The short-term effect of nifedipine tocolysis on placental, fetal cerebral and atrioventricular Doppler waveforms.
OBJECTIVE
To evaluate the effect of nifedipine on placental and fetal middle cerebral and atrioventricular Doppler waveforms.


METHODS
Doppler waveforms of uterine (UtA), umbilical (UA) and middle cerebral (MCA) arteries and both atrioventricular valves were measured from 21 pregnant women/fetuses prior to and during nifedipine therapy for preterm labor. Maternal and fetal heart rates (FHR), maternal systolic and diastolic blood pressure, the Doppler pulsatility index and systolic/diastolic ratio of the UtA, UA and MCA were measured. The total time velocity integrals (TVI) of tricuspid and mitral valves and their E-wave/A-wave (E/A) TVI ratios were measured. Wilcoxon signed pairs test was used to compare the differences in Doppler parameters before and at 3 h after nifedipine loading up to a maximum dose of 40 mg.


RESULTS
Fetal arterial and UtA Doppler parameters were not different before and after nifedipine therapy. Blood flow across the atrioventricular valves and the TVI were equally unaffected by nifedipine. The TVI x FHR product was also unchanged following nifedipine therapy.


CONCLUSIONS
In women with otherwise uncomplicated pregnancies, nifedipine loading and tocolysis are generally well tolerated by the mother. Placental and fetal cerebral arterial blood flow, fetal systolic and diastolic cardiac function and downstream distribution of fetal cardiac output are unaffected by nifedipine loading. These results apply to women with unchanged vital parameters. Further studies are necessary to show long-term effects of nifedipine therapy and may help to refine choice of tocolytic agents.
Guclu
S
S
Department of Obstetrics and Gynecology, Dokuz Eylül University School of Medicine, Izmir, Turkey. serkan.guclu@deu.edu.tr
Saygili
U
U
Dogan
E
E
Demir
N
N
Baschat
A A
AA
D000328:Adult; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D009543:Nifedipine / Q000627:therapeutic use*; D007752:Obstetric Labor, Premature / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D010920:Placenta / Q000000981:diagnostic imaging; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012039:Regional Blood Flow; D018709:Statistics, Nonparametric; D015149:Tocolytic Agents / Q000627:therapeutic use*; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging
D015149:Tocolytic Agents; D009543:Nifedipine