Tocolysis with atosiban: experience in the management of premature labor before 24 weeks of pregnancy.
OBJECTIVE
Atosiban has been shown to be an effective tocolytic agent with a low rate of side effects during 24 to 33 weeks of gestation. Atosiban acts through selective, competitive inhibition of both oxytocin and vasopressin, so that there are reasons to assume that a tocolytic effect can also be achieved earlier in the pregnancy.


METHODS
In this prospective, randomized pilot study, 20 women in the 18th through 24th week of gestation who presented at our hospital with preterm labor were treated with atosiban. In the control group 20 women received saline infusions. All patients received antibiotic therapy. A cervical cerclage was performed when indicated as was correction of the vaginal pH.


RESULTS
The tocolytic effect began after 3-10 min (median: 6.5 min). Treatment time until the complete absence of contractions was 3-12 h (median: 7.5 h). Pregnancies were prolonged between 11.1 and 21.7 weeks (median: 15.6 weeks) in the atosiban group vs. 10.5-19.1 weeks in the control group. If well tolerated, atosiban was continued. There were no significant alterations in the routine laboratory parameters, circulation parameters, and fluid balance.


CONCLUSIONS
In summary, atosiban showed itself to be effective for tocolytic treatment for premature labor, even during 18 and 24 weeks of pregnancy, while exhibiting its known, favorable profile of side effects.
Richter
Oliver N
ON
Department of Obstetrics and Gynecology, University of Bonn School of Medicine, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. oliver.richter@klinikum-nuernberg.de
Dorn
C
C
van de Vondel
P
P
Ulrich
U
U
Schmolling
J
J
D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D018045:Receptors, Oxytocin / Q000037:antagonists & inhibitors; D015149:Tocolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D014590:Uterine Contraction / Q000187:drug effects; D014668:Vasotocin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
D018045:Receptors, Oxytocin; D015149:Tocolytic Agents; C047046:atosiban; D014668:Vasotocin