Abstract
ObjectivesThis study aimed to generate baseline evidence regarding the effectiveness of atosiban in delaying delivery by ≥48 hours among pregnant women presenting with threatened preterm labour (TPL). The secondary objective was to assess the relationship between atosiban success and various perinatal factors and neonatal outcomes.MethodsThis retrospective study was conducted between June 2008 and May 2018 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all pregnant women who received atosiban between 24–34 gestational weeks for TPL during this period were reviewed.ResultsA total of 159 women were included in the study. Atosiban was successful in delaying delivery by ≥48 hours in 130 cases (81.8%). Approximately half of the women (50.9%) achieved uterine quiescence in <12 hours. Failure to delay delivery by ≥48 hours was significantly lower among women with normal versus abnormal cervical findings (11.1% versus 25.6%; P = 0.023). Only 9.4% of women experienced minor side-effects. Mean birth weight (2,724.55 versus 1,707.59 g; P <0.001) and Apgar scores at 5 minutes (9.66 versus 8.28; P <0.001) were significantly higher among neonates delivered at ≥48 versus <48 hours post-atosiban, whereas the rate of neonatal respiratory distress syndrome was significantly lower (18.4% versus 81.6%; P <0.001).ConclusionAtosiban was highly effective in delaying delivery by ≥48 hours and resulted in few adverse maternal side-effects and neonatal outcomes. To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the effectiveness of atosiban in preventing preterm labour.
Highlights
Atosiban was successful in delaying delivery by ≥48 hours in 130 cases (81.8%)
Advances in Knowledge - The results of this study will inform future research comparing the effectiveness and safety profile of atosiban to other tocolytic agents such as nifedipine. - To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the use of atosiban as a tocolytic drug for managing threatened preterm labour (TPL)
Application to Patient Care - The findings of this study indicate that atosiban is highly effective in delaying delivery by ≥48 hours among selected patients presenting with TPL. - In addition, the successful administration of this agent resulted in few maternal side-effects or adverse neonatal outcomes
Summary
Advances in Knowledge - The results of this study will inform future research comparing the effectiveness and safety profile of atosiban to other tocolytic agents such as nifedipine. - To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the use of atosiban as a tocolytic drug for managing threatened preterm labour (TPL). - To the best of the authors’ knowledge, this is the first study conducted in Oman to evaluate the use of atosiban as a tocolytic drug for managing threatened preterm labour (TPL). The exact mechanisms behind preterm labour are still unclear, various risk factors have been identified such as multiple pregnancies, cervical disease, decidual haemorrhage, placental ischaemia, fetal endocrine activation, intrauterine infections and various immunological or allergic phenomena and inflammatory processes.[2] Maternal ethnicity and a previous history of preterm delivery, undernutrition, smoking and stress may contribute to preterm labour.[5] In 30% of PTBs, preterm rupture of the membranes occurs at least one hour prior to the onset of uterine contractions, whereas 15–20% result from iatrogenic causes such as pre-eclampsia and fetal growth restriction which necessitate medically indicated or elective preterm deliveries due to maternal or fetal indications.[1,5] Late PTB occurs more often than early PTB and has significantly greater risks of adverse complications and outcomes compared to full-term births.[4]. Tocolytic drugs include β-adrenergic receptor agonists, oxytocin receptor antagonists, calcium channel blockers, nitric oxide, prostaglandin synthase inhibitors and magnesium sulphate.[8]
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