Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study.

BACKGROUND: Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as ß2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair. METHODS: Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery. RESULTS: Twenty-five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 ± 0.05 vs. 7.396 ± 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 ± 12.76 mg.dL-1 vs. 13.06 ± 6.35 mg.dL-1, for atosiban, p = 0.001) levels. CONCLUSIONS: Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair.

Carvacrol-Loaded Nanoemulsion Promotes Tocolytic and Anti-Dysmenorrhea Effects in Rodents.

INTRODUCTION: Carvacrol is a phenolic constituent of essential oils that has antinociceptive, anti-inflammatory, and antioxidant activities. METHOD: This study aimed to evaluate the in vitro spasmolytic and in vivo anti-dysmenorrhea potential of a nanoemulsion-containing carvacrol (nanoCARV). RESULTS: In isolated rat uterus, nanoCARV reduced spontaneous contractions (pEC50 = 3.91 ± 0.25) and relaxed preparations pre-contracted with oxytocin (pEC50 = 3.78 ± 0.2), carbachol (pEC50 = 4.15 ± 0.4), prostaglandin F2α (pEC50 = 3.00 ± 0.36), and KCl (pEC50 = 3.98 ± 0.32). The investigation of the mechanism of action revealed significant differences (p < 0.05) between the pEC50 values of nanoCARV in the absence or presence of aminophylline or tetraethylammonium. In a primary dysmenorrhea model, treatment with nanoCARV reduced the number of oxytocin-induced abdominal writhes. CONCLUSIONS: These data indicate that the anti-dysmenorrhea effect of nanoCARV may be related to the relaxation of uterine smooth muscle, with participation of the cAMP signaling pathway and potassium channels.

Guia practica clinica para el manejo de parto pretermino / Clinical practice guide for the management of preterm birth

El parto pretérmino en la región centroamericana tiene variaciones en cada país, así como la mortalidad perinatal neonatal y materna que se deriva de la condición. La atención adecuada sigue siendo una barrera en las zonas con más limitaciones en los servicios y el personal sanitario disponible. El parto pretérmino es considerado un problema con implicaciones sociales y económicas que produce impacto a corto, mediano y largo plazo (Goldenberg, 2012). El 75% de las complicaciones que genera conllevan a un aumento en la mortalidad infantil. La mayoría de sus factores de riesgo son considerados como prevenibles con la implementación de medidas sencillas y económicas (WHO, 2015). La investigación clínica de esta condición, en una gran mayoría, se ha generado en países de alto ingreso (Opiyo, 2017) 1 . Algunas veces se desconocen los resultados de algunas intervenciones en condiciones de recursos limitados. Esta guía presenta y pretende abordar algunas de estas limitaciones. También alerta sobre algunas intervenciones que pueden producir más problemas y dificultades si se implementan, al considerar los recursos disponibles en los lugares donde se desarrollaron las investigaciones que generaron la evidencia y hacer la comparación con la realidad de los países de Centroamérica en donde se usará la evidencia. Por otra parte, para cada recomendación que en este instrumento se facilita, los resúmenes de evidencia consideran las efectividades clínicas y los efectos adversos cuando han estado disponibles.

Effects of Bryophyllum pinnatum Administration on Wistar Rat Pregnancy: Biochemical and Histological Aspects.

INTRODUCTION: Bryophyllum pinnatum is widely used in folk medicine. It has neuropharmacological, anti-inflammatory, immunomodulatory, antidiabetic, hepatoprotective, and nephroprotective effects, among others. It also acts on uterine contractility. It is prescribed by practitioners of anthroposophic medicine for preterm labor, insomnia, and emotional disorders, and has other potential uses in obstetrics. As all drugs currently used in preterm labor have side effects, new tocolytic agents remain an area of active research. OBJECTIVE: To evaluate the effect of B. pinnatum mother tincture (MT) on albino rats and their offspring throughout pregnancy from a biochemical and histological standpoint. METHODS: Longitudinal, prospective, randomized controlled bioassay. This is the second stage of a trial that investigated 60 animals distributed across six equal groups: controls C1 and C2, which received 1 and 25 times the vehicle dose (30% ethanol), B1 and B2 (1- and 25-fold doses of B. pinnatum MT), and B3 and B4 (which received 50- and 100-fold doses of B. pinnatum concentrate). At this stage, blood chemistry parameters (glucose, alanine aminotransferase [ALT], aspartate aminotransferase [AST], creatinine, and blood urea nitrogen) were measured in dams, as well as histological aspects of dam liver, kidney, placenta, and uterine tissue and fetal liver, kidney, heart, and brain. RESULTS: No differences were found between group B1 (therapeutic dose) and its control C1 in relation to glucose, AST, ALT, and creatinine. Group B2 exhibited lower glucose levels than groups C1, B3, and B4. There was no difference in AST across groups. Groups B3 and B4 exhibited higher ALT levels than groups C1 and B1. Groups B1-B4 exhibited higher urea nitrogen levels than group C1. Creatinine levels were higher in groups B2 and B3 than group C1. On morphological evaluation, fatty infiltration of the liver was observed in the alcoholic vehicle control groups (C1 and C2). CONCLUSIONS: Daily administration of B. pinnatum at therapeutic doses (group B1) to pregnant albino rats appears to be safe, with reduced glucose at dose B2, elevated ALT at doses B3 and B4, and increased urea at doses B1 to B4 and creatinine at B2 and B3, but never exceeding the normal reference range. It was not associated with histological changes in specimens of the maternal or fetal structures of interest.

Cerebral Palsy in Very Preterm Infants: A Nine-Year Prospective Study in a French Population-Based Tertiary Center.

OBJECTIVES: To describe the prevalence of cerebral palsy (CP) at age 2 years in infants born before 33 weeks of gestation and to analyze the fetal neuroprotective effect of the antenatal administration of magnesium sulfate (MgSO4) treatment on CP. STUDY DESIGN: Preterm infants born before 33 weeks of gestation and discharged from the Rouen University Hospital's Neonatal Intensive Care Unit between 2007 and 2015 were included. At age 2 years, pediatricians of the perinatal network of Eure and Seine-Maritime counties administered standardized questionnaires analyzing motor, cognitive, and behavioral items, derived from the Denver and Amiel-Tison scales. A routine protocol based on MgSO4 infusion was introduced in 2010. The primary outcome measure was the occurrence of CP according to the Surveillance of Cerebral Palsy in Europe network definition. RESULTS: A total of 1759 very preterm infants were included, among whom 138 (7.8%) died and 148 (9.1%) were lost to follow-up. Assuming that those lost to follow-up had no CP, at 2 years, 55 of 1621 infants (3.4%; 95% CI, 2.6%-4.4%) had CP. After statistical adjustment for birth term and antenatal corticosteroid use, a significant decrease in CP was observed after implementation of a protocol of MgSO4 administration in mothers before imminent preterm birth at <33 weeks of gestation (aOR, 0.53; 95% CI, 0.29-0.98; P = .04). CONCLUSIONS: The prevalence of CP at 2 years after very preterm birth was low. The implementation of a neuroprotective protocol with MgSO4 was associated with reduced CP occurrence; however, several relevant limitations must be considered for interpretation.

Essential oil from Lippia microphylla Cham. modulates nitric oxide pathway and calcium influx to exert a tocolytic effect in rat uterus.

The essential oil of Lippia microphylla (LM-OE) presents several pharmacological activities. This work evaluates the tocolytic effect of LM-OE on rats. LM-OE inhibited phasic contractions and relaxed tonic contractions on rat uterus. Considering that nitric oxide (NO) pathway regulates uterine contraction, LM-OE potency was attenuated in the presence of NO synthase (NOS) inhibitor and this reduction was reversed in the presence of a NOS substrate. Similarly, the relaxant potency of LM-OE was reduced in the presence of soluble guanylyl cyclase (sGC) and protein kinase G (PKG) inhibitors. LM-OE also demonstrates a positive modulation of large and small conductance calcium-activated, voltage-gated and adenosine triphosphate-sensitive potassium channels and inhibited curves to CaCl2 as well as relaxed the uterus pre-contracted by S-(-)-Bay K8644, suggesting voltage-gated calcium channels type-1 (CaV1) blockade. Thus, the tocolytic effect of LM-OE on rat involves positive modulation of NO/NOS/sGC/PKG/K+-channels pathway and Ca2+ influx blockade through CaV1.[Formula: see text].

Tocoliticos en la amenaza de parto prematuro / Tocolitics in premature labor

La amenaza de parto prematuro se considera hoy en día como una urgencia obstétrica en la que, si no se realiza alguna intervención desemboca en un parto prematuro. Por tanto, una vez confirmado el diagnóstico, el tratamiento consiste en la administración de tocolíticos, cuyo objetivo principal es el retraso del nacimiento ganando tiempo para administrar maduración pulmonar y neuroprotección con el fin de disminuir el síndrome de dificultad respiratoria y parálisis cerebral, así como lograr el traslado de la madre a un centro de referencia, si fuere el caso. La elección de un fármaco u otro debe basarse en una adecuada valoración riesgo-beneficio, una vez tenida en cuenta la situación clínica de cada gestante. El empleo de tocolíticos al inicio de este proceso es esencial y en esta revisión se analiza la información disponible sobre su uso en la amenaza de parto prematuro

The preterm labour is now considered an obstetric emergency in which, if no intervention is performed, it leads to premature delivery. Therefore, once the diagnosis has been confirmed, the treatment consists of the administration of tocolytics, whose main objective is to delay the birth by gaining time to administer lung maturation and neuroprotection in order to reduce respiratory distress syndrome and cerebral palsy, as well as to achieve the transfer of the mother to a reference center, if necessary. The choice of one drug or another should be based on an adequate risk-benefit assessment, once the clinical situation of each pregnant woman has been taken into account. The use of tocolytics at the beginning of this process is essential and in this review the available information on their use in threatened preterm labor is analyzed.

Comprehensive treatment in severe dengue during preterm and term labor: could tocolysis be useful?

Objective: There is lack of data on the management of severe dengue infection during labor. The objective of this study was to describe our experience in the management of preterm and term labor of pregnant patients with severe dengue infection and thrombocytopenia.Materials and methods: We describe patients with dengue infection confirmed by dengue serology or NS1 antigen in Cali, Colombia. All of the patients had warning or severity signs for dengue and initiated labor, either term or preterm, during their hospital stay. All had thrombocytopenia at the moment labor started. Therefore, we treated them with support management, including intravenous fluids and a tocolytic agent (either atosiban, magnesium sulfate or nifedipine). Tocolytics aimed to stop contractions until platelets were in a safe range previous to delivery. Platelets transfusions were performed if the count was less than 10,000 cells/ml and active bleeding was present. The primary outcome we evaluated was postpartum hemorrhage (defined as a loss of >500 ml following a vaginal delivery or >1000 ml after cesarean section) or maternal and neonatal morbidity and mortality.Results: We present a total of six pregnant women. The median platelet count 24 h previous to delivery was 94,000 cells/ml and after tocolysis was 132,500 cells/ml. Two patients suffered postpartum hemorrhage despite the management. Only one woman required platelet transfusion. No maternal or newborn mortality were present. Three patients were diagnosed with preeclampsia. Four patients had delivery via cesarean section. Five out of six newborns required hospitalization, three of them due to neonatal respiratory distress syndrome.Conclusion: Comprehensive treatment including fluids resuscitation and uterine inhibition in pregnant women with severe dengue in preterm or term labor could be useful. More clinical studies are required to evaluate the benefit of this intervention in tropical countries.Brief rationale: We present an original research article and literature review entitled "Comprehensive treatment in severe dengue during preterm and term labor: could tocolysis be useful?". Our article describes the clinical manifestation, laboratory findings, complications and management provided to a group of six patients that presented to the hospital with acute dengue virus infection and initiated labor while viremic and thrombocytopenic in this study.In the present study, we found that most of our patients (5 out of 6), presented with signs of severe dengue fever and all of the patients had warning signs. In this population, we decided to provide support treatment and tocolytic agents to these patients with the aim of delaying labor to allow platelet count to rise, thus reducing the odds of hemorrhagic complications. We concluded that although tocolysis is not regularly used in patients with dengue fever, our results suggest that our protocol could benefit pregnant patients with thrombocytopenia due to dengue; however, prospective studies which determine the safety and effectiveness of our intervention are needed.

Tocolysis for open prenatal repair of myelomeningocele: systematic review.

Objectives: To summarize current evidence on the use of tocolytic medications perioperatively for open prenatal repair of fetal myelomeningocele including tocolytic agent options, regimens, efficiency, and potential risks.Methods: A search of Medline, Embase, and SCOPUS databases was conducted from inception to March 2017. Studies that described their tocolytic protocol, gestational age at delivery, perinatal outcomes were included. Studies that did not exclusively assessed fetal myelomeningocele or did not adequately endorse obstetric and neonatal outcomes were excluded. Neither sample size nor language was a basis for exclusion.Results: Out of 570 studies retrieved on initial search, 462 were excluded for irrelevance. Of the 61 remaining titles, 17 were animal studies, 17 were reviews, 12 studied a spectrum of anomalies, three specified fetoscopy, four did not report neonatal outcomes, and one article was retracted. Two studies were added to the pool when the literature search was updated. Nine articles were eventually included; three case reports, six cohort studies with a total of 205 cases. Fetuses were managed at gestational ages between 19 and 30 weeks. Although tocolytic regimens were variable, indomethacin was commonly utilized as a preoperative tocolytic. Magnesium sulfate was usually initiated intraoperatively and was resumed postoperatively for a variable duration (18-48 hours) with or without subcutaneous terbutaline. Gestational age at delivery ranged from 30-37 weeks with an average of 33-35 weeks. Pulmonary edema was reported in two studies to be 2.2-5.5%. Perinatal outcomes were overall favorable.Conclusion: Preoperative indomethacin and postoperative course of magnesium sulfate seem to be a favorable tocolytic option in women with open prenatal myelomeningocele repair. Risks are generally minimal. However, adequate information on the duration of postoperative tocolysis seems to be inadequate.

Effectiveness of an oral versus sublingual loading dose of nifedipine for tocolysis.

OBJECTIVE: To determine the effectiveness of an oral versus sublingual loading dose of nifedipine for tocolysis. METHODS: An open, randomized clinical trial conducted between March 1, 2013, and April 31, 2014. Participants were pregnant women with a diagnosis of premature labor, single live fetus, topical pregnancy, gestational age 24-36 weeks, normal fetal vitality, cervical dilatation less than or equal to 4 cm, cervical effacement less than or equal to 80%, and intact amniotic membranes. They were randomized into two groups, oral and sublingual nifedipine, 20 mg loading dose, repeated every 30 minutes (maximum dose of 60 mg). The primary endpoint was the time until tocolysis and the secondary endpoints were the effectiveness of tocolysis within 90 minutes, 12 hours, and 48 hours; premature delivery within 48 hours; and maternal hemodynamic parameters and side effects. RESULTS: There were 80 patients randomized to oral (n=40) and sublingual (n=40) nifedipine. The time required for tocolysis was significantly less with sublingual nifedipine (160 minutes vs 340 minutes; P=0.0003). Sublingual nifedipine was also more successful than oral nifedipine at inhibiting premature labor within 90 minutes (n=8 [20.0%] vs n=1 [2.5%], P=0.014). There was no statistically significant difference between the groups for the other secondary endpoints. CONCLUSION: Compared with oral administration, a sublingual loading dose of nifedipine resulted in faster tocolysis in patients with premature labor. Brazilian Clinical Trials Registry (ReBEC): U1111-11566186.

Associations between postpartum depression and hypertensive disorders of pregnancy.

OBJECTIVE: To identify possible relationships between postpartum depression and hypertensive disorders of pregnancy (HDP), as well as the associated risk factors for developing postpartum depression. METHODS: The present prospective descriptive cross-sectional study was conducted among postpartum women who attended a public maternity hospital in Brazil between January 15, 2015, and January 15, 2017. The diagnosis and severity of HDP were based on blood pressure measurements (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), proteinuria, clinical findings, and laboratory findings. A group of normotensive women was also included. The Edinburgh Postnatal Depression Scale was used to assess the risk of postpartum depression. RESULTS: Of 168 participants (42 with HDP and 126 normotensive), 40 (23.8%) women displayed depressive symptoms (25 normotensive and 15 with HDP). The probability of postpartum depression correlated with a diagnosis of HDP (Spearman correlation coefficient [rS ] 0.219; P=0.004); premonitory signs of eclampsia (rS 0.171; P=0.027); magnesium sulfate therapy (rS 0.199; P=0.010); diastolic blood pressure (rS 0.165; P=0.033); and use of milk formula during hospitalization (rS 0.152; P=0.048). CONCLUSION: Women diagnosed with HDP were more likely to have depressive symptoms than their normotensive counterparts.

Preterm premature rupture of membranes. / Ruptura prematura de membranas en nacimientos de pretérmino.

Preterm premature rupture of membranes occurs in around 3% of pregnancies, and several aspects related to its management are still controversial. The objective of this update is to provide a detailed review of strategies aimed at reducing morbidity and mortality associated with this maternal condition. We will discuss the available evidence regarding the maternal use of antibiotics, the use of corticosteroids according to gestational age, the use of magnesium sulphate for fetal neuroprotection, the use of tocolytic agents, and the best moment for and route of delivery. This review also covers the effects of prolonged preterm premature rupture of membranes, infant morbidity and mortality in the short and long term, the harmful effects of antibiotics after delivery, including the effects on neurodevelopment and the presence of longterm chronic diseases.

La ruptura prematura de membranas de pretérmino ocurre en, aproximadamente, el 3% de los embarazos y numerosos aspectos vinculados a su manejo continúan siendo controversiales. El objetivo de esta actualización es revisar en forma detallada las estrategias destinadas a disminuir la morbilidad y mortalidad asociadas a esta situación clínica en las madres. Se discutirá la evidencia disponible acerca del uso en las madres de antibióticos, corticoides a distintas edades gestacionales, sulfato de magnesio como neuroprotector fetal, tocolíticos y el momento óptimo y la vía de finalización del embarazo. Asimismo, se incluyen los efectos de la ruptura prolongada de membranas en prematuros, la mortalidad y morbilidad de los recién nacidos en el corto y largo plazo, los perjuicios de la administración de antibióticos luego del nacimiento con las secuelas en el neurodesarrollo y la presencia de enfermedades crónicas a largo plazo.

Association between the use of magnesium sulfate as neuroprotector in prematurity and the neonatal hemodynamic effects.

PURPOSE: Cerebral palsy is often associated with prematurity and magnesium sulfate (MgSO4) has been used as a neuroprotector, with favorable results. However, its mechanism of action has not been fully elucidated. This study aimed to evaluate the association between MgSO4 at the imminent premature delivery and neonatal hemodynamic effects. MATERIALS AND METHODS: A cross-sectional study involving 94 newborns (NB) between 24 and 32 weeks at a Brazilian hospital was performed. Bivariate analysis between the use or the non-use of MgSO4 and hemodynamic characteristics was performed, using the Chi-square test. RESULTS: NB were evaluated between those who received MgSO4 (27.7) and those who did not (72.3%). Normal heart rate was verified in 62.8% of NB, normal respiratory rate in 70.2%, and normal temperature in 22.3%. Oxygen saturation higher or equal than 95% was evidenced in 85.1% of NB, normal hemoglucotest in 74.5%, and hemoglobin greater or equal than 16.4 g/dL in 30.9%. Non-invasive ventilation was performed in 48.9% of NB, while 51.1% were submitted to endotracheal ventilation. There was no significance relation detected between the use of MgSO4 and the hemodynamic characteristics. CONCLUSIONS: MgSO4 does not appear to influence hemodynamic factors as a cause of the neuroprotection in premature NB.

Tocolytic action and underlying mechanism of galetin 3,6-dimethyl ether on rat uterus.

BACKGROUND: Galetin 3,6-dimethyl ether (FGAL) is a flavonoid isolated from aerial parts of Piptadenia stipulacea. Previously, FGAL was shown to inhibit both carbachol- and oxytocin-induced phasic contractions in the rat uterus, which was more potent with oxytocin. Thus, in this study, we aimed to investigate the tocolytic action mechanism of FGAL on the rat uterus. METHODS: Segments of rat uterus ileum were suspended in organ bath containing modified Locke-Ringer solution at 32 °C, bubbled with carbogen mixture under a resting tension of 1 g. Isotonic contractions were registered using kymographs and isometric contractions using force transducer. RESULTS: FGAL was more potent in relaxing uterus pre-contracted with oxytocin than with KCl. Additionally, FGAL shifted oxytocin-induced cumulative contractions curves to the right in a non-parallel manner, with Emax reduction, indicating a pseudo-irreversible noncompetitive antagonism of oxytocin receptors (OTR) or a downstream pathway target. Moreover, FGAL shifted CaCl2-induced cumulative contraction curves to the right in a non-parallel manner in depolarizing medium, nominally without Ca2+, with Emax reduction, suggesting the inhibition of Ca2+ influx through CaV. The relaxant potency of FGAL was reduced by CsCl, a non-selective K+ channel blocker, suggesting positive modulation of these channels. Furthermore, in presence of apamin, 4-aminopyridine, glibenclamide or 1 mM TEA+, the relaxant potency of FGAL was attenuated, indicating the participation of SKCa, KV, KATP and highlighting BKCa. Aminophylline, a non-selective phosphodiesterase (PDE) blocker, did not affect the FGAL relaxant potency, excluding the modulation of cyclic nucleotide PDEs pathway by FGAL. CONCLUSION: Tocolytic effect of FGAL on rat uterus occurs by pseudo-irreversible noncompetitive antagonism of OTR and activation of K+ channels, primarily BKCa, leading to calcium influx reduction through CaV.

Magnesium sulfate and ophthalmic artery Doppler velocimetry in patients with severe preeclampsia: a case series.

BACKGROUND: In the present study, we used Doppler velocimetry in the ophthalmic artery to evaluate the hemodynamic status of the intracranial vasculature. This is the first time in the literature that indices of ophthalmic artery Doppler sonography of women with preeclampsia were evaluated before and after the use of magnesium sulfate to prevent eclampsia. CASE PRESENTATION: Indices of ophthalmic artery Doppler sonography of six women with severe preeclampsia at 27 to 33 weeks of gestational age were evaluated before and after the use of magnesium sulfate (10 minutes, 30 minutes, and 60 minutes after the magnesium sulfate loading dosage. The patients' ages were 26 years (patient 01), 29 years (patient 02), 20 years (patient 03), 21 years (patient 04), 20 years (patient 05), and 19 years (patient 06). The ethnic group of patients 01 and 04 was white and the ethnic group of patients 02, 03, 05 and 06 was mulatto. CONCLUSIONS: The apparent increase in resistance index and pulsatility index values, although there is no statistical significance in this series of cases, and the decrease in peak ratio values after the administration of magnesium sulfate reflect an increase in the impedance to flow in the ophthalmic artery and consequently a reduction in cerebral perfusion after the use of magnesium sulfate. This may explain how magnesium sulfate protects women with severe preeclampsia against cerebral damage and prevents acute convulsions in these patients. We believe that this case series report may have a broader clinical impact across medicine because the mechanism of how magnesium sulfate can protect patients and prevent acute convulsions is controversial.

Effect of vaginal progesterone in tocolytic therapy during preterm labor in twin pregnancies: Secondary analysis of a placebo-controlled randomized trial.

AIM: Our aim was to investigate the effect of the prophylactic use of vaginal progesterone on the latency period from the initiation of tocolytic therapy to delivery in twin pregnancies with preterm labor. METHODS: This study was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies in mothers who were exposed to a 200 mg vaginal progesterone ovule or a placebo ovule daily from 18 to 34 weeks gestation. Patients who were administered tocolysis with Atosiban because of preterm labor were included. The latency from tocolysis to delivery, mean gestational age at delivery and the rates of delivery within 48 h and within seven days were compared between progesterone and placebo groups. RESULTS: The analysis included 27 women in the progesterone group and 30 in the placebo group. The baseline characteristics were similar between the groups. Overall, there were no differences in the latency period to delivery (17.54 ± 13.54 days and 21.58 ± 13.52 days; P = 0.289), rates of delivery within 48 h (14.8% and 6.7%; P = 0.40) or within seven days (29.64% and 23.3%; P = 0.76) or mean gestational age at delivery (32.53 ± 3.33 and 34.13 ± 2.87; P = 0.08) between the progesterone and placebo groups, respectively. CONCLUSIONS: Prophylactic use of 200 mg of vaginal progesterone does not influence the latency to delivery in women with twin pregnancies treated with tocolysis because of preterm labor.

Puesta al dia sobre atosiban denominacion del medicamento tractocile 6. 75 MG/ 0. 9 ML solución inyectable / Up to the day about atosiban name of the medicinal product tractocile 6.75 Mg/ 0.9 Ml solution for injection

Este trabajo trata de la actualización del uso de ATOSIBAN para el tratamiento de la amenaza de parto prematuro, utilizando para su aplicación el protocolo de administración de Tractocile en el servicio de partes vs internado general, a los efectos de sistematizar los cuidados de enfermería en la utilización de este medicamento.

The Synergic In Vitro Tocolytic Effect of Nifedipine Plus Ritodrine on Human Myometrial Contractility.

Many pharmacological agents have been investigated to manage preterm labor; we postulate that a combination of tocolytic drugs may achieve a better effect in the prevention of uterine contractions without dose-dependent adverse effects. The aim of this study was to evaluate the inhibitory effect of dual combinations of tocolytics in vitro. Human myometrium was obtained during elective cesarean sections (term without labor; n = 40). Myometrial strips were placed in organ baths for the measurement of isometric tension. Contractile activity was induced by oxytocin (10-8 mol/L), then a concentration-response curve to single or dual combinations of tocolytics was started. All studied tocolytics (nifedipine, ritodrine, nitroglycerin, atosiban, and NS-1619), when used alone, significantly inhibited myometrial contractions. When combined, nifedipine plus ritodrine produced a significantly greater inhibition of contractility than each drug alone in the midrange of concentrations. The combination of nifedipine plus nitroglycerin or nifedipine plus atosiban produced a significantly greater inhibition than nitroglycerin or atosiban alone but not greater than nifedipine. The combination of nifedipine plus NS-1619 (Ca+2-activated K+ [BKCa] channel opener) reduced the inhibitory effect of each drug. We concluded that a selected combination of tocolytics (nifedipine plus ritodrine) produced a significantly greater inhibitory effect on contractility than each drug alone at intermediate concentrations. Thus, specific combinations of tocolytics with different intracellular signaling pathways may have a synergic effect constituting a provocative new option for preterm labor treatment.

Situational analysis of facilitators and barriers to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil.

BACKGROUND: Eclampsia is the main cause of maternal death in Brazil. Magnesium sulfate is the drug of choice for seizure prevention and control in the management of severe preeclampsia and eclampsia. Despite scientific evidence demonstrating its effectiveness and safety, there have been delays in managing hypertensive disorders, including timely access to magnesium sulfate. To conduct a general situational analysis on availability and use of magnesium sulfate for severe preeclampsia and eclampsia in the public health system. METHOD: A situational analysis was conducted with two components: a documental analysis on information available at the official websites on the policy, regulation and availability of the medication, plus a cross sectional study with field analysis and interviews with local managers of public obstetric health services in Campinas, in the southeast of Brazil. We used the fishbone cause and effect diagram to organize study components. Interviews with managers were held during field observations using specific questionnaires. RESULTS: There was no access to magnesium sulfate in primary care facilities, obstetric care was excluded from urgency services and clinical protocols for professional guidance on the adequate use of magnesium sulfate were lacking in the emergency mobile care service. Magnesium sulfate is currently only administered in referral maternity hospitals. CONCLUSION: The lack of processes that promote the integration between urgency/emergency care and specialized obstetric care possibly favors the untimely use of magnesium sulfate and contributes to the high maternal morbidity/mortality rates.

[Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital]. / Cirugía laparoscópica de urgencia en el tercer trimestre de gestación y su manejo anestésico. Experiencia de un hospital general.

BACKGROUND: Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. OBJECTIVE: The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. MATERIAL AND METHODS: An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. CLINICAL CASES: The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. CONCLUSION: The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour.