title: Management of recurrent preterm labor in twin gestations with nifedipine tocolysis.
abstract: We examined outcomes of twin pregnancies complicated by recurrent preterm labor receiving nifedipine tocolysis. In a retrospective study design, twin pregnancies receiving outpatient preterm labor surveillance services and oral nifedipine tocolysis following a diagnosis of preterm labor were identified from a database ( N = 1421). Eligible for inclusion were patients subsequently rehospitalized with recurrent preterm labor symptoms ( N = 862). Included were patients at < 35 weeks' gestation, having intact membranes, and remaining undelivered for > 48 hours after recurrent preterm labor ( N = 656). Pregnancy outcomes of women resuming nifedipine tocolysis ( N = 418) following hospitalization were compared with those having an alteration in treatment ( N = 238) to continuous subcutaneous terbutaline. Alteration of tocolytic treatment versus resuming nifedipine resulted in increased pregnancy prolongation (34.7 +/- 18.8 days versus 27.5 +/- 19.9 days, P < 0.001), with delivery of fewer low birth weight (67.2% versus 78.3%, P < 0.001) and very low birth weight infants (6.5% versus 15.0%, P < 0.001) and a decreased incidence of neonatal intensive care unit admission (44.7% versus 52.9%, P = 0.005). In twin pregnancies receiving nifedipine tocolysis, alteration of tocolytic treatment to subcutaneous terbutaline following hospitalization for recurrent preterm labor symptoms had a positive impact on pregnancy prolongation and neonatal outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, University of Miami, Miami, Florida 33101, USA.
authors.forename: Lesley
authors.initials: L
authors.lastname: de la Torre
authors.forename: Niki B
authors.initials: NB
authors.lastname: Istwan
authors.forename: Cheryl
authors.initials: C
authors.lastname: Desch
authors.forename: Debbie J
authors.initials: DJ
authors.lastname: Rhea
authors.forename: Luis
authors.initials: L
authors.lastname: Roca
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Stanziano
authors.forename: Víctor Hugo
authors.initials: VH
authors.lastname: González-Quintero
mesh_terms: D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005865:Gestational Age; D006801:Humans; D007279:Injections, Subcutaneous; D009543:Nifedipine / Q000627:therapeutic use*; D007752:Obstetric Labor, Premature / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D013726:Terbutaline / Q000627:therapeutic use*; D047929:Term Birth; D015145:Tocolysis / Q000379:methods; D015149:Tocolytic Agents / Q000627:therapeutic use*; D016896:Treatment Outcome; D014427:Twins
chemical_list: D015149:Tocolytic Agents; D009543:Nifedipine; D013726:Terbutaline