title: An examination of the clinical benefits and cost-effectiveness of tocolytic replacement following recurrent preterm labor.
abstract: We examined pregnancy outcomes in women receiving nifedipine tocolysis having recurrent preterm labor (RPTL). Singleton gestations enrolled for outpatient nursing surveillance and prescribed nifedipine tocolysis were identified (N = 4748). Women hospitalized for RPTL at <35 weeks then resuming outpatient surveillance were included (N = 1366). Pregnancy outcomes of women resuming nifedipine (N = 830) were compared with those having an alteration in treatment to continuous subcutaneous terbutaline (N = 536). Overall, 56.7% (2692/4748) experienced RPTL. Half (50.7%) were stabilized and resumed outpatient surveillance with nifedipine or continuous subcutaneous terbutaline. Infants from women resuming nifedipine versus those with alteration of treatment to terbutaline were more likely to deliver at <35 weeks (28.0% versus 13.8%), weigh <2500 g (32.9% versus 20.3%), and require a stay in the neonatal intensive care unit (34.0% versus 23.1%), all P < 0.001. Alteration of tocolytic treatment following RPTL resulted in a decreased incidence of preterm birth and low birth weight, resulting in less admission to the neonatal intensive care unit and fewer nursery days.
authors.affiliation: University of Miami, Department of Obstetrics and Gynecology, Miami, Florida 33101, USA.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Flick
authors.forename: Lesley
authors.initials: L
authors.lastname: de la Torre
authors.forename: Luis E
authors.initials: LE
authors.lastname: Roca
authors.forename: Niki
authors.initials: N
authors.lastname: Istwan
authors.forename: Debbie
authors.initials: D
authors.lastname: Rhea
authors.forename: Cheryl
authors.initials: C
authors.lastname: Desch
authors.forename: Victor Hugo
authors.initials: VH
authors.lastname: González-Quintero
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D009543:Nifedipine / Q000008:administration & dosage / Q000191:economics*; D007752:Obstetric Labor, Premature / Q000188:drug therapy / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012008:Recurrence; D013726:Terbutaline / Q000008:administration & dosage / Q000191:economics*; D015149:Tocolytic Agents / Q000191:economics* / Q000627:therapeutic use
chemical_list: D015149:Tocolytic Agents; D009543:Nifedipine; D013726:Terbutaline