Our experience of nifedipine as a tocolytic agent in preterm labor (24 weeks to 36 weeks 6 days)
Keywords:Nifedipine, Preterm, Tocolytic
Background: Preterm birth is defined as birth between the age of viability and 37 completed weeks of gestation. The aim of this study is to evaluate the safety and efficacy of nifedipine, a calcium channel blocker, as a tocolytic in prolonging duration of pregnancy in case of preterm labor.
Methods: This is a retrospective analytical study conducted in Department of Obstetrics and Gynaecology, SKNMC and GH, Pune, India conducted over a period of one year from June 2014 to May 2015. All uncomplicated, singleton preterm labor cases were given Cap. Nifedipine as tocolytic and Inj. Betamethasone for enhancing fetal lung maturity. Maternal parameters studied were Gravida and Parity, previous history of preterm labor, gestational age at delivery, mode of delivery, side effects. Neonatal parameters studied were weight at birth, APGAR score at birth, complications at birth, NICU admissions, mortality.
Results: Out of total 4478 deliveries from June 2014 to May 2015, 252 women with preterm labor were treated with nifedipine. 214 out of 252 delivered at term with overall success rate of 84.92%. Out of remaining 38 cases, 36 cases delivered as preterm normal deliveries and 2 required Caesarean section. No major side effects observed in mothers receiving nifedipine. As regards neonatal outcome, 12 babies required NICU admission and mortality was of 2.
Conclusions: Nifedipine is safe and effective in prolonging preterm labor and has minimal maternal and neonatal side effects. It eliminates the need for intensive maternal monitoring as required in case of betamimetics.
WHO. Managing complications in pregnancy and childbirth- abdominal pain in later pregnancy and after childbirth. 2007. Available at: http://apps.who.int/iris/bitstream/10665/43972/1/9241545879_eng.pdf.
WHO Preterm birth fact sheet no. 363. Updated November 2015. Available at: http://www.who.int/ mediacentre/factsheets/fs363/en/
Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, et al. National, regional and worldwide estimates of preterm birth. The Lancet. 2012;379(9832):2162-72.
Haas DM, Benjamin T, Sawyer R, Quinney SK. Short-term tocolytics for preterm delivery- current perspectives. Int J Women Health. 2014;6:343-9.
Flenady V, Wojcieszek AM, Papatsonis D, Stock O. Calcium channel blockers for inhibiting preterm labor and birth. Cochrane Database Syst Rev 2014;5(6):CD002255.
Gasper R, Toth JH. Calcium Channel Blockers as Tocolytics: Principles of their actions, adverse effects and therapeutic combinations. Pharmaceuticals (Basel). 2013;6(6):689-99.
Papatsonis D, Flenady V, Cole S, Liley H. Calcium channel blockers for inhibiting preterm labor (Cochrane Review). Cochrane Database Syst Rev. 2005;20;(3):CD0044528.
Chandraharan E, Sabaratnam A. Recent advances in management of preterm labor. J Obstet Gynecol India. 2005;55(2):118- 24.
Raju TN. Epidemiology of late preterm (near-term) births. Clin Perinatol. 2006;33:751–63.
Conde-Agudelo A, Romero R, Kusanovic JP. Nifedipine in the management of preterm labor: a systematic review and metaanalysis. Review article. Am J Obstet Gynecol. 2011;204(2):134.
Dhawle A, Kalra J, Bagga R, Aggarwal N. Nifedipine versus nitroglycerin for acute tocolysis in preterm labor: a randomised controlled trial. Int J Reprod Contracept Obstet Gynecol. 2013;2(1):61-6.
Smith P, Anthony J, Johanson R. Nifedipine in pregnancy. BJOG. 2000;107(3):299-307.
Papatsonis DN, Van Geijn HP, Adèr HJ, Lange FM, Bleker OP, Dekker GA. Nifedipine and ritodrine in the management of preterm labor: a randomized multicenter trial. Obstet Gynecol. 1997;90:230-4.
Kashanian M, Akbarian AR, Soltanzadeh M. Atosiban and nifedipine for the treatment of preterm labor. Int J Gynecol Obsyet. 2005;91:10-14.
Veet AJ, Pelink MJ, Pampus MG. Severe hypotension and fetal death due to tocolysis with nifedipine. BJOG. 2005;112:509 -10.
Tocolysis for women in preterm labor: RCOG green top guidelines no. 1b; February 2011.
de Heus R, Mol BW, Erwich JJ, van Geijn HP, Gyselaers WJ, Hanssens M, et al. Adverse drug reactions to tocolytic treatment for preterm labor: prospective cohort study. BMJ. 2009;338:b744.
Padovani TR, Guyyat G, Lopez LC. Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial. BCPT. 2015;116(3) 244-50.
Hayes E, Moroz L, Pizzi L, Baxter J. A cost decision analysis of tocolytic drugs. Am J Obstet Gynecol. 2007;197:383.e1-6.
Oei S. Calcium channel blockers for tocolysis: a review of their role and safety following reports of serious adverse events. Eur J Obstet Gynecol Reprod Biol. 2006;126:137-45.
Anotayanonth S, Subhedar NV, Garner P, Neilson JP, Harigopal S. Betamimetics for inhibiting preterm labor. Cochrane Database Syst Rev. 2004;4:CD004352.