TRANSDERMAL NITROGLYCERIN VERSUS ORAL NIFEDIPINE ADMINISTRATION FOR TOCOLYSIS IN PRETERM LABOUR
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 52
Abstract
BACKGROUND Preterm labour is defined by the world health organization as the onset of labour in a pregnancy before the completion of 37 weeks of gestation and after 20 weeks of gestation. In about 45 - 50% of cases of preterm labour, the aetiology remains obscure. So attempts at prevention have not been very encouraging, but arrest of preterm labour continues to be the need of the hour. Currently, main goal for use of tocolytic therapy is to delay the birth so as to allow the use of corticosteroids for accelerating foetal lung maturity and maternal transfer to a tertiary care centre and thereby reducing neonatal morbidity and mortality. There are many number of tocolytic drugs, but unfortunately none has been completely effective because of questionable efficacy and potentially serious side effects outweigh the use of many tocolytic agents. In this study, comparison of effectiveness of oral nifedipine with transdermal nitroglycerin in the inhibition of preterm delivery is being done. MATERIALS AND METHODS Study on tocolysis in preterm labour was conducted in Government Rajaji Hospital from December 2010 to November 2011; 100 women with preterm labour randomly selected from the pregnant women attending antenatal OP and from labour ward from the Department of Obstetrics and Gynaecology, Government Rajaji Hospital, Madurai. Out of which 50 women were recruited for oral nifedipine and another 50 women were recruited for transdermal nitroglycerin patch. If and time needed for tocolysis, prolongation of pregnancy and the neonatal outcomes were observed. The results were tabulated in performed proforma and meticulously analysed. RESULTS The study was designed with a total sample of non-randomly selected 100 women who were in preterm labour, out of which 50 women were allotted for oral nifedipine in Group I and another 50 women were non-randomly selected for transdermal nitroglycerin patch in Group II. The age distribution of the two groups has no significant difference. The maximum number of patients in both groups fall in age group between 20 - 24 years. There is no significant difference in the antenatal care received, parity, distribution of the presenting part and cervical effacement by the 2 groups of patients. Pre-term labour in previous pregnancy was 22% (11 out of 50) in Group I and 18% (9 out of 50) in Group II. There is no significant difference in the history of pre-term labour between the 2 groups of patients. Though there was not much significant difference in the gestational age on admission in both groups, the time of prolongation of pregnancy varied considerably in both groups. Mean prolongation with Group I was significant when compared to Group II, in case of cervical dilatation 1 cm or less than 1 cm. Time needed for Tocolysis ranging between 2 - 12 hours in both the groups. There is significant difference in the incidence of complications among the 2 groups of patients. Among Group I, it was about 6% and in Group II 22%. When the gestational age at delivery was compared in both the groups, it differed significantly. There is no much significant difference in the birth weight of the babies in both the groups. The acute tocolytic effect between the 2 groups was significantly different. Only 10% in Group I delivered within 2 days, but in Group II it was 28%. Admission in neonatal ward differed significantly. Only 7 babies in Group I got admitted in neonatal ward, whereas in Group II 16 babies got admitted. This indicates nifedipine successfully reducing the neonatal admission and had the better perinatal outcome. CONCLUSION Oral nifedipine has a very good role to play in the treatment of acute tocolysis and for prolongation of pregnancy. So it can be considered as the first line drug of choice.
Authors and Affiliations
Shanthi Rani Balasubramani, Kameswari Kamatchi
Keywords
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- EP ID EP220236
- DOI 10.14260/Jemds/2017/859
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