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doi:10.1111/j.1447-0756.2010.01434.x
787..791
Division of Maternal-Fetal Medicine, and 2Division of Obstetrics and Gynecology Nursing, Department of Obstetrics and
Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Abstract
Aim: To compare the success rates and gestational ages at delivery of nifedipine, proluton depot administration as a tocolytic agent and bed rest groups to pregnant women with threatened preterm labor.
Material and Methods: A total of 150 pregnant women with threatened preterm labor between 28 and
35 weeks of gestation were enrolled in the study. All women underwent contraction inhibition randomly
sorted into three groups. The rst and second groups were inhibited with nifedipine and proluton depot,
respectively. The third group was admitted for bed rest.
Results: Nifedipine, proluton depot and bed rest can be used to inhibit contraction in threatened preterm
labor. However, when time-to-event test was used, nifedipine took the shortest time for contraction inhibition
with statistical signicance.
Conclusion: Nifedipine, proluton depot and bed rest can be used successfully to inhibit contraction in
threatened preterm labor. However, nifedipine took the shortest time to inhibit uterine contraction in threatened preterm labor.
Key words: bed rest, nifedipine, proluton depot, threatened preterm labor.
Introduction
Preterm labor is the main etiology which causes high
perinatal morbidity and mortality. The prevalence of
preterm labor in Siriraj Hospital is 12.89%.1 Siriraj
Hospital is the tertiary center to which complicated
preterm pregnant women are referred. The limited
availability of neonatologists and newborn intensive
care units (NICU) nationwide has resulted in insufcient care of preterm births. Therefore, many trials
have been initiated to inhibit or prevent preterm birth.
Recent evidence from the Statistical Unit at Siriraj
Hospital showed that pregnant women with threatened preterm labor who had only bed rest developed
preterm labor at a rate of about 3050%.2,3 After bed
rest, 30% of women with threatened preterm labor proceeded to advanced stage of labor and underwent
delivery. Our study suspected that if threatened
preterm labor was stopped, the prevalence of preterm
birth could be minimized and perinatal mortality and
morbidity could be reduced. Therefore, nifedipine25
and proluton depot25 were of interest to be studied for
inhibiting contraction in threatened preterm labor
compared with bed rest.
787
S. Chawanpaiboon et al.
Results
From 1 May 2007 to 31 December, 2008, a total of 150
pregnant women with a diagnosis of threatened
preterm labor were admitted to the labor room at
Siriraj Hospital. Each group consisted of 50 pregnant
women and their contractions were inhibited with
nifedipine, proluton depot and bed rest, respectively.
There was no statistical signicance in maternal age,
mean gestational age of admission, mean gravida,
parity, abortion and cervical length among the patients
in the three groups (Table 1). Nifedipine, proluton
depot and bed rest were used to inhibit contractions
with a success rate of 80%, 66% and 64%, respectively,
without statistical signicance (Table 2). However,
when time-to-event test was used, nifedipine took the
shortest time for contraction inhibition in threatened
preterm labor with statistical signicance (Fig. 1,
Tables 2,3). Nifedipine took the shortest median time
to inhibit contraction (3.00 0.48 h with 95% CI of
4.185.83) (Table 4). Mode and gestational age of
Table 1 Demographic data of pregnant patients in three groups who received nifedipine, proluton depot and bed rest for
inhibiting uterine contraction in threatened preterm labour
Data
Nifedipine (n = 50)
Maternal age
Mean gravida
Mean parity
Mean abortion
Mean gestational age of admission
Mean cervical length (mm)
26.4 6.6
2.4 1.8
0.7 0.8
0.7 1.3
31.8 1.5
2.4 0.5
28.6 7.4
1.9 1.1
0.7 0.8
0.2 0.6
31.6 2.1
2.2 0.3
26.4 6.6
2.0 1.2
0.6 0.9
0.4 0.7
31.8 2.3
2.1 0.5
788
(1443)
(17)
(02)
(05)
(2835)
(1.53.0)
(1845)
(17)
(03)
(03)
(2335)
(1.33.0)
(1739)
(15)
(03)
(02)
(2635)
(1.63.0)
Nifedipine
(n = 50)
Proluton depot
(n = 50)
Bed rest
(n = 50)
Number of succession
(%)
Mean time of
succession
P-value
40 (80)
33 (66)
32 (64)
2.9 2.1(112)
0.152
0.164
0.828
Figure 1 Time of succession between nifedipine, proluton depot and bed rest for inhibiting uterine contraction in threatened preterm labor by time-to-event test.
Discussion
Many interventions have long been used to prevent
preterm labor.10 Some interventions, including good
antenatal care, bed rest, and intravenous uid hydration seem to improve outcome, but there has been no
strong evidence supporting those interventions in the
prevention of preterm labor.10 Only fetal bronectin in
cervical mucus and cervical length are used to predict
preterm birth with well supported evidence.11,12
However, threatened preterm labor, which is classied
as regular uterine contraction, can progress to preterm
birth in about 30% of cases.2,5 Therefore, if this process
can be stopped the chances of both preterm birth and
perinatal morbidity and mortality can be reduced.
Terbutaline (bricanyl) is the rst-line drug which has
been used intravenously or subcutaneously to inhibit
789
S. Chawanpaiboon et al.
Table 3 P-value between nifedipine, proluton depot and bed rest for inhibiting
uterine contraction in threatened preterm labour by time to event and c2 test
Type of intervention
Nifedipine
Proluton depot
Bed rest
Nifedipine
Proluton depot
Bed rest
P < 0.05*
P < 0.05*
P < 0.05*
P = 0.219
P < 0.05*
P = 0.219
Estimate
Median
Standard error
95% CI
3.00
5.00
10.00
5.00
0.48
0.42
3.08
0.34
4.185.83
2.073.93
3.9716.03
4.345.66
Table 5 Delivery and newborn data between the patients in three groups (nifedipine, proluton depot and bed rest)
Data
Mode of delivery (P > 0.05)
Normal delivery
Vacuum extraction
Cesarean section
Mean gestational age of delivery (weeks)
(P > 0.05)
Mean neonatal body weight (grams) (P > 0.05)
Mean Apgar score (P > 0.05)
1 min
5 min
Nifedipine (n = 50)
36
1
13
37.1 1.7 (3240)
40
0
10
36.9 2.1 (3040)
42
0
8
36.3 3.0 (2741)
9 0.8 (710)
10 0.4 (810)
8.7 1.0
9.8 0.4
9.1 0.6
9.8 0.4
Indication of procedure:
Non-reassuring fetal heart rate pattern.
Previous cesarean section 4, non-reassuring fetal status 2, breech presentation 2, cephalopelvic disproportion 3, placenta previa 1, intrauterine growth restriction 1.
Previous cesarean section 4, non-reassuring fetal status 2, CPD 4.
Previous cesarean section 2, non-reassuring fetal status 2, placenta previa 2, unfavorable cervix 2.
790
References
1. Chawanpaiboon S, Sutantawibul A. Preterm birth rate in
Siriraj Hospital: A seven-year review (20022008 BE). Thai J
Obstet Gynecol 2009; 17: 204211.
2. Chawanpaiboon S, Wanitpongpan P, Titapant V et al. Nifedipine for inhibiting threatened preterm labour in Siriraj
Hospital. Siriraj Med J 2008; 60: 111113.
3. Vatish M, Grom K, Bennett P, Thornton S. Management of
threatened preterm labour. In: Norman J, Greer I (eds).
Preterm Labour: Managing Risk in Clinical Practice. Cambridge:
Cambridge University Press, 2005; 192208.v
4. Chawanpaiboon S. Clinical Practice Guidelines: Management of
Preterm Labour. Bangkok: Department of Obstetrics and
Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol
University, 2010.
5. Chawanpaiboon S, Sutantawibul A, Pimol K, Sirisomboon R,
Worapitaksanond S. Preliminary study: Comparison of the
efcacy of progesterone and nifedipine in inhibiting threatened preterm labour in Siriraj Hospital. Thai J Obstet Gynecol
2009; 17: 17.
791
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