Recent pharmacological advances in the treatment of preterm membrane rupture, labour and delivery.
Preterm delivery (before 37 completed weeks of gestation) is the major determinant of infant mortality. In women with a previous preterm birth associated with bacterial vaginosis, prophylactic antibiotics (e.g., metronidazole) reduce the risk of preterm birth and low birth weight. Trichomonas vaginalis increases the risk of preterm delivery, but metronidazole is not beneficial for this and may even be detrimental. Antibiotic use (e.g., erythromycin) prolongs pregnancy in late premature rupture and has health benefits for the neonate. However, antibiotics are probably not useful in preterm labour. Intramuscular 17alpha-progesterone and vaginal progesterone reduce the rate of preterm labour in high-risk pregnancies, including previous spontaneous preterm delivery. Magnesium sulfate, beta2-adrenoceptor agonists and the oxytocin-receptor antagonist, atosiban, are effective in reducing uterine contractions short-term, but there is little evidence that this leads to improved outcomes for the neonate. However, tocolysis with calcium-channel blockers does seem to lead to better outcomes for the neonate. Fetal side effects, such as ductus arteriosus constriction and impaired renal function, are associated with the inhibition of prostaglandin synthesis with indomethacin. New approaches and more effective drugs are required in the treatment of preterm delivery.
Doggrell
Sheila A
SA
The University of Queensland, School of Biomedical Sciences, QLD 4072, Australia. s_doggrell@yahoo.com
D058666:Adrenergic beta-2 Receptor Agonists; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011374:Progesterone / Q000627:therapeutic use; D018045:Receptors, Oxytocin / Q000037:antagonists & inhibitors; D015149:Tocolytic Agents / Q000627:therapeutic use*
D058666:Adrenergic beta-2 Receptor Agonists; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D018045:Receptors, Oxytocin; D015149:Tocolytic Agents; D011374:Progesterone; D008278:Magnesium Sulfate; D005996:Nitroglycerin