8/6/2019 Nifedipine in the Management of Preterm Labor

http://slidepdf.com/reader/full/nifedipine-in-the-management-of-preterm-labor 1/2

Nifedipine in the management of preterm labor: a systematic review and metaanalysis

Twenty-six trials (2179 women) were included. Nifedipine was associated with a significant reduction in the risk of delivery within 7 days of initiation of treatment and before 34 weeks' gestation, respiratory distress syndrome,necrotizing enterocolitis, intraventricular hemorrhage, neonatal jaundice, and admission to the neonatal intensive careunit when compared with 2-adrenergic-receptor agonists. There was no difference between nifedipine andmagnesium sulfate in tocolytic efficacy. Nifedipine was associated with significantly fewer maternal adverse eventsthan 2-adrenergic-receptor agonists and magnesium sulfate. Maintenance nifedipine tocolysis was ineffective inprolonging gestation or improving neonatal outcomes when compared with placebo or no treatment. Nifedipine issuperior to 2-adrenergic-receptor agonists and magnesium sulfate for tocolysis in women with preterm labor. TheWorld Health Organization has estimated that 12.9 million births, or 9.6% of all births worldwide, were preterm in2005.In the United States, the preterm birth rate has risen over the last 2 decades. In 2007, preterm births constituted12.7% of live births, an increase of 20% since 1990, and 36% since the early 1980s.Trends in most other developedcountries are similar to those in the United States., Preterm birth is the leading cause of perinatal morbidity andmortality and one of the leading causes of infant mortality.Despite the improvement in survival rates of pretermneonates, they are at increased risk of long-term neurodevelopmental disabilities and respiratory and gastrointestinalcomplications.Because uterine contractions are the most frequently recognized symptom and sign of preterm labor,inhibition of uterine contractility with tocolytic agents to prolong pregnancy and reduce neonatal complicationscontinues to be the focus of treatment of preterm labor. Tocolytic agents are intended to arrest uterine contractionsduring an episode of preterm labor (acute tocolysis) or maintain uterine quiescence after an acute episode hasabated (maintenance tocolysis).

Several agents have been used for the inhibition of uterine contractility, but it remains unclear what the first-linetocolytic agent should be: 2-adrenergic-receptor agonists reduce the rate of preterm delivery within 48 hours of initiation of treatment. Nevertheless, there is no evidence that this delay in the timing of birth by itself translates intoimprovements in neonatal outcomes, and maternal side effects are considerable; magnesium sulfate has not beenproven to be an effective tocolytic agent, and its use could be associated with an increased risk of fetal, neonatal, andinfant mortality; there is insufficient evidence of whether prostaglandin synthesis inhibitors reduce the risk of pretermbirth; the oxytocin receptor antagonist atosiban was found to increase the proportion of patients remainingundelivered and not requiring an alternate tocolytic at 7 days when compared with placebo, yet this was notassociated with an improvement in neonatal outcome, which has been attributed to the complexities of study designand interpretation of trials of tocolysis that involve a rescue intervention; barusiban, a selective oxytocin antagonist,has not been found to be more effective than placebo in delaying delivery for 48 hours; there is currently insufficientevidence to support the use of nitric oxide donors as a tocolytic drug,although recent studies suggest that this optionrequires further consideration; and maintenance tocolysis with 2-adrenergic-receptor agonists and oral magnesiumsulfate is ineffective in prolonging gestation or reducing adverse neonatal outcomes. Atosiban maintenance treatment

can increase the time interval to the next episode of preterm labor but does not reduce the rate of preterm delivery or improve infant outcomes.Some authors have proposed that nifedipine, a calcium channel blocker, could be used as afirst-line tocolytic agent. The most recent substantial update of the Cochrane review regarding calcium channelblockers for acute tocolysis in preterm labor included 12 randomized controlled trials (10 using nifedipine) involving1029 patients. This review concluded that calcium channel blockers (mainly nifedipine) reduce the risk of deliverywithin 7 days of initiation of treatment and delivery before 34 weeks' gestation with improvements in some clinicallyimportant neonatal outcomes such as respiratory distress syndrome, intraventricular hemorrhage, necrotizingenterocolitis, and neonatal jaundice when compared to other tocolytic agents (mainly beta-mimetics).A second reviewfrom the Cochrane database on maintenance tocolysis reported that nifedipine neither reduces the risk of pretermbirth before 37 weeks' gestation nor improves neonatal outcomes, compared with no treatment. However, this reviewincluded only 1 trial of 74 women. The literature searches on which these reviews were based were performed in2002 and 2004, respectively. Since that time, additional randomized controlled trials with nifedipine have beenpublished; therefore, reassessment of the efficacy and safety of this agent is justified.

Reaction

Inhibition of uterine contractions has been a major component of the therapy of patients with preterm labor with thehope that inhibiting uterine contractility would prevent preterm delivery and the neonatal complications associatedwith the unscheduled onset of labor. Despite decades of basic and clinical research in tocolytic agents, it is unclear whether inhibition of uterine contractions can substantially change the prognosis of preterm labor. It seems thattocolysis can achieve a slight prolongation of pregnancy and sometimes a reduction in neonatal morbidity, particularlywhen used in combination with steroids.

8/6/2019 Nifedipine in the Management of Preterm Labor

http://slidepdf.com/reader/full/nifedipine-in-the-management-of-preterm-labor 2/2

 

DAY 1:

This is our first day at A. Dela Cruz hospital we came late because we need to attend our enrichment

program. It¶s about 2 ½ hours since we got to the hospital and our C.I introduce her self to us. After that she

teaches us how to perform gloving hand washing and how to wear the gown. She also teached us the

different instruments in the D.R. after that she dismissed us.

DAY 2:

This time we had many patients almost all of us was given a chance to assist the doctor. Cord care is my job

the nurse teach me on what to do; I cleaned the baby, put an ointment in his eyes, suction his nose and

mouth, inject a medication, clamp the cord and dressed the baby

DAY 3:

Sad to say I wasn¶t able to attend my duty because I am sick.