Tocolytic Therapy Research Articles

Methods of preventive intervention in women with multiple pregnancies in non-assymptomic circulation

The aim: The purpose of the study is a comparative evaluating the effectiveness of using the different methods of treatment of miscarriage in multiple pregnancies taking into account the condition of the cervix. Materials and methods: 86 pregnant women with diarrheal twins were monitored. On the basis of studying the premorbid background, somatic and reproductive history, features of the gestational period, leading antenatal risk factors for the development of complications in multiple pregnancies were identified. With the help of transvaginal cervicometry the prognostic ultrasound criteria of the condition of the cervix and its obstructive capacity in case of premature birth are investigated. Results: In the event of uncomplicated pregnancy multiple birth is characterized by a gradual shortening of the cervix in dynamics from 43.2 ± 3.9 mm to 38.2 ± 4.0 mm by 20 weeks, from 37.7 ± 4.1 mm to 30.2 ± 3.9 mm to 30 weeks, to 21.1 ± 3.1 mm to 37 weeks. In the period of 25-27 weeks, the appearance of a V-shaped opening of the uterine cervix in half of the women was observed, which remained until the end of gestation. Shortening of the cervix was the most significant in patients with the risk of abortion who received only tocolytic therapy. In the 2nd trimester revealed a V- or U-shaped opening of the cervical canal. In pregnant women at risk who had an obstetric pessary, a decrease in the length of the cervix was found, which was similar to the rate of its shortening in uncomplicated multiple pregnancies. The condition of the cervix in the presence of a pessary before delivery probably did not differ from the condition of the cervix with the normal course of multiple pregnancies. Conclusions: Pregnant women with uncomplicated multiple pregnancies revealed a decrease in the length of the cervix with an increase in gestation. At the end of pregnancy, the internal jaws acquired a predominantly Y-shape. In pregnant women with the risk of pregnancy termination who received tocolytic therapy, the cervix was the shortest. In late gestation, V- and U-shaped internal jaws were observed. Changes in the cervix after the placement of obstetric pessaries are similar to changes in uncomplicated pregnancy.

The outcomes of triplet pregnancies

Introduction. Extensive use of assisted reproduction has resulted in an increased incidence of triplet pregnancies, which are associated with higher risk of complications in mothers and newborns. Material and Methods. A retrospective study reviewed a total of 85 triplet pregnancies delivered at the Department of Obstetrics and Gynecology, Clinical Center of Vojvodina, Novi Sad, from January 1, 2010 to December 31, 2017. Results. The average maternal age was 32 years and the average body mass index was 30.56 kg/m2. The average gestational age at birth was 32 weeks. One patient (1.18%) had vaginal delivery, while 84 (98.82%) pregnancies were completed by cesarean section. The average blood loss was 1294 ml and there was one postpartum hysterectomy. The most common maternal pregnancy-induced complications were sideropenic anemia (70.58%), hypertensive syndrome (40%) and obstetric cholestasis (35.29%). Preterm premature rupture of membranes was observed in 17 (20%) patients. Prophylactic cerclage was performed in 57 patients (67.05%) and 12 patients (14.11%) received tocolytic therapy. The average birth weight of the first newborn was 1838 g, 1755 g of the second, and 1695 g of the third. Body weight ? 1500 g was observed in 61 newborns (24.01%). The mean Apgar score in the first minute was 7, while in the fifth minute it was 8. Respiratory distress syndrome was found in 64 newborns (25.19%). Conclusion. Monitoring and treatment of triplet pregnancies remains a complex task for obstetricians due to the increased incidence of prematurity and perinatal morbidity.

755: Nifedipine versus ritodrine during external cephalic version procedure: a case control study

Published series regarding interventions for facilitating external cephalic veriosn (ECV) have concluded that parenterally administered beta-stimulant tocolytics, increased ECV success rate and reduced the number of caesarean sections. However, there were insufficient data regarding calcium channel blockers (CCB) to provide good evidence regarding its efficacy. Given the paucity of literature, we aimed to compare the efficacy of nifedipine to that of ritodrine on ECV success rates. This is a retrospective case control study of prospectively collected data of patients who underwent ECV between January 2012 and December 2013 at Bikur Cholim Medical Center and Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Patient undergoing ECV with tocolysis by ritordine were compared to those using nifedipine as tocolysis. Patients were matched in a one-to-one ration by parity and placental location. Overall, 148 women received ritodrine and 148 women received nifedipine prior to ECV procedure. Overall Success rate was higher among the ritodrine group (82.4% vs. 63.5%, p< 0.001). Among nuliiparous and among parous, success rate was higher in the ritodrine group (78.9% vs. 57.9% and 88.6% vs. 73.5%, p=0.001, p=0.04, respectively). Vaginal delivery rate was higher among the ritodrine group (86.5% vs. 68.9%, p< 0.001). Cesarean delivery rate was 31.1% for the nifedipine group versus 13.5% in the ritodrine group (p< 0.001). Number needed to treat to benefit (NNTb) 5.7 (95% confidence interval 3.7 to 12.1). Overall, 216/296 (72.9%) of ECV were successful. Ritodrine was associated with higher success rates as compared with nifedipine (56.5% vs. 32.5%, p< 0.001). In a multivariate analysis, ritodrine tocolytic therapy was independently associated higher ECV success rates as compared with nifedipine (OR 4.54, 95% CI 2.38-9.09. Higher AFI (OR 1.16, 95% CI 1.05-1.28) and nulliparity (OR 0.16, 95% CI 0.08-0.30) were additional independent predictors of ECV outcome. Ritordine significantly improve the success of ECV compared to nifedipine. Both drugs are shown to be safe.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Obstetric and neonatal outcomes of delayed interval delivery in cerclage: A retrospective study

ObjectiveDelayed delivery is sometimes selectively performed in twin pregnancy when the first birth occurs inevitably in order to improve the prognosis and decrease the morbidity and mortality of the second twin. The aim of this study is to explore the maternal and fetal outcomes of pregnancies in which cerclage is carried out following the loss of first fetus in twin gestation for delayed interval delivery. MethodsThree cases of delayed-interval delivery of dichorionic-diamniotic twin pregnancies were reported in our center between 2017 and 2018 and were retrospectively analyzed. Once the first twin was delivered, the second twin was left in utero and the patient underwent in utero percutaneous umbilical cord ligation, antibiotics, tocolytic therapy and cervical cerclage. ResultsMean gestational age at delivery of the first fetuses was 21.6 ± 2.9 weeks and 24.8 ± 4.0 weeks for the remaining fetuses, respectively. The mean interval of the delay was 22 days (4–50 days). Mortality of the first fetus was 66.7%, and the retained one was 33.3%. In general, maternal outcome was good, one patient experienced postpartum hemorrhage and placenta accreta. However neonatal aftermath was generally not favorable, probably due to extreme prematurity. ConclusionsCervical cerclage after the first delivery could prolong the pregnancy until an adequate gestational age at which an enhanced prognosis and better perinatal outcome for the second twin can be achieved.

Cervical Length Estimation and Cervicovaginal Fluid for Placental &amp;lt;i&amp;gt;α&amp;lt;/i&amp;gt;-Microglobulin 1 Testing to Screen Women Had Threatened Preterm Labor for Time till Spontaneous Labor

Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL). Patients & Methods: 37 women presenting with TPTL underwent CVF samplings before digital examination and then underwent transvaginal ultrasonography for estimation of cervical length (CL). All women received fluid and anxiolytic therapy and if uterine contractions persisted, all had received tocolytic therapy with oral nifedipine or intravenous magnesium sulphate according to requirements. Incidence of SL within <48 hr, 2 - 7 and 7 - 14 days was recorded and related to CL and result of FFN and PAMG-1 tests. Results: Incidence of SL was 13.5%, 35.2% and 51.3% within 48-hr, 2 - 7 and 7 - 14 days, respectively. Duration till labor after sampling was positively correlated with CL, while was negatively correlated with positive FFN and PAMG-1 tests. Positive FFN test had high specificity, while positive PAMG-1 test had high sensitivity for labor within 7 days. Regression analysis defined short CL and positive PAMG-1 test as significant predictors for short duration till SL. ROC curve analysis defined short cervix and positive PAMG-1 test as significant predictors for labor within 48-hr and within 2 - 7 days respectively and combined negative PAMG-1 test and CL of 20 - 25 mm were significant predictors for labor within 7 - 14 days. Conclusion: PAMG-1 test had high specificity, if positive, for predicting SL and high NPP, if negative, for excluding labor within 7 days, so it can be used as rapid adjuvant to clinical evaluation to help management decision-making. Moreover, PAMG-1 test is recommended screening test for being easy-to-use bedside test, provides rapid results, can be used after vaginal exam and coitus and does not require a speculum examination or specialized equipment to analyze results.

Nifedipine versus ritodrine during external cephalic version procedure: a case control study

Objective Published series regarding interventions for facilitating external cephalic version (ECV) have concluded that parenterally administered beta-stimulant tocolytics, increased ECV success rate and reduced the number of cesarean sections. However, there were insufficient data regarding calcium channel blockers to provide good evidence regarding its efficacy. Given the paucity of literature, we aimed to compare the efficacy of nifedipine to that of ritodrine on ECV success rates. Methods This is a retrospective case control study of prospectively collected data of patients who underwent ECV between January 2012 and December 2013 at Bikur Cholim Medical Center and Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Patient undergoing ECV with tocolysis by ritodrine were compared with those using nifedipine as tocolysis. Patients were matched in a one-to-one ration by parity and placental location. Results Overall, 148 women received ritodrine and 148 women received nifedipine before ECV procedure. Overall success rate was higher among the ritodrine group (82.4 vs. 63.5%, p < .001). Among nulliparous and among parous, success rate was higher in the ritodrine group (78.9 vs. 57.9 and 88.6 vs. 73.5%, p = .001, p = .04, respectively). Vaginal delivery rate was higher among the ritodrine group (86.5 vs. 68.9%, p < .001). Cesarean delivery rate was 31.1% for the nifedipine group versus 13.5% in the ritodrine group (p < .001). Number needed to treat to benefit (NNTb) 5.7 (95% confidence interval 3.7–12.1). Overall, 216 of 296 (72.9%) of ECV were successful. Ritodrine was associated with higher success rates as compared with nifedipine (56.5 vs. 32.5%, p < .001). In a multivariate analysis, ritodrine tocolytic therapy was independently associated higher ECV success rates as compared to nifedipine (OR 4.54, 95% CI 2.38–9.09). Higher amniotic fluid index (OR 1.16, 95% CI 1.05–1.28) and nulliparity (OR 0.16, 95% CI 0.08–0.30) were additional independent predictors of ECV outcome. Conclusion Ritodrine significantly improve the success of ECV compared with nifedipine. Both drugs are shown to be safe.

Prenatal Probiotics: The Way Forward in Prevention of Preterm Birth

Preterm birth (PTB) has presented a major challenge since decades among the obstetricians. Many premature born individuals have learning disabilities, visual and hearing problems. Abnormal vaginal microbiota and bacterial vaginosis (BV) are important risk factors for PTB and premature rupture of the membranes. In women with BV, there is a dramatic reduction of Lactobacillus and heavy colonization of the pathogenic bacteria. Administration of Lactobacillus rhamnosus GR1 and Lactobacillus reuteri RC14 in pregnant women restores the normal vaginal flora and acidic pH and interrupts the infectious/inflammatory process. Probiotics are preferred over tocolytic therapy to reduce the adverse maternal and fetal outcome. J Clin Gynecol Obstet. 2019;8(3):63-69 doi: https://doi.org/10.14740/jcgo571

Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor.

BackgroundPreterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome.ObjectiveTo evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL.Materials and MethodsThis comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20░mg of rapid release nifedipine orally. If uterine contraction continued, a 10░mg dose was repeated every 20░min with a maximum of 40░mg within the first hour. After completing the first hour, 20░mg was given every 4–6 hr for 72░hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200░mg daily.ResultsSuccessful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13░±░5.08 days in group A while 29.73░±░3.10 days in group B. (p░≤░0.001)ConclusionAcute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions.

COMPARATIVE ESTIMATION OF THE EFFICIENCY OF PREVENTIVE INTERVENTION IN WOMEN WITH MULTIPLE PREGNANCY WITH ASYMPTOMATIC CUTTING NECK OF UTERUS

The purpose of the study is a comparative assessment of the effect of different methods of treatment for nonpregnancy in multiple pregnancies, taking into account the state of the cervix. Material and methods of research. Under supervision were 86 pregnant women with dyhoidal twins. Based on the study of premorbid background, somatic and reproductive anamnesis, features of the gestation period, the leading antenatal factors of the risk of development of complications during multiple pregnancy are highlighted. Prognostic ultrasound criteria for the state of the cervix and its obstructive capacity in the event of a threat to premature births were studied using transvaginal cervicomercia.Results of the research and their discussion. Given the uncomplicated flow of multiple pregnancy, the gradual shortening of the cervix in the dynamics from 43.2 ± 3.9 mm to 38.2 ± 4.0 mm to 20 weeks, from 37.7 ± 4.1 mm to 30.2 ± 3 , 9 mm to 30 weeks, to 21.1 ± 3.1 mm to 37 weeks. In the period of 25-27 weeks, the appearance of a V-shaped opening of the cervix uterine in half of the women, which remained until the end of gestation. Breaking the cervix was most significant in patients with a risk of abortion, receiving only toсolithic therapy. In the second trimester, V- or U-shaped disclosure of the cervical canal was revealed. In pregnant women, the risk of obstetric pessary has been shown to reduce the length of the cervix, which was similar to the rate of its shortening in uncomplicated multiple pregnancy. The state of the cervix in the presence of psiaritis before childbirth probably did not differ from the state of the cervix with the normal course of multiple pregnancy.Conclusions. In pregnant women with uncomplicated flow of multiple pregnancy revealed a decrease in the length of the cervix with an increase in gestational age. At the end of pregnancy, internal salts acquired predominantly Y-shaped forms. In pregnant women with a risk of abortion, who received tocolytic therapy, the cervix was the most truncated. In the late gestational age, V- and U-shaped forms of the inner throat were observed. Changes in the cervix after the establishment of obstetric pessary are similar to changes in the uncomplicated pregnancy.

Characterization of the effects of Atosiban on uterine electromyograms recorded in women with threatened preterm labor

Although research studies using electrohysterography on women without tocolytic therapy have shown its potential for preterm birth diagnosis, tocolytics are usually administered in emergency rooms at the first sign of threatened preterm labor (TPL). Information on the uterine response during tocolytic treatment could prove useful for the development of tools able to predict true preterm deliveries under normal clinical conditions. The aim of this study was thus to analyze the effects of Atosiban on Electrohysterogram (EHG) parameters and to compare its effects on women who delivered preterm (WDP) and at term (WDT). Electrohysterograms recorded in different Atosiban therapy stages (before, during and after drug administration) on 40 WDT and 27 WDP were analyzed by computing linear, and non-linear EHG parameters. Results reveal that Atosiban does not greatly affect the EHG signal amplitude, but does modify its spectral content and reduces the energy associated with the fast wave high component in both WDP and WDT, with a faster response in the latter. EHG signal complexity remained constant in WDT, while it increased in WDP until it reached similar values to WDT during Atosiban treatment. The spectral and complexity parameters were able to separate (p < 0.05) WDT and WDP prior to and during tocolytic treatment and before and after treatment, respectively. The results pave the way for developing better and more reliable medical decision support systems based on EHG for preterm delivery prediction in TPL women in clinical scenarios.

Term pregnancy not requiring cerclage placement or tocolytic therapy in a patient with a unicornuate uterus and history of myomectomy

The authors present the case of a 28-year-old nulliparous woman, who successfully carried a term pregnancy in a unicornuate uterus with a solid non-communicating rudimentary horn, and a history of myomectomy, without cerclage placement or tocolytic therapy. The patient was admitted to the present clinic for uterine fibroids and menorrhagia. The patient underwent laparotomy, during which a myomectomy was performed. Twelve months after the surgery, the patient conceived spontaneously. Routine obstetric ultrasounds revealed normal intrauterine fetal development. Cerclage and tocolytic therapy were not indicated at any stage of the pregnancy. A live female neonate was delivered via cesarean section at 39 weeks’ gestation.

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.

41: Three-dimensional patient-derived uterine cell culture for evaluating the efficacy of tocolytic combinations

Despite some improvements in the preterm labor (PTL) treatment, the rates are remaining high. Tocolytic therapies vary in drug class and mechanism of action. Since tocolytics are frequently associated with serious maternal/fetal side effects, using drug combinations could (1) be more efficacious over a single tocolytic, while allowing for (2) dose and, thus, toxicities reduction. Indeed, in cardiovascular, infectious and other disorders, drug combinations are common, yielding safer (lower doses) and more efficient (synergistic action) therapies. However, a recent review (Cochrane 2014) concluded that “It is unclear if a combination of tocolytic drugs for PTL is more advantageous ...”. A possible reason for that outcome can be the need for individualization of the doses of tocolytic agents used in combination. Our objective was to design an assay that can shed more light on the efficacy of tocolytic drug combinations for PTL management. We developed a new in vitro assay, Contractility Bio (CBiO) Assay, that uses magnetic bioprinting/levitation to assemble cells into 3D rings (Fig 1). The bioprinted uterine rings spontaneously contract and the kinetics/ dynamics of this contraction can (1) be assessed by area change using an imaging device; (2) prevented by tocolytics. We have evaluated the effects of tocolytic agent combinations (indomethacin, IND, and nifedipine, NIF) on preventing contraction of uterine cell rings bioprinted from patient derived cells. Uterine tissues were obtained from women undergoing cesarean sections at term (39w) and preterm (34w) gestations. Various combinations of tocolytics were assessed in CBiO assay. Changes in contractility were calculated based on the ring area over time. (1) There are differences between the response of bioprinted uterine tissues from term and preterm patients (Fig 2); (2) Effects of clinically used tocolytics in preventing the contractions in CBio assay vary; (3) There is a dose range in which drug combinations had synergistic effect in preventing the contractions, as evident from preterm uterine tissue response to a combination of IND 75% and NIF 25%. CBiO assay can serve as a basis for studying the mechanisms by which the use of tocolytics can be personalized to yield safer and more efficient regimens for PTL management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Nifedipine alone or combined with sildenafil citrate for management of threatened preterm labour: a randomised trial.

To study the tocolytic action of nifedipine combined with sildenafil citrate (SC) and if the combination is superior to nifedipine alone in inhibiting threatened preterm labour (PTL). Prospective randomised study. An Egyptian university hospital. Women with threatened PTL who received either nifedipine with SC or nifedipine alone. Patients were randomly allocated to receive either (1) nifedipine 20mg orally (stat dose), followed by 10mg orally every 6-8hours at the same time as vaginal administration of SC (25mg at 8-hourly intervals) or (2) nifedipine alone. Medications were continued for 48-72hours. The percentage of women who remained undelivered during hospitalisation. From January 2015 to November 2016, 239 women were randomised. The baseline characteristics of participants were similar. Nifedipine combined with SC was associated with more women remaining undelivered (81.8 versus 68.6%; P=0.018) during hospitalisation. Regarding secondary outcomes, the addition of SC was also associated with fewer deliveries within 7days of admission (9.1 versus 20.3%; P=0.014), prolonged latency (29 versus 7days; P=0.002), fewer admissions to neonatal intensive care units (31.4 versus 44.1%; P=0.043), fewer very preterm deliveries (from 28 to <32weeks, 20.7 versus 38.1%; P=0.043), and increased neonatal birthweight (1900 versus 1500g; P=0.018). Vaginal SC combined with nifedipine is an effective option for tocolytic therapy during threatened PTL. Vaginal SC enhances the tocolytic effect of nifedipine.

Differences between evidence-based recommendations and actual clinical practice regarding tocolysis: a prospective multicenter registry study

BackgroundInternational guidelines recommend that tocolytic therapy be restricted to a single 48-h application. However, multiple cycles of tocolytic therapy and maintenance therapy that exceeds 48 h appear to play a role in daily clinical practice. We aimed to evaluate current trends in clinical practice with respect to treatment with tocolytic agents and to identify differences between evidence-based recommendations and daily clinical practice in Austria.MethodsA prospective multicenter registry study was conducted from October 2013 through April 2015 in ten obstetrical departments in Austria. Women ≥18 years of age who received tocolytic therapy following a diagnosis of threatened preterm birth were included, and details were obtained regarding clinical characteristics, tocolytic therapy, and pregnancy outcome.ResultsA total of 309 women were included. We observed a median of 2 cycles of tocolytic therapy per patient (IQR 1–3) with a median duration of 2 days per cycle (IQR 2–5). Repeat tocolysis was administered in 41.7% of women, resulting in up to six tocolysis cycles; moreover, 40.8% of the first tocolysis cycles were maintenance tocolysis (i.e., longer than 48 h). Only 25.6% of women received one single 48-h tocolysis cycle in which they received antenatal corticosteroids for fetal lung maturation in accordance evidence-based recommendations.ConclusionsHere, we report a clear disparity between evidence-based recommendations and daily practice with respect to tocolysis. We believe that the general practice of prescribing tocolytic therapy must be revisited. Furthermore, our findings highlight the need for contemporary studies designed to investigate the effectiveness of performing maintenance and/or repetitive tocolysis treatment.

Comparative assessment of various methods of miscarriage treatment efficacy in multifetal pregnancy

Aim. Comparative assessment of various methods of miscarriage treatment efficacy in multifetal pregnancy taking into account the cervical remodeling. Materials and Methods. 62 pregnant women with dichorionic twins were observed. The general, somatic, obstetric-gynecological anamnesis, the pregnancy and childbirth course and the state of newborns were studied. All women underwent transvaginal cervicometry throughout the pregnancy. The cervical length and the shape of internal cervical os were determined. Results . In women with uncomplicated pregnancy cervical length was shortened from 43.2 ± 3.9 mm to 38.2 ± 4.0 mm up to 20 weeks’ gestation, from 37.7 ± 4.1 mm to 30.2 ± 3.9 mm up to 30 weeks and to 21.1 ± 3.1 mm up to 37 weeks. In the period of 25–27 weeks V-shaped endocervical canal opening was observed in half of the women and remained until the end of gestation. Cervix shortening was most pronounced in patients with pregnancy threatening miscarriage, who received only tocolytic therapy. In the 2nd trimester V- or U-shaped endocervical canal opening was observed. At 34–36 weeks the length of cervix was significantly shorter than in uncomplicated pregnancy. The rate of cervical length shortening among pregnant women of the risk group, who were treated with a vaginal pessary, and women with uncomplicated pregnancy was similar. The cervical remodeling with a vaginal pessary was not significantly different from that in normal course of multifetal pregnancy before childbirth. In addition, there were no significant differences in the characteristics of delivery, the perinatal mortality indicators and the newborns state. Conclusions. In pregnant women with uncomplicated multifetal pregnancy cervical length shortening is observed as the gestational age increases. In pregnant women with pregnancy threatening miscarriage, who received tocolytic therapy, the cervix was the most shortened. V- and U-shaped endocervical canal changes were observed in the late gestation. Changes in the cervix after vaginal pessary placement are similar to those in uncomplicated pregnancy.

Uterine electromyography for discrimination of labor imminence in women with threatened preterm labor under tocolytic treatment.

As one of the main aims of obstetrics is to be able to detect imminent delivery in patients with threatened preterm labor, the techniques currently used in clinical practice have serious limitations in this respect. The electrohysterogram (EHG) has now emerged as an alternative technique, providing relevant information about labor onset when recorded in controlled checkups without administration of tocolytic drugs. The studies published to date mainly focus on EHG-burst analysis and, to a lesser extent, on whole EHG window analysis. The study described here assessed the ability of EHG signals to discriminate imminent labor (< 7days) in women with threatened preterm labor undergoing tocolytic therapy, using both EHG-burst and whole EHG window analyses, by calculating temporal, spectral, and non-linear parameters. Only two non-linear EHG-burst parameters and four whole EHG window analysis parameters were able to distinguish the women who delivered < 7days from the others, showing that EHG can provide relevant information on the approach of labor, even in women with threatened preterm labor under the effects of tocolytic therapy. The whole EHG window outperformed the EHG-burst analysis and is seen as a step forward in the development of real-time EHG systems able to predict imminent labor in clinical praxis. Graphical abstract The ability of EHG recordings to predict imminent labor (< 7days) was analyzed in preterm threatened patients undergoing tocolytic therapies by means of EHG-burst and whole EHG window analysis. The non-linear features were found to have better performance than the temporal and spectral parameters in separating women who delivered in less than 7days from those who did not.

Association between preterm labour and pelvic floor muscle function

We hypothesised that the pressure on the cervix increases with advancing gestation and it may lead to a cervical shortening and cause preterm labour in women with weak pelvic floor muscles. The aim of this prospective study was to measure vaginal resting pressure and pelvic floor muscle strength in the first trimester of pregnancy and to investigate their effects on labour. A study was conducted on the pregnant women with a low risk for preterm birth. The pelvic floor muscle strength and vaginal resting pressure were assessed in 320 pregnant women at their first trimester with a vaginal pressure measurement device. Fifty-two pregnant women were hospitalised for tocolytic therapy because of spontaneous preterm labour. Thirty-two of them (10.2%) had a preterm delivery despite the tocolytic therapy. Both the vaginal resting pressure (p = .009, 95%CI: 0.8; 5.9) and the pelvic floor muscle strength (p = .01, 95%CI: 3.5; 13.1) were significantly lower in the women with a preterm labour.Impact statementWhat is already known on this subject? The pelvic floor muscles have an essential role in continence and provide support to the pelvic organs. They also have an impact on labour. The pelvic floor muscles should distend to allow the passage of the foetus during labour. The rotation and flexion of the foetal head is due to the pelvic floor resistance. The effect of a vaginal birth on the pelvic floor’s function is readily understood. On the other hand, the effect of the pelvic floor muscle function on labour is still controversial.What do the results of this study add? This prospective study showed that there is a negative association between the pelvic floor muscle strength and preterm labour. This is the first clinical study indicating that weak pelvic floor muscles may cause a preterm labour.What are the implications of these findings for clinical practice and/or further research? Pelvic floor physical therapy may be an alternative preventive strategy to reduce the risk of a spontaneous preterm birth.

Oxytocin Receptor Antagonist (Atosiban) in the Threat of Preterm Birth: Does It Have Any Effect on Breastfeeding in the Term Newborn?

Oxytocin is a hormone involved in the mechanism of breastfeeding, uterine contractions, and social relationships. Atosiban (competitive oxytocin antagonist) is one of the most commonly used tocolytics for the threat of preterm labor in Europe. The aim of this study is to determinate if the administration of atosiban has any influence in the type of feeding in the term newborn at discharge. The secondary objective is to verify its effectiveness for the prevention of preterm delivery and in the possibility of applying treatment to complete lung maturation. Retrospective cohort study carried out in a tertiary University Hospital distinguished by WHO-UNICEF as a Baby-Friendly Hospital Initiative. The analysis included 264 women exposed to atosiban during a period of 4 years. One hundred met inclusion criteria. Unexposed infants born right after and before the exposed ones were selected as the not exposed subgroup (n = 200). Among women treated with atosiban, 82% maintained exclusively breastfed (EBF), 8% had mixed breastfeeding, and 10% had formula feeding at discharge. In the nonexposed group, 82% maintained EBF, 9.5% had mixed breastfeeding, and 8.5% had formula feeding at discharge (p = 0.84). 97.5% of pregnant women treated with atosiban received corticosteroid for lung maturation, and 49.5% completed gestation with term newborns. There were no significant differences in the type of feeding at discharge between the atosiban group and the nonexposed group. In most cases, the administration of tocolytic therapy allowed to complete lung maturation.

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.