Tocolytic therapy and clinical experience. Combination therapy.
OBJECTIVE
Inhibiting preterm labour at extremely early gestations.


METHODS
Observational study. Case reports.


METHODS
Perinatal Centre Lund University Hospital, South Sweden.


METHODS
Twenty-five women (13 cases with intact membranes and 12 cases with ruptured) with threatened preterm labour and advanced cervical status before 26 completed weeks of gestation.


METHODS
A combination of different drugs was used. Atosiban, an oxytocin antagonist, was the first line drug and was given as an infusion for several days as required. Supportive therapy was also given to most women with subcutaneous injections of the beta-receptor agonist terbutaline (0.25 mg up to six times a day); sulindac, a prostaglandin synthetase inhibitor (200 mg one to two times a day up to a week); and broad-spectrum antibiotics (metronidazole and cefuroxime intravenously for three days and thereafter oral therapy).


METHODS
Prolongation of pregnancy more than 48 hours or 7 days. Neonatal survival.


RESULTS
Prolongation of pregnancy for more than 48 hours to enable administration of corticosteroid therapy was obtained in all but three cases. Eight women were delivered after more than a week from admission. Three neonates died at birth due to obstetric complication or sepsis. The other neonates had normal pH in cord or venous blood at birth. No severe side effects were recorded and in no case did the treatment have to be discontinued due to side effects.


CONCLUSIONS
The policy described here is not evidence based, relating only to clinical observations, and as such is of very limited value. However, it seems that with this combined approach to management, some days can be gained by achieving full effect of corticosteroid treatment and prolongation of the pregnancy, hopefully reducing time in the neonatal intensive care in these critical cases. No severe side effects were reported.
Ingemarsson
Ingemar
I
Department of Obstetrics and Gynaecology, Lund University Hospital, S-221 85 Lund, Sweden.
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000900:Anti-Bacterial Agents; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007262:Infusions, Intravenous; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D013467:Sulindac / Q000627:therapeutic use*; D016019:Survival Analysis; D013726:Terbutaline / Q000627:therapeutic use*; D015149:Tocolytic Agents / Q000627:therapeutic use*; D014668:Vasotocin / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000318:Adrenergic beta-Agonists; D000900:Anti-Bacterial Agents; D016861:Cyclooxygenase Inhibitors; D015149:Tocolytic Agents; C047046:atosiban; D013467:Sulindac; D013726:Terbutaline; D014668:Vasotocin