Tocolytic Research Articles

The Spread of Anti-Union Business Coordination: Evidence from the Open-Shop Movement in the U.S. Interwar Period

What explains the development of repressive employer coordination? Classic historical American business and labor literature focuses on institutions of labor repression and employer associations, but little systematic examination of such associations exists, particularly during the interwar period. Similarly, recent political science literature on the origins of industrial institutions underemphasizes the importance of repressive employer associations. I use new quantitative subnational evidence from the U.S. interwar period, with data from the open-shop movement in the United States at the local level after World War I. I test a variety of families of hypotheses regarding variation in repressive employer coordination, with specific data measuring the threat posed by organized labor. I find that such threats posed by unions are correlated to repressive employer associations. The results have implications for understanding local-level variation in the business repression of labor movements in the early twentieth century and contribute to our understanding of labor repressive institutions and the incentives of firms to collectively act.

Administration of Tocolytic Agents is not Only un useful but also Culprit to Prevent Preterm Labor

Administration of Tocolytic Agents is not Only un useful but also Culprit to Prevent Preterm Labor

Political Economy of Labor Repression in the United States by Andrew Kolin

Political Economy of Labor Repression in the United States by Andrew Kolin

The Effect of Nifedipine used as Tocolytic Agent on Postpartum Blood Loss among Filipino Pregnant Patients in a Tertiary Hospital: a Prospective Cohort Study

Objective. To determine the risk of postpartum hemorrhage among patients who were treated with nifedipine for tocolysis of preterm labor.
 Methods. A prospective cohort study was conducted with 66 pregnant women admitted for preterm labor. One group of women was given nifedipine to give time for the administration of corticosteroids for fetal lung maturity and/or control of preterm labor and another group was not given nifedipine as they were admitted in advanced stage of labor (ie, more than or equal to 4 cm cervical dilatation). Independent/paired sample t-test, Mann-Whitney U/Wilcoxon signed rank test, and Fisher’s exact test were used to determine the difference of mean, median, and frequency between and within groups, respectively. STATA 12.0 was used for data analysis.
 Results. There was more blood loss during delivery, which was statistically significant, among those who received nifedipine compared to those who have not taken the medicine (350 mL versus 250 mL, p = 0.021). Furthermore, the decreases in hemoglobin and hematocrit were also lower among those who did not receive nifedipine compared to those who received nifedipine for tocolysis (8.5 mg/dL versus 16.0 mg/dL, p = 0.014 and 0.03 versus 0.05, p = 0.010), again, statistically significant.
 Conclusion. Nifedipine used as tocolytic appear to increase blood loss during delivery, which was statistically significant. Greater amount of blood loss may be anticipated among those with nifedipine intake thus helping the obstetrician in preparing for active management of postpartum hemorrhage and preventing maternal morbidity and mortality.

Maternal serum dehydroepiandrosterone sulfate as a predictor of labor inhibition in preterm labor

Objective The aim of this study was to assess the relationship between endogenous serum dehydroepiandrosterone sulfate (DHEA-S) levels and success of labor inhibition in preterm labor. Background Preterm birth is the leading cause of neonatal mortality and morbidity. Patients and methods This prospective trial included 43 pregnant women with preterm labor. Labor inhibition was achieved using calcium channel blockers such as nifedipine (epilat 10-mg capsules at a dose of 10 mg orally every 20 min until uterine contractions are inhibited and maintained regularly by epilat retard tablets every 8 h). Serum DHEA-S levels were measured twice, the first just before labor inhibition by tocolytic drugs, and the second sample was obtained after 48 h from starting tocolytic drugs. The levels were evaluated by radioimmunoassay. Ultrasound assessment of the cervix was also carried out. Results There was a highly significant statistical difference between cases delivered at full term (n = 29) and cases delivered preterm (n = 14) regarding post-tocolytic DHEA-S levels (P = 0.0009). There was a significant statistical difference in pretocolytic levels of DHEA-S in cases that delivered preterm and failed to respond to tocolytic therapy. The cutoff value of pretocolytic DHEA-S was greater than or equal to 94 μg/dl, at which tocolytic therapy failed. Conclusion Maternal serum DHEA-S concentrations were normal in patients with successful tocolysis compared with elevated levels in patients with failed tocolysis who experienced preterm delivery. Elevated serum DHEA-S levels of more than 94 μg/dl could be used to predict failure of labor inhibition in preterm labor.

Role of Transdermal Glyceryl Trinitrate Patch versus Oral Isoxsuprine as a Tocolytic Agent in Preterm Labor

Role of Transdermal Glyceryl Trinitrate Patch versus Oral Isoxsuprine as a Tocolytic Agent in Preterm Labor

On Labour Repression

On Labour Repression

693: Tocolysis the setting of preterm premature rupture of membranes

Tocolysis after PPROM is controversial, and evidence to guide management is limited. We sought to determine if tocolysis after PPROM is associated with adverse neonatal outcomes. This is a secondary analysis of a randomized trial of magnesium for neuroprotection. Women at 24-32 weeks with singleton gestations and PPROM were eligible. We excluded women tocolyzed prior to randomization, fetuses with chromosomal or single gene abnormalities, and those with incomplete outcome data. The primary exposure was post randomization tocolysis. The primary neonatal outcome was culture proven sepsis, and the primary childhood outcome was a composite of death or Bayley scores 2 standard deviations below the mean at age 2 (score <70). Death is included as a competing outcome. Patient characteristics were compared by exposure. We fit logistic regression models to adjust for factors that influence odds of the outcomes including exposure to magnesium, race, education level, gestational age at birth, maternal BMI and smoking status. Of 1667 patients, 38 (2.3%) received tocolysis while 1629 (97.7%) did not. The most common tocolytic agent was magnesium (42.1%). Maternal age, race and BMI were similar among groups. Women in the tocolysis group were more educated, more likely to have multiple courses of steroids, and less likely to smoke. Neonates of tocolyzed women were larger (1687g v 1439g, p=0.01) and delivered at a later gestational age (31+1 v 29+6 weeks, p=0.01). Rates of neonatal sepsis were similar in tocolyzed versus non-tocolyzed groups (6 (15%) v 260 (16%), p=0.9). In the adjusted model the odds for sepsis and abnormal psychomotor developmental index (PDI) or death were elevated with tocolysis, although this finding did not reach statistical significance. There was no difference in abnormal mental developmental index (MDI) or death. Although the neonates of mothers given tocolysis prolonged gestation and achieved higher birth weights, tocolysis after PPROM may be harmful given possible increase risks for sepsis and low Bayley PDI/death. Further data are needed to verify findings and guide practice.

Comparison of intramuscular progesterone with oral nifedipine for treating threatened preterm labor: A randomized controlled trial.

Background: Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic agent. Methods: This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December 2011 to November 2012. Three hundred and fifteen singleton pregnant women aged >18 yrs at 26-34 weeks’ gestation with the diagnosis of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant. IRCT registration number of this study is IRCT201112198469N1 Results: The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery, birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p<0.05). None of the two drugs caused any major side effects. Conclusion: Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the NICU stay.

СРАВНЕНИЕ ТОКОЛИЗА ГЕКСОПРЕНАЛИНОМ И АТОЗИБАНОМ

The aim of the study was to compare the efficacy and safety of tocolytic agents - atosiban and hexoprenaline.Patients and methods: The study included 119 pregnant women with threatening preterm labour between 28 to 34 weeks of gestation. Sixty two pregnant received 62 tocolysis by hexoprenaline and fifty seven - atosiban. There were no differences in the clinical condition of pregnant women and features of preterm labour among groups before start of the tocolysis.The degree of effectiveness is determined by the duration of the pregnancy prolongation (48 hours, 7 days, more than 14 days).Results: 9 women of 62 that received hexoprenaline tocolysis (22,6%), and 2 – atosiban (3.5%) failed to prolong the pregnancy for more than 48 hours (p &lt; 0,05). Additionally, 5 women of the hexoprenaline group had premature labour within the first week from the treatment start and eight within 7-14 days. In the group of women with an effective atosiban tocolysis all births took place in a range of more than 7 days from the beginning of tocolysis. Four woman in hexoprenaline group received one repeated course of therapy with this drug (without a loading dose) for 24 hours. In atosiban group full repeated course was conducted in the two cases. Full-term gestation births occurred in 14 women (22.6%) after hexoprenaline tocolysis and in 19 (33.3%) – atosiban (p &gt; 0,05%). On average, atosiban tocolysis allowed to prolong pregnancy by 6.5 days longer than hexoprenaline (p &lt; 0,05).Conclusion: The results of study has shown that atosiban is more effective than hexoprenaline in pregnancy prolongation for more than 48 hours in threatening preterm labor.

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

World War I and Urban Order: The Local Class Politics of National Mobilization

In World War I and Urban Order Adam J. Hodges examines aspects of the wartime experience in Portland, Oregon, focusing on how local elites collaborated with federal authority and attempted to channel federal power to achieve a variety of prewar desires for political and social control. According to Hodges, these efforts, occurring in similar ways nationwide, established long-overlooked precedents for the surveillance and repression of labor and political activism in the United States. In Portland, local and federal officials were primarily concerned with keeping relations peaceful in the shipyards, but they also dealt forcefully with radicals, the enemy alien population, and the city's vice industry. Their collaborations obtained mixed results and often displayed surprising levels of restraint and ineffectiveness. But Hodges presents government intervention in overwhelmingly negative terms, as inspiring a “policing” of the workplace and home; neighbors who “spy” on each other; shipyard workers who have no choice but to submit to a federal agency's “paternal protection”; and labor activists, German nationals, and prostitutes who are harassed, arrested, and interned.

Annual Report of the Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2016: Overall report on a comprehensive retrospective study of obstetric management of preterm labor and preterm premature rupture of the membranes.

We conducted a questionnaire survey on the current obstetric management of preterm labor (PL) and preterm premature rupture of the membranes (pPROM). The questionnaire covered approximately a third of all preterm deliveries and nearly half of the preterm deliveries before 32 gestational weeks. The diagnostic criterion for PL was either painful uterine contractions or cervical dilatation. Tocolytic agents were primarily used as long-term maintenance therapy. Intrauterine infection was clinically diagnosed at most responding institutions. Amniocentesis was performed for PL or pPROM at only a small number (10%) of institutions. Prenatal steroids were administered for PL or pPROM, if indicated, at approximately 40-60% of responding institutions. Prophylactic antibiotics to maintain pregnancy were administered for pPROM at approximately 90% and for PL at approximately 20% of institutions. Maintenance therapy with a tocolytic agent was used for pPROM at approximately 90% of institutions.

Maternal Magnesium Level Effect on Preterm Labor Treatment

Objectives: This study intended to compare the serum magnesium level in women with preterm labor, with its level in women with normal pregnancy of the same age, and assess the relationship between serum magnesium level and response to magnesium sulfate (MgSO4). Materials and Methods: Forty women aged 18-40, with gestational age of 26-32 weeks and signs of preterm labor, and 40 women in similar age and gestational age with normal pregnancy were included in this study. Case group received betamethasone 12 mg in 2 separate doses with 24-hour interval. MgSO4 was administrated (in dose of 4 mg), and continued by 2 mg/h. Once the tocolytic therapy goal was achieved, the administration of MgSO4 continued for an additional 12-hour. Results: The mean age, gestational age, gravidity, parity, number of live born children, number of dead children, miscarriage, and molar pregnancy were similar in 2 groups. The mean of serum magnesium level showed a significant difference between 2 groups. In the case group, 27 patients showed positive therapeutic response to MgSO4; the difference between the mean of serum magnesium level in these 27 patients and the other 13 patients who did not respond well was significant. The serum magnesium level < 1.85 mg/dL as a cut-off point had 85 sensitivity and 78 specificity with CI = 0.75-0.97 in predicting response to MgSO4 in the case group. Conclusion: Serum magnesium level can be used as a predictive tool for preterm labor. It can help in preterm labor in selecting patients who benefit from MgSO4 as a tocolytic agent. Magnesium supplementation may be helpful in patients with decreased serum magnesium level to prevent preterm labor. © 2018 The Author (s).

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

Effectiveness and safety of the oxytocin antagonist( atosiban) versus beta-adrenergic agonists (salbutamol) in the treatment of preterm labor

Background and Objectives: preterm labor complicates 5-10% of pregnancies and is a leading cause of neonatal morbidity and mortality worldwide and 70-80% of perinatal deaths occur in preterm infants. The aim of this study is to compare the effectiveness, safety and adverse effects of the oxytocin antagonist medication(atosiban) with those of beta-adrenergic agonist (salbutamol) in the treatment of patients with preterm labor.Patients and Methods: one hundred pregnant women with preterm labor were enrolled in this study from the period of( January 2014 – January 2015) at Al-Diwaniya Maternity and Pediatrics Teaching Hospital-Iraq with a gestational age of 24-34 weeks, they were randomly assigned to receive tocolytics either salbutamol (n=50) or atosiban (n=50).Salbutamol was given by(intravenous infusion 10-50 microgram)for up to 48 hour. Atosiban was given by (intravenous bolus dose of 6.75 mg then 300microgram/minute for 3 hour and 100microgram/minute for up to 48hour). Retreatment with the study drugs or alternative tocolytic agents was allowed. Main outcome measures included were tocolytic effectiveness, which was assessed in terms of number of women undelivered after 48hour and 7 days. Tocolytic safety was assessed in terms of maternal and fetal side effects and neonatal morbidity.Results: there were no significant differences between the salbutamol and the atosiban group in prolongation of pregnancy for 48 hour (44% versus 46%;p=0841)and 7 days(20% versus 32%;p=0.171) ,respectively. Maternal adverse events , including tachycardia occurred more frequently in the salbutamol group(22% versus 8%;p=0.050).Neonatal outcomes and complications were comparable between the two study groups(42% versus 32%;p=0.30).Conclusions: the oxytocin antagonist (atosiban) was as effective as beta-agonist(salbutamol) in delaying threatened preterm birth , and found to be better tolerated by both the mother and fetus than salbutamol , with a comparable neonatal safety profil.This study supports the clinical use of atosiban as a first line tocolytic in the treatment of preterm labor.

Neonatal Survival Rate following Premature Rupture of Membranes at Gestational Age 15-30 Weeks

Objectives: To determine neonatal survival rate and associated factors in pregnancies with preterm premature rupture of membranes (PPROM) at gestational age (GA) between 15 and 30 weeks. Materials and Methods: This retrospective descriptive study was conducted by reviewing the medical records of the pregnant women with premature rupture of membranes (PROM) at 15-30 weeks’ gestation admitted at King Chulalongkorn Memorial Hospital between 1st January 2002 and 31st December 2013. Logistic regression analysis was used to determine association between factors and neonatal survival. Results: The total number of pregnancies in this study was 99 and neonatal survival rate was 80.8% (95% confidence interval 71.4-87.8%). Women with PPROM at GA between 15 and 19+6 weeks had neonatal survival rate of 16.7% while neonatal survival rates of cases with PPROM at 20-23+6 weeks and 24-30 weeks were 50.0% and 92.2%, respectively. Factors associated with increased neonatal survival from logistic regression analysis included GA at PROM ≥ 24 weeks and tocolytic administration. Conclusion: Neonatal survival in pregnancies with midtrimester PPROM depended on GA when PROM started. Neonates in women with PPROM at ≥ 24 weeks’ gestation had more chances to survive than those with PROM at GA less than 24 weeks. Use of tocolysis was associated with increase neonatal survival.

Laparoscopic cystectomy in pregnancy, a viable solution - A 14 years series.

Study objective:To evaluate the safety and maternal fetal outcome of laparoscopic surgery in the management of ovarian mass in pregnant women and the usage of analgesia in postoperative period.Materials and methods:This is a retrospective cross-sectional study which was carried out at department of O&G, Putrajaya Hospital. A total of 120 cases of ovarian mass in pregnancy between Jan 2000–December 2014 were evaluated. 115 patients had undergone laparoscopy cystectomy/salpingo-oophorectomy. Women’s age, parity, gestational age, surgical technique, operative findings and time, estimated blood loss, postoperative hospital stay, post operative pain score, usage of analgesia, complications of surgery, outcome of the pregnancy and histopathology reports were evaluated.Measurement and main results:Outcome of the pregnancy and post operative pain score and usage of analgesic were evaluated. The mean gestational week at the time of surgery was 14 weeks 1 day (±2 weeks 1 day). The duration of surgery was 87.4 mins (±34.8 mins) with average blood loss of 110.3 ml (±32.0). Median size of ovarian cyst was 6 cm (IQR 2 cm). 2 cases converted to laparotomy. Only 2 cases were reported with second trimester loss which was diagnosed after 4 weeks and 10 weeks respectively. 5 women received tocolytic agent post operatively, all of them delivered at term.The mean length of hospitalization was 1.51 day (±0.597). The average gestational age of delivery was 37.78 (±3.42) mean birth weight 2.97 kg (±0.65 kg). There was one intrauterine growth restriction baby with birth weight of 1.89 kg at 35 weeks of gestation and another baby with bladder exstrophy with ambiguous genitalia which was not related to surgery. The mean of pain score was 1.5 (±1.6) over 10. 87.9% of the women had mild pain which only 64.6% require paracetamol or no analgesia.Conclusion:Majority of women with ovarian masses in pregnancy can be treated with ensured safety and reduced morbidity using the endoscopic approach.

A case of sudden onset of thyroid storm just before cesarean section manifesting congestive heart failure and pulmonary edema

BackgroundSince acute respiratory failure (ARF) is a life-threatening complication, particularly in the gestational period, differential diagnosis and rapid treatment are required. Among the various causes of sudden onset of ARF, thyroid storm is a rare cause in a parturient complicated with well-controlled hyperthyroidism. In this case report, we describe a parturient with hyperthyroidism in whom a thyroid storm manifesting congestive heart failure and pulmonary edema developed just before an emergency ceasarean section, even though hyperthyroidism was well-controlled with antithyroid drugs.Case presentationA 36-year-old pregnant woman was diagnosed as having clinical chorioamnionitis, and an emergency cesarean section was performed at 25 weeks of pregnancy. She had a complication of hyperthyroidism accompanied by mild mitral regurgitation, and she had been treated with methimazole. She was treated with ritodrine and MgSO4 for the threat of premature delivery. At the preoperative consultation, her percutaneous oxygen saturation (SpO2) was 98% on room air. When she was admitted to the operating room, her heart rate and blood pressure were 130 beats/min and 196/78 mmHg, respectively. SpO2 was 88% on room air without any symptoms; however, just after starting oxygen administration via a facemask, she complained of severe respiratory distress and became agitated. Partial pressure of arterial oxygen was 108 mmHg with an inspiratory oxygen fraction of 1.0. Chest radiography revealed pulmonary congestion, and transesophageal echocardiography revealed normal right ventricular function without an embolus and severe mitral regurgitation with preserved left ventricular function. Contrast-enhanced computed tomography after the operation revealed no pulmonary embolus but revealed a pulmonary effusion, and free triiodothyronine level was increased at the onset of dyspnea. Therefore, we diagnosed the causes of sudden onset of dyspnea as pulmonary edema and congestive heart failure induced by a thyroid storm.ConclusionSudden onset of a thyroid storm just before a cesarean section occurred in a patient with several risk factors of thyroid storm and pulmonary edema, including pregnancy, treatment with tocolytic agents, and infection. The involvement of these multiple factors was considered to be the cause of the sudden onset of the thyroid storm and the cause of rapidly progressive pulmonary edema.

The Essence of Tocolysis

The Essence of Tocolysis