Comparison of the effect of vaginal progesterone and oral nifedipine for maintenance tocolysis after arrested preterm labour, to prolong the pregnancy and the neonatal outcome
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250187Keywords:
High-risk pregnancy, Preterm labor, Preterm deliveries, Neonatal and maternal outcomeAbstract
Background: Preterm birth is a major determinant of neonatal morbidity and mortality and has long term adverse consequences. It is defined as childbirth occurring at less than 37 weeks of gestation. Various drugs with different doses and routes have been used for maintenance tocolysis has been used. Aims and objectives were to compare the effect of vaginal progesterone and oral nifedipine for maintenance tocolysis after arrested preterm labour and their effect concerning the neonatal outcomes.
Methods: This study was conducted in the department of obstetrics and gynecology, Mata Chanan Devi hospital, New Delhi in collaboration with the department of pediatrics. The 90 pregnant women who fulfilled inclusion criteria were recruited and were randomized into 2 groups namely nifedipine and progesterone group.
Results: The mean gestational age at delivery in the nifedipine group was 35 weeks, while in the progesterone group it was 37 weeks, and it was a significant difference (p=0.002). There was a significant difference in the prolongation of pregnancy between both the groups (p<0.001). Mean prolongation of pregnancy in the nifedipine group was 18 days, and 38 days in the progesterone group which was significant (p=0.000). The mean APGAR score at five minutes was 7 for the nifedipine group and 8 for the progesterone group. The mean duration of the NICU stay was 5 days in the nifedipine group and 2 days in the progesterone group.
Conclusions: Progesterone was found to be a better drug for maintenance tocolysis compared to nifedipine. It is associated with better maternal and perinatal outcomes when used as a maintenance tocolytic as compared to nifedipine.
Metrics
References
Liu L, Oza S, Hogan D, Jamie P, Igor R, Joy EL, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015;385(9966):430-40. DOI: https://doi.org/10.1016/S0140-6736(14)61698-6
Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP. The perinatal mortality rate as an indicator of quality of care in international comparisons. Med Care. 1998;36(1):54-66. DOI: https://doi.org/10.1097/00005650-199801000-00007
Mishra GS, Inamdar SA. Role of micronised progesterone in maintenance therapy following arrested preterm labor: a randomised controlled trial. Int J Reprod Contracept Obstet Gynecol. 2014;3(4):1050-5. DOI: https://doi.org/10.5455/2320-1770.ijrcog20141234
Da Fonseca EB, Bittar RE, Carvalho MH, Zugaib M. Prophylactic administration of Progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstetr Gynecol. 2003;188(2):419-24. DOI: https://doi.org/10.1067/mob.2003.41
Lyell DJ, Pullen K, Campbell L. Magnesium sulfate compared with Nifedipine for acute tocolysis of preterm labor: a randomized controlled trial. Obstet Gynecol. 2007;110(1):61-7. DOI: https://doi.org/10.1097/01.AOG.0000269048.06634.35
Papatsonis DN, Van Geijn HP, Ader HJ, Lange FM, Bleker OP, Dekker GA. Nifedipine and ritodrine in the management of preterm labor: a randomized multicenter trial. Obstetr Gynecol. 1997;90(2):230-4. DOI: https://doi.org/10.1016/S0029-7844(97)00182-8
Antenatal corticosteroids to reduce neonatal morbidity and mortality. London: RCOG; 2010.
Bolisetty S, Bajuk B, Vincent T, Sutton L, Lui K. Preterm outcome table (POT): a simple tool to aid counselling parents of very preterm infants. Australian and New Zealand J Obstetr Gynaecol. 2006;46(3):189-92. DOI: https://doi.org/10.1111/j.1479-828X.2006.00564.x
Carr DB, Clark AL, Kernek K, Spinnato JA. Maintenance oral Nifedipine for preterm labor: a randomized clinical trial. Am J Obstetr Gynecol. 1999;181(4):822-7. DOI: https://doi.org/10.1016/S0002-9378(99)70308-X
Dodd JM, Crowther CA, Dare MR, Middleton P. Oral betamimetics for maintenance therapy after threatened preterm labour. Cochrane Database of Syst Rev. 2006(1):CD003927. DOI: https://doi.org/10.1002/14651858.CD003927.pub2
Han S, Crowther CA, Moore V. Magnesium maintenance therapy for preventing preterm birth after threatened preterm labour. Cochrane Database of Sys Rev. 2013(5):CD000940. DOI: https://doi.org/10.1002/14651858.CD000940.pub3
ACOG Committee opinion. Management of preterm labour. Obstet Gynaecol. 2003;101:(5):1039-47. DOI: https://doi.org/10.1016/S0029-7844(03)00395-8
Aggarwal A, Bagga R, Girish B, Kalra J, Kumar P. Effect of maintenance tocolysis with Nifedipine in established preterm labour on pregnancy prolongation and neonatal outcome. J Obstetr Gynaecol. 2018;38(2):177-84. DOI: https://doi.org/10.1080/01443615.2017.1331340
Parry E, Roos C, Stone P, Hayward L, Mol BW, McCowan L. The NIFTY study: A multicentre randomised double‐blind placebo‐controlled trial of Nifedipine maintenance tocolysis in fetal fibronectin‐positive women in threatened preterm labour. Aust N Zeal J Obstetr Gynaecol. 2014;54(3):231-6. DOI: https://doi.org/10.1111/ajo.12179
Choudhary M, Suneja A, Vaid NB, Guleria K, Faridi MM. Maintenance tocolysis with oral micronized Progesterone for prevention of preterm birth after arrested preterm labor. Int J Gynecol Obstetr. 2014;126(1):60-3. DOI: https://doi.org/10.1016/j.ijgo.2014.01.019
Haghighi L, Rashidi M, Najmi Z, Homam H, Hashemi N, Mobasseri A, Moradi Y. Comparison of intramuscular Progesterone with oral Nifedipine for treating threatened preterm labor: A randomized controlled trial. Med J Islamic Republic Iran. 2017;31:56. DOI: https://doi.org/10.14196/mjiri.31.56
Downloads
Published
How to Cite
Issue
Section
