Exploring the role of Tractocile in everyday clinical practice.

The purpose of this retrospective study is to evaluate the effects of atosiban (Tractocile available in Austria since February 2000) for routine treatment of women with threatened preterm delivery. The advantage of this drug compared to other tocolytic agents is its specific action on reproductive tissues without the accompanying severe side effects. Women (n = 208) were retrospectively evaluated. Diagnoses at admission were preterm labour (n = 117), preterm rupture of membranes (n = 65), incompetent cervix (n = 19) and vaginal bleeding (n = 7). Gestational age was between weeks 21 and 33 of pregnancy. Preterm labour was defined as >/=4 uterine contractions/30 min and cervical length <30 mm examined by vaginal ultrasound and/or detection of vaginal fetal fibronectin. Tocolytic effectiveness was determined as the number of women having a diagnosis of preterm labour who were still pregnant after 48 hours and after 7 days. The influence on the frequency of contractions before and 3-12 hours after the start of treatment was assessed. Maternal side effects, perinatal and neonatal morbidity and transfers to the NICU were also evaluated. The proportion of women who remained undelivered was 78.7% after 48 hours, and 64.3% after 7 days. Atosiban decreased the frequency of contractions from 5.4/30 min before treatment to 1.6 contractions/30 min after the start of treatment. At the initial bolus application, 20.2% of women presented drug-related side effects, such as nausea, vertigo and flush over a short period of 1-2 minutes. During infusion, side effects possibly related to atosiban could be detected in 6% of women. Mean length of stay was 11.8 days in the NICU and 30.9 days in intermediate care. Twenty-three children developed intraventricular haemorrhage (I-IV). In conclusion, atosiban is an effective tocolytic drug in the treatment of preterm labour and preterm rupture of the membranes. It has significantly less side effects due to its lack of cardiovascular activity.

Cervical length and dilatation of the internal cervical os detected by vaginal ultrasonography as markers for preterm delivery: A systematic review.

OBJECTIVE: We performed a systematic review to evaluate endovaginal cervical ultrasonography as a predictor of preterm delivery. STUDY DESIGN: Selection criteria were original published English-language reports of prospective studies including women at <37 weeks' gestation with intact amniotic membranes. Parameters and outcomes were cervical length or dilatation of the internal cervical os and preterm delivery. RESULTS: In 3 subgroups of studies including patients with preterm labor or low-risk, symptom-free patients with early (20-24 weeks) or late (27-32 weeks) ultrasonographic examination, optimal cutoff values for cervical lengths ranged between 18 and 30, 25 and 35, or 25 and 39 mm. At these cutoff values, sensitivity rates were between 68% and 100%, 33% and 54%, or 63% and 76%, and specificity rates were between 44% and 79%, 73% and 91%, or 59% and 69%, respectively. Sensitivity rates for dilatation of the internal cervical os were 70% to 100%, 16% to 25%, or 33%, and specificity rates were 54% to 75%, 95% to 99%, or 92%, respectively. CONCLUSION: In patients with symptoms of preterm labor, endovaginal cervical ultrasonography appears to be an effective predictor of preterm delivery.