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TEMPLATE DESIGN © 2008 www.PosterPresentations.com MAINTENANCE NIFEDIPINE FOR TOCOLYSIS IN PRETERM LABOUR: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL Uma M, Ixora KA, Nor Azlin MI, ZA Mahdy Department of Obstetrics & Gynaecology, Universiti Kebangsaaan Malaysia Medical Centre (UKMMC) Objectives ResultsConclusions References 1. Lewis R. Oral terbutaline after parenteral tocolysis: A randomised, double-blind, placebo- controlled trial. American Journal of Obstetrics and Gynaecology 1996;175 (4):834-37 2. King JF, Flenady V, Papatsonis D et al. Calcium Channel Blockers for inhibiting preterm labour: A systematic review of the evidence and a protocol for administration of nifedipine. Aust and NZ Journal of Obstet and Gynaecol 2003; 43:192-98 3. Oei, SG, Mol BW, de Kleine MJ et al. Nifedipine versus ritodrine for suppression of preterm labor; a meta-analysis. Acta Obstet Gynecol Scand 1999; 78(9): 783-8. 4. Tsatsaris V, Papatsonis D, Goffinet F et al. Tocolysis with nifedipine or beta-adrenergic agonists: a meta-analysis. Obstet Gynecol 2001; 97(5 Pt 2): 840-47. 5. Ferguson JE, Dyson DC, Schutz T et al. A comparison of tocolysis with nifedipine or ritodrine: analysis of efficacy and maternal, fetal, and neonatal outcome. Am J Obstet Gynecol 1990; 163(1 Pt 1):105-11. 6. Papatsonis DN, Van Geijn HP, Ader HJ et al. Nifedipine and ritodrine in the management of preterm labor: a randomized multicenter trial. Obstet Gynecol 1997; 90(2): 230-4. 7. Sanchez-Ramos L, Kaunitz AM, Gaudier FL et al. Efficacy of maintenance therapy after acute tocolysis: a meta-analysis. Am J Obstet Gynaecol 1999; 181(2):484-90. 8. Conde-Agudelo A, Romero R, Kusanovic JP. Nifedipine in the management of preterm labour: a systematic review and metaanalysis. Am J Obstet Gyecol 2011; 204(2): 134 e1-20. 9. Ixora KA, Nor Azlin MI, Ani Amelia Z et al. Terbutaline versus nifedipine in the management of preterm labour. Unpublished thesis for the Masters of Obstetrics and Gynaecology (UKM) 2007: 177-200. 10. Wigton TR, Tamura RK, Wickstrom E et al. Neonatal morbidity after preterm delivery in the presence of documented lung maturity. AmJ Obstet Gynecol 1993;169:951e5. 11. Di Renzo GC, Giardina I, Rosati A et al. (the Italian Preterm Network Study Group). Maternal risk factors for preterm birth: a country-based population analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology Oct 2011; 7482:1-5. Main objective 1.1. To compare incidence of preterm delivery less than 37 weeks in patients treated with or without maintenance nifedipine 1.2. To compare incidence of recurrent preterm contractions in patients treated with or without maintenance nifedipine Specific objective 2.1. To compare the latency period to delivery in both groups 2.2. To compare the maternal haemodynamics for both groups 2.3. To compare the neonatal outcome at delivery for both groups 2.2.4. To compare the maternal side effects for both groups Inhibition of uterine contractility with tocolytic agents to prolong pregnancy and reduce neonatal complications continues to be the focus of treatment of preterm labour. The results of this randomized controlled study showed maintenance tocolysis with nifedipine up to 36 weeks was successful in prolonging gestation to 36.9 weeks as compared to 35.6 weeks with no treatment (A difference of 9 days). This may not be clinically significant as neonatal morbidity rates were less than 2% in neonates born at ≥34 weeks’gestation. 10 It was also not effective in preventing recurrent preterm contractions when compared with no treatment. This concurred with the systematic review by Conde-Agudelo 8 which showed no significant differences between nifedipine maintenance therapy and placebo or no treatment for preterm birth before 34 or 37 weeks gestation, episodes of recurrent preterm labour and adverse neonatal outcomes. In this study, Nifedipine was not associated with adverse effects and had no haemodynamic changes with long term use. Methods A prospective randomized controlled trial was conducted in UKMMC over a period of 20 months, between 1 st January 2010 to 30 th August 2011, with the approval of the Ethics Committee. A total of 98 women were admitted with preterm labour between 22- 34 weeks. All patients had the gestational age confirmed by their last menstrual period (LMP) or a dating scan. Exclusion criteria multiple pregnancies contraindication to nifedipine such as cardiovascular ds, hyperthyroidism, severe PE maternal/fetal indication for delivery – eg. Fetal distress contraindication for tocolysis, eg. PE, IUGR, fetal anomaly, chorioamnionitis, significant APH cervical dilatation of 3cm or more patients with previous tocolytic treatment during this pregnancy 49 women were randomly assigned to the treatment group and 49 women to the control group. The mean gestational age on admission was 31.64 weeks in the control group and 32.38 weeks in the treatment group. UTI and vaginal candidiasis are main causes of preterm labour. 30% had multiple causes contributing to preterm labour Deliveries and prolongation of pregnancy All women eligible for study, consent obtained Baseline Ix taken : ECG/FBC/BUSE/RBS levels/UFEME/HVS C&S All patients treated with nifedipine as per protocol for acute phase tocolysis Given IM dexa 12mg x 2 doses *Patients in nifedipine group given T. nifedipine 20mg tds till 36w upon discharge *patients in no treatment group was not given any medication after acute phase Pts with recurrent preterm contractions were given acute phase tocolysis once again & continued in the originally assigned group once the recurrent preterm contractions has subsided Randomised to maintenance nifedipine or no maintenance treatment group Group ControlTreatmentp-value Latency (days)No. (%) Delivery within 1 day10 (77%)3 (23%)0.052 Delivery after 1 to 7 days4 (57%)3 (43%)0.705 Delivery after 7 days35 (45%)43 (55%)0.365 Delivery Mean gestational age at delivery35.59 ± 2.8236.92 ± 2.240.012 < 34 weeks11 (69%)5 (31%)0.134 34 - 37 weeks24 (51%)23 (49%)0.884 > 37 weeks14 (40%)21 (60%)0.237 * Chi-square test Group ControlTreatmentp-value Latency (days) for all patient (n=98)29.65 ± 23.6334.41 ± 20.240.287 Latency (days) for gestation age ≤ 30weeks (n =14)49.10 ± 27.6170.00 ± 20.610.200 Latency (days) for gestation age ≤ 32weeks (n =39)41.00 ± 27.3248.69 ± 24.850.376 Latency (days) for gestation age ≤ 34weeks (n =90)31.25 ± 24.0335.72 ± 20.060.340 * Independent T-test and chi-square test Latency (Days gained) Recurrent preterm labour Neonatal outcome Group ControlTreatmentp-value Gestation age at delivery35.59 ± 2.8236.92 ± 2.240.012 Birth weight2.67 ± 0.652.79 ± 0.580.349 Cord pH7.29 ± 0.087.30 ± 0.100.713 Apgar score at 1 min8.29 ± 0.948.23 ± 1.100.785 Apgar score at 5 mins9.43 ± 0.659.38 ± 0.730.703 NICU admission(yes)13 (68%)6 (32%)0.108 * Independent T-test and chi-square test * No significant difference
Christopher R. Graber, MD Salina Women’s Clinic September 27, 2011 (revised from Mar 2010)
Progesterone Therapy for Preterm Labor Perinatal Conference April 14, 2006.
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Preterm Labor Williams CH.36. Preterm Birth Death, severe neonatal morbidities Common before 26 weeks Universal before 24 weeks.
MANAGEMENT OF PRETERM LABOR WITH INTACT MEMBRANES by Dr. Elmizadeh.
門診處方討論 Nifedipine 用於安胎 主講者 : 黃意文. Nifedipine ❃ OVERVIEW A. Nifedipine is a calcium channel antagonist. B. Nifedipine is a vasodilator with antianginal.
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TEMPLATE DESIGN © Objectives ResultsConclusions References 1.Richard W. Watts, Rural General Practitioner, Port Lincoln,
Preterm Birth Hazem Al-Mandeel, M.D Course 481 Obstetrics and Gynecology Rotation.
Preterm labor. Preterm termination of pregnancy Abortion: …22 week of gestation Abortion: …22 week of gestation Premature labor [PTL]: Premature labor.
William Goodnight, MD, MSCR Assistant Professor Division of Maternal Fetal Medicine UNC Chapel Hill School of Medicine.
Done by : –Mazen Basheikh Done by : –Mazen Basheikh.
UOG Journal Club: July 2016 Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study J Min, HA Watson, NL Hezelgrave,
TEMPLATE DESIGN © Backgroud Methods ResultsConclusions References OPTIONAL LOGO HERE 1.Heslehurst N, Rankin J, Wilkinson.
APOSTEL IV Assessment of Perinatal Outcome by uSe of Tocolysis in Early Labour Nifedipine versus placebo in the treatment of preterm premature rupture.
Magnesium Sulfate in Severe Perinatal Asphyxia: A Randomized, Placebo-Controlled Trial Mushtaq Ahmad Bhat, et al Apr 6, 2009 Presented By: Yasser Al-Garni.
TEMPLATE DESIGN © EFFICACY OF GLYCERYL TRINITRATE (GTN) TRANSDERMAL PATCH FOR INHIBITION OF PRETERM LABOUR. Kellogg A,
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POSTTERM PREGNANCY: THE IMPACT ON MATERNAL AND FETAL OUTCOME Dr. Hussein. S. Qublan- Al-Hammad Jordanian Board in Obstet &Gynecology European Board in.
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Natalia Cruces, Marta Sobral, Amália Pacheco, Ivone Lobo Department of Obstetrics and Gynecology Hospital de Faro (Portugal) Amnioinfusion to Treat Severe.
UOG Journal Club: July 2011 Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized,
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TEMPLATE DESIGN © Maternal Obesity & Obstetric outcomes John R, Johnson JK, Pavey J Department of Obstetrics and Gynaecology,
IMPACT OF PREECLAMPSIA ON BIRTH OUTCOMES Xu Xiong, MD, DrPH Department of Obstetrics and Gynecology Université de Montréal, Quebec, Canada.
Cara Pessel, MD et al American Journal of Obstetrics and Gynecology 2013.
Progesteron for Preterm Labour Prevention Prof.Dr.S.Cansun DEM İ R President of FGOM 16.May.2013-Antalya.
Objectives Conclusions References 1.Tzafettas JM, Farmakides G, Delkos D, et al. Asynchronous delivery of twins and triplets with a delivery interval ranging.
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Elective Cesarean Delivery, Neonatal Intensive Care Unit Admission, and Neonatal Respiratory Distress 楊明智.
TEMPLATE DESIGN © Objectives Results(Continued) References Methods Audit on outcome of Instrumental Deliveries: Are we.
Preterm Birth Present by: Dr.Worapa Asavaritikrai Health Promotion Center Region 4.
Obstetrical team of the « Mother-Child » College Members: L.Decatte J.M. Foidart C. Hubinont C. Kirkpatrick D. Leleux M. Temmerman F. Van Assche J. Van.
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In the name of God. Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history.
TEMPLATE DESIGN © DISCUSSION: The risk of overt PUR in our study is extremely low (0.48%) compared to others [1,2,3].
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