonth S, Subhedar NV, Garner P, Neilson JP, Harigopal S. Betamimetics for inhibiting preterm labour. Cochrane Database Syst Rev. 2004;18(4):4352.
- Crowther CA, Hiller JE, Doyle LW. Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database Syst Rev. 2002;(4):1060.
- King J, Flenady V, Cole S, Thornton S. Cyclo-oxygenase (COX) inhibitors for treating preterm labour. Cochrane Database Syst Rev. 2005;18(2):1992.
- Ulmsten U, Anderson KE, Wingerup L. Treatment of premature labor with the calsium antagonist nifedipine. Arch Gynecol. 1980; 229(1): 1-5.
- Kıng JF, Fledany V, Papasonis DN, Dekker G, Carbonne B. Calcium channel blokers for inhibiting preterm labor ; a systematic review of the evidence and a protocol for administration of nifedipine. Aus and New Zealand J Obstet Gynecol. 2003;43(3): 192-8.
- Tsatsaris V, Papatsonis DN, Goffinet F, Dekker G, Carbonne B. Tocolysis with nifedipine or beta-adrenergic agonist: A meta-analysis. Obstet Gynecol. 2001;97(5 Pt 2):840-7.
- Kacmar J, Bhimani L, Boyd M, Shah-Hosseini R, Peipert J.Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study. Obstet Gynecol. 2003; 102(2):141-5.
- Lockwood CJ. Recent advances in elecudating the pathogenesis of preterm delivery, the detection of patients at risk and prevantative therapies. J Matern Fetal Medicine. 1994; 6(1): 7-18.
- Alverez dela Rosa M, Rebollo FJ. Maternal serum interleukin 1, 2, 6, 8 and interleukin 2 receptor levels in preterm labour and delivery. Eur J Obstet Gynecol Reprod Biol. 2000;88(1):57-60.
- Gibson CS, MacLennan AH, Dekker GA, Goldwater PN, Dambrosia JM, Munroe DJ et al. Genetic polymorphisms and spontaneous preterm birth. Obstet Gynecol. 2007;109(2):384-91.
- Mumtaz G, Nassar A, Mahfoud Z, Abdallah A, Khalid Y. Consanguinity, a risk factor for preterm birth at less than 33 weeks’ Gestation. Am J Epidemiol. 2010;172(12):1424-30.
- Caroll SG, Blott M, Nicolaides KH. preterm prelabour amniorrhexis: Outcome of live births.Obstet Gynecol. 1995;86(1):18-25.
- Grant A, Penn ZJ, Steer PJ: Elective or selective caesarean delivery of the small baby? A systematic review of the controlled trials. Br J Obstet Gynecol. 1996;103(12):1197200.
Abstract
Objective: Our aim is to determine the effectiveness of nifedipine as a tocolytic in woman with preterm labor and to determine the factors to prolong pregnancy.Material and Methods: 112 woman in 24-37 weeks’ gestation who were admitted to Suleymaniye Birth And Women Health Education And Research Hospital and hospitalized to take nifedipine as tocolytic from january 2007 to 2011 december were added to our study. Partisipants were diveded into two groups according to their delay in timing of birth: Less than seven days and lonfer than seven days. These groups were compared on the basis of their demographical feature,nenotal and maternal followup results.Results: There were no statistically difference in between two groups for age, body mass index, gravidity, parity, cervical lenght at time of admission, Bishop score and the mean gestational age (p< 0,05). In 69,7% of patients delivery was prolonged for longer than 7 days and 32 patients gave birth before 34 weeks. 21 of these 32 patients (65,6%) was in the first group in which delivery was prolonged for 7 days or less (p: 0,021). In the other group as compared for mode of delivery cesarean section was statistically low (61,8% vs 34,6% p: 0,008). Neonatal complications as respiratory distress syndrome need for intensive care unit was statistically high in less than 7 days prolonged for gestation group (p: 0,017, p: 0,036 respectively). Conclusion: Use of nifedipine is pervaded as a tocolytic since it has minimal adverse effects on fetal and maternal systems with its simple oral usage, but there is no satisfactory placebo clinical trials on ideal medication.
Keywords
References
- van Vliet EO, Schuit E, Heida KY, Opmeer BC, Kok M, Gyselaers W, et al. Nifedipine versus atosiban in the treatment of threatened preterm labour (Assessment of Perinatal Outcome after Specific Tocolysis in Early Labour: APOSTEL III-Trial). BMC Pregnancy Childbirth. 2014 Mar 3;14: doi: 10.1186/1471-2393-14-93.
- Kara M, Yılmaz E, Avcı İ, Öge T. Comparison of nifedipine with magnesium sulphate plus terbutaline for treatment of preterm labor. J Turk Soc Obstet Gynecol. 2009; 6(4): 250- 6.
- Haas DM, Caldwell DM, Kirkpatrick P, McIntosh JJ, Welton NJ. Tocolytic therapy for preterm delivery: systematic review and network metaanalysis. BMJ. 2012 Oct 9;345:e6226. doi: 1136/bmj.e6226.
- Conde-Agudelo A, Romero R, Kusanovic JP. Nifedipine in the management of preterm labor: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011 Feb;204(2):134. e1- doi: 10.1016/j.ajog.2010.11.038.
- King JF, Flenady VJ, Papatsonis DN, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting preterm labour. Cochrane Database Syst Rev. 2003;(1):2255.
- Ferguson JE, Schutz T, Pershe R, Stevenson DK, Blaschke T. Nifedipine pharmacokinetics during preterm labor tocolysis. Am J Obstet Gynecol. 1989;161(6):1485-90.
- Papatsonis D, Flenady V, Liley H. Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour. Cochrane Database Syst Rev. 2009;21(1):5938.
- Anotayanonth S, Subhedar NV, Garner P, Neilson JP, Harigopal S. Betamimetics for inhibiting preterm labour. Cochrane Database Syst Rev. 2004;18(4):4352.
- Crowther CA, Hiller JE, Doyle LW. Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database Syst Rev. 2002;(4):1060.
- King J, Flenady V, Cole S, Thornton S. Cyclo-oxygenase (COX) inhibitors for treating preterm labour. Cochrane Database Syst Rev. 2005;18(2):1992.
- Ulmsten U, Anderson KE, Wingerup L. Treatment of premature labor with the calsium antagonist nifedipine. Arch Gynecol. 1980; 229(1): 1-5.
- Kıng JF, Fledany V, Papasonis DN, Dekker G, Carbonne B. Calcium channel blokers for inhibiting preterm labor ; a systematic review of the evidence and a protocol for administration of nifedipine. Aus and New Zealand J Obstet Gynecol. 2003;43(3): 192-8.
- Tsatsaris V, Papatsonis DN, Goffinet F, Dekker G, Carbonne B. Tocolysis with nifedipine or beta-adrenergic agonist: A meta-analysis. Obstet Gynecol. 2001;97(5 Pt 2):840-7.
- Kacmar J, Bhimani L, Boyd M, Shah-Hosseini R, Peipert J.Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study. Obstet Gynecol. 2003; 102(2):141-5.
- Lockwood CJ. Recent advances in elecudating the pathogenesis of preterm delivery, the detection of patients at risk and prevantative therapies. J Matern Fetal Medicine. 1994; 6(1): 7-18.
- Alverez dela Rosa M, Rebollo FJ. Maternal serum interleukin 1, 2, 6, 8 and interleukin 2 receptor levels in preterm labour and delivery. Eur J Obstet Gynecol Reprod Biol. 2000;88(1):57-60.
- Gibson CS, MacLennan AH, Dekker GA, Goldwater PN, Dambrosia JM, Munroe DJ et al. Genetic polymorphisms and spontaneous preterm birth. Obstet Gynecol. 2007;109(2):384-91.
- Mumtaz G, Nassar A, Mahfoud Z, Abdallah A, Khalid Y. Consanguinity, a risk factor for preterm birth at less than 33 weeks’ Gestation. Am J Epidemiol. 2010;172(12):1424-30.
- Caroll SG, Blott M, Nicolaides KH. preterm prelabour amniorrhexis: Outcome of live births.Obstet Gynecol. 1995;86(1):18-25.
- Grant A, Penn ZJ, Steer PJ: Elective or selective caesarean delivery of the small baby? A systematic review of the controlled trials. Br J Obstet Gynecol. 1996;103(12):1197200.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Original Research |
| Authors | |
| Publication Date | December 3, 2014 |
| Published in Issue | Year 2014 Volume: 4 Issue: 3 |
