ATOSIBAN VERSUS NIFEDIPIN FOR THE MANAGEMENT OF PRETERM LABOR: A PROSPECTIVE STUDY
|
|
- Magdalen Candace Singleton
- 5 years ago
- Views:
Transcription
1 AAMJ, VOL11, NO4, OCT 2013 SUPLL 2 ATOSIBAN VERSUS NIFEDIPIN FOR THE MANAGEMENT OF PRETERM LABOR: A PROSPECTIVE STUDY Tarek R. Abbas Department of Obstetrics and Gynecology, Al-Azhar Faculty of Medicine, Cairo, Egypt ABSTRACT Objective: to compare the effectiveness and the safety of atosiban (oxytocin antagonist) and nifedipin (calcium channel blocker) as a tocolytic agent in preterm labor. Patients & Methods: This prospective study was performed in Bab Alshaaria university hospital. It involved one hundred and twenty pregnant women diagnosed with preterm labor at gestational weeks from January 2012 to June They were randomized to receive Atosiban intravenously (n=60) or Nifedipin orally (n=60) as a tocolytic. The two groups compared for effectiveness in delaying delivery for more than 48 h in order to undergo steroid therapy, and also to assess their maternal safety. Results: There was no statistically significant difference between the two groups in the effectiveness in treatment of preterm labor. Atosiban was effective in 81.7% of cases, and nifedipin in 75.0% of the cases ( P value =1.000), for delaying delivery for 48 h. Atosiban was effective in 75% of the cases, and nifedipin in 65% of the cases, for delaying delivery for more than 7 days. The maternal side effects in the atosiban group were 18.3%, and in the nifedipin group they were 40%, which had a statistically significant difference (P <0.001). The duration between treatment and delivery was ± days in the atosiban group and ± 14.6 days in the nifedipin group with no statistically significant difference (P =0.79). Conclusion: Both Atosiban and Nifedipin are effective in treatment of preterm labour with a comparable effectiveness, but atosiban with less side effects and can be used in patients with 329
2 Tarek R. Abbas heart diseases,and patient with multifetal pregnancy with minimal adverse effects. Keywords: Atosiban, Nifedipin, Preterm labor. INTRODUCTION Preterm delivery is defined by a birth occurring before 37 weeks of gestation or before 259 days from the last menstrual period. Prematurity is multifactorial and its incidence has increased during the last decade in most occidental countries, probably due to increased risk factors responsible for elective prematurity [1 3]. The mechanisms for preterm labour are still unclear. It could be associated either with a premature activation of the physiological contracting process or with a pathological factor responsible for uterine contractions, leading to preterm delivery [1 3]. Premature birth is responsible for 75-90% of neonatal mortalities, not due to congenital anomalies, and is also responsible for up to 50% of cases of neurodevelopment disability [4]. The majority of cases of adverse outcome occur in those cases under 34 weeks gestation. There is now growing evidence that the moderately preterm group (delivered between 32 and 37 weeks) are also at increased risk of infant death [5, 6]. Finding a safe and also effective method for the treatment of preterm labour has been continually under investigation [7]. Atosiban, which is an oxytocin vasopressin competitive antagonist, was recently used for the management of preterm labor [8, 9] and was able to inhibit the uterine contractions. In the new studies performed, it was noticed that atosiban has the same efficacy as other tocolytics, but had lower side effects [10 13]. The plasma concentration of atosiban reaches a steady state 1 h after the beginning of its infusion. Its half-life is about 18±3 min; therefore, after finishing the infusion, its plasma concentration decreases rapidly [14]. During the first 3 h of
3 AAMJ, VOL11, NO4, OCT 2013 SUPLL 2 treatment, the number of contractions decreases by about 75%. The predicted side effects include; nausea, vomiting, headaches and chest pains [14]. Atosiban is widely used in clinical practice because of its low side effects profile [15, 16]. A German meta-analysis based on 6 randomized trials, among them 3 double blind studies, confirmed a similar tocolytic action for atosiban and β adrenergic receptor agonists. A significantly low incidence of adverse effects is reported. Moreover, a lower cost saving in terms of hospital length and extra tests for excluding morbidity causes is found for the atosiban treated patients when compared to continuous fenoterol administration controls [17]. Another good and safe method of treatment of preterm labor is nifedipin [18, 19], which is a calcium channel blocker [20, 21] and inhibits the uterine contractions by inhibiting the sliding of actin over myosin in the myometrial cell membrane. Its main side effect is hypotension, which may lead to decrease in uteroplacental perfusion [20]. After oral administration, 90 percent is absorbed rapidly through the gastrointestinal tract, and maximum serum concentration is observed within min.the main side effects of nifedipin include; headaches, syncope, weakness, dizziness, hypotension and palpitations [20]. Nifedipin is the most commonly used drug for preterm labour inhibition at a daily dose of mg daily [22]. A Cochrane Database review met analysis published in 2003, reported a decreased number of deliveries within 7 days following treatment and also, a reduced incidence of neonatal respiratory distress syndrome [23]. These data confirm that nifedipin is a efficient tocolytic agent, with an easy oral route of administration, few side effects, and a low neonatal complications rate. However, it should be used with caution in patients with compromised cardiovascular condition as they may be at risk of pulmonary edema and cardiac failure [15]. 331
4 Tarek R. Abbas The objective of this study is to compare the effectiveness and the safety of atosiban (oxytocin antagonist) and nifedipin (calcium channel blocker) as a tocolytic agent in preterm labor. PATIENTS AND METHODS This prospective study was performed in the in Bab Alshaaria university hospital. It involved one hundred and twenty pregnant women diagnosed with preterm labor at gestational weeks from January 2012 to June They were randomized to receive Atosiban intravenously (n=60) or Nifedipin orally (n=60) as a tocolytic. The two groups compared for effectiveness in delaying delivery for more than 48 h in order to undergo steroid therapy, and also to assess their maternal safety. The inclusion criteria for this study were: 1- Contractions occurring at a frequency of four or more in 20 minutes 2- Cervical dilatation of 0-3 cm (in nulliparae) or 1-3 cm (in multiparae) and cervical effacement of 50% or more. 3- Gestational age between 24 and 34 weeks of pregnancy, which had been confirmed by a reliable menstrual date and sonography in the first trimester [20]. The exclusion criteria for this study were: High order multiple pregnancy greater than twins, ruptured membranes, vaginal bleeding, severe pre-eclampsia or hypertension, fever (body temperature >37.5C), fetal/placental abnormalities, serious maternal disease, any contraindication or hypersensitivity to any component of the study drugs, fetal death or fetal distress, IUGR, a history of trauma, a known uterine anomaly, and a blood pressure of less than 90/50 mmhg. All vaginal examinations and drug administration were done by the same investigator, and written informed consent was obtained from all patients. Atosiban was administered at a rate of 300 µg /min by venous infusion via
5 AAMJ, VOL11, NO4, OCT 2013 SUPLL 2 micro set, 48 drops [10]. Atosiban was continued for a maximum of 12 h, or 6 h after the patient s contractions stopped. If contractions continued without any changes and the dilatation of cervix increased, the drug was discontinued and it was noted as a failure of the treatment. In the nifedipin group the initial dose was 10 mg (one capsule) sublingually every 20 min for four doses. If the contractions were ceased, nifedipin was continued orally (20 mg) every 6 h for the first 24 h, and then every 8 h for the following 24 h, and finally 10 mg every 8 h for the last 24 h. If the contractions continued and the dilatation of the cervix increased, or the blood pressure decreased below 90/50 mmhg, the use of nifedipin was discontinued [18, 19]. During this period, patients were observed for uterine contractions and also for any possible side effects. Corticosteroids in the form of dexamethasone were given intramuscularly, 6 mg every 12 h for 48 h in both groups, and then all patients were observed for the evaluation of the tocolytic s effects. If severe side effects were observed, the drug s administration was discontinued. Although the main outcome was to delay delivery for more than 48 h, all patients were followed until the delivery, and interval between the treatment and delivery, was also recorded. Because some of patients did not give birth in this hospital, and the date of delivery were verified by telephone, it was not possible to evaluate the neonates precisely. Therefore, the neonatal safety was not considered in the present study. The χ 2 test was used to compare the categorical variable where appropriate. Unpaired Student s T tests were used to compare the continuous variables with normal distribution. RESULTS There were no statistically significant differences between the maternal age, parity, twin pregnancy or not, gestational age, history of preterm delivery, cervical dilatation and cervical effacement at the beginning of the treatment, the 333
6 Tarek R. Abbas duration of uterine contractions, and the number of contractions in the two groups. In 49 cases (81.7%) of the atosiban group and 45 cases (75%) of the nifedipin group, delivery was delayed for 48 h; there was no statistically significant difference between them. In 4 cases (6.6%) of the atosiban group and 6 cases (10%) of the nifedipin group, delivery occurred between 48 h and 7 days after treatment, which did not have a significant difference. In 11 cases (18.3%) in the atosiban group and 15 cases (25%) in the nifedipin group, they did not respond to treatment, and delivery occurred in less than 48 h; again there was no significant difference between them (the mean interval between the beginning of treatment and delivery was 12.25± 8.09 h in the atosiban group and 8.78± 3.67 h in the nifedipin group). In patients with response to treatment, the mean interval between the beginning of treatment and delivery in the atosiban and nifedipin group was 31.06± and 24.61± 14.6 days, respectively, with no significant difference (Table 1). There were side effects in 11 cases (18.3%) in the atosiban group and in 24 cases (40%) in the nifedipin group, with a statistically significant difference (P < , Table 2). Table (1): The effectiveness of atosiban and nifedipin as a tocolytic agent in preterm labor: Response to treatment Atosiban Group, N (%) Nifedipin Group, N (%) Delivery in less 15 (25%) 11 (18.3%) than 2 days(48 h) Delivery from 2-7 days 4 (6.6%) 6 (10%) Delivery After 7 days 45 (75%) 39 (65%)
7 AAMJ, VOL11, NO4, OCT 2013 SUPLL 2 Table (2): Maternal side effects after use of atosiban or nifedipin as a tocolytic agent: Side effect Atosiban Group, N (%) Nifedipin Group, N (%) Tachycardia 0(0 %) 5(8.3%) Tachycardia 0(0 %) 5(8.3%) Hypotension 0(0 %) 5(8.3%) Palpitation 0(0 %) 5(8.3%) Headache 1(1.6%) 3(5%) Vertigo 3(5%) 2(3.3%) Flank pain 2(3.3%) 0(0 %) Vomiting 1(1.6%) 3(5%) Tremors 1(1.6%) 2(3.3%) Dyspnoea 1(1.6%) 2(3.3%) Chest pain 1(1.6%) 3(5%) Anxiety 1(1.6%) 2(3.3%) Syncope 0(0 %) 1(1.6%) In some patients, there were 2 or 3 side effects(tachycardia, Hypotension, Palpitation) simultaneously, so total number of patients with side effects is 11 patients in Atosiban group and 24 patients in Nifedipin group. DISCUSSION Medical treatment of preterm labor is of great importance regarding to the amount of neonatal death due to prematurity [24]. Nifedipin has a proven therapeutic effect as a tocolytic agent. However, due to lack of uterine specificity, nifedipin is associated with significant maternal side effects. A relative new therapeutic approach is the use of uterine specific Oxytocin receptor antagonists (Atosiban) [25]. In the previous studies the success rate of the pharmacologic substance, either Atosiban or nifedipin was not related to gestational age at treatment. To 335
8 Tarek R. Abbas our opinion it could be of great importance in the choice of drug agent. Myometrial sensitivity to oxytocin increases with gestational age due to an upregulation of the oxytocin receptor, which has been demonstrated towards the end of pregnancy. This relative lack of oxytocin receptors earlier in pregnancy might contribute to a possibly reduced efficacy of Atosiban [26]. There are many possible interventions aiming to treat this multifactorial syndrome called preterm delivery. As described here, only some drugs have been proved to be effective on the contraction process, but there is no clear evidence of associated improved neonatal outcome. Some drugs are used as first-line single therapy such as β adrenergic receptor agonists and atosiban in Europe [17]. In our study atosiban has been compared with nifedipin for the treatment of preterm labor. According to the results of this study the efficacy of both medications was similar, but the adverse effects of nifedipin were significantly more than atosiban. Coomarasamy et al. [27] compared atosiban with nifedipin for the treatment of preterm labor. This study showed that two drugs had good efficacy, but nifedipin tocolysis was associated with a significant reduction in respiratory distress syndrome, compared with atosiban, and increased the number of women whose delivery was delayed by 48 h, although the result was not statistically significant. They concluded that when indirectly compared with atosiban, nifedipin is more effective. In a study performed by Moutquin et al. [11], atosiban was compared with ritodrin for the treatment of preterm labor. In this study, in agreement with the present study, the success rate (delaying delivery for 48 h) was 84.9% for atosiban and 86.8% for ritodrin, without a significant difference, but the side effects of atosiban were significantly lower than ritodrin. Also in another study by Goodwin et al. [10], delaying delivery for 48 h using atosiban was 70.5%
9 AAMJ, VOL11, NO4, OCT 2013 SUPLL 2 effective and the side effects, including, nausea, vomiting, headaches, and chest pain, were mild and tolerable. Valenzuela et al. [13] have been used atosiban as a maintenance treatment for reducing the preterm labor attacks (after one course of treatment with atosiban for inhibiting the acute attack of preterm labor) and have been compared with a placebo. The mean interval between the drug s administrations until the first recurrence of preterm labor in the atosiban group was significantly higher than the placebo. In the present study, atosiban has not been used as a maintenance treatment, and it is suggested that it be used in this way in a further study. In a study done by European Atosiban Study Group [28] in which atosiban was compared with terbutalin, both drugs had the same efficacy, but the side effects of terbutalin were more than those of atosiban. The comparison between atosiban and salbutamol [29] showed that their efficacy was similar, but the neonatal and maternal side effects of atosiban were less than salbutamol. Atosiban also has been used for the treatment of uterine hyperactivity in the active phase of labor [30], and was effective and well tolerated by the patients, and also the abnormal pattern of FHR recovered after its administration. Another study has been performed by Afshar et al. [31] comparing between atosiban and hexoprenaline for the treatment of fetal distress during labor. Both drugs inhibited contractions well and the fetal distress was recovered, but the side effects of atosiban were less than hexoperenalin. Moreover, as soon as the drug was discontinued, contractions returned faster than with hexoperenalin, suggesting that atosiban is a suitable option for tocolysis during labor in order to relieve fetal distress. Regarding atosiban s lower side effects in comparison with other tocolytics, Tsatsaris et al. [9] concluded that atosiban is a drug of choice for the treatment of preterm labor, especially in patients who are at risk from the 337
10 Tarek R. Abbas cardiovascular effects during using these drugs, such as cardiac disease during pregnancy and multifetal pregnancies. CONCLUSION Both Atosiban and Nifedipin are effective in treatment of preterm labour with a comparable effectiveness, but atosiban with less side effects and can be used in patients with heart diseases,and patient with multifetal pregnancy with minimal adverse effects.
11 AAMJ, VOL11, NO4, OCT 2013 SUPLL 2 REFERENCES [1] L. J.Muglia and M. Katz, The enigma of spontaneous preterm birth, The New England Journal of Medicine, vol. 362, no. 6, pp , [2] H. N. Simhan and S. N. Caritis, Prevention of preterm delivery, The New England Journal of Medicine, vol. 357, no. 6, pp , [3] R. Romero, J. Espinoza, J. P. Kusanovic et al., The preterm parturition syndrome, BJOG: An International Journal of Obstetrics and Gynaecology, vol. 113, supplement 3, pp , [4]Hack M, Fanaroff AA., Outcomes of children of extremely low birth weight and gestational age in the 1990 s. Early Human Development, vol. 53(3): , [5]Moser K, Macfarlane A, Chow YH, Hilder L, Dattani N., Introducing new data on gestation-specific infant mortality among babies born in 2005 in England and Wales. Health Stat Q: 13 27, [6]Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R, et al., The contribution of mild and moderate preterm birth to infant mortality. JAMA; vol. 284:843 9, [7] American College of Obstetricians and Gynecologist preterm labor. Technical Bulletin, NO. 206 June [8] Romero R, Sibai BM, Sanchez-Ramos L, Valenzuela GJ, Veille JC, Tabor B, et al. An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a randomized, double-blind, placebo-controlled trial with tocolytic rescue. Isr J Obstet Gynecol.vol. 182(5):1173 6,
12 Tarek R. Abbas [9] Tsatsaris V, Carbonne B, Cabrol D. Atosiban for preterm labor. Drugs, vol.64 (4):375 82, [10] Goodwin TM, Valenzuela G, Silver H, Hayashi R, Creasy GW, Lane R. Treatment of preterm labor with the oxytocin antagonist atosiban. Am J Perinatol, vol. 13(3): , [11] Moutquin JM, Sherman D, Cohen H, Mohide PT, Celnikier DH, Fejgin M, et al. Double-blind, randomized controlled trial of atosiban and ritodrin in the treatment of preterm labor: a multicenter effectiveness and safety study. Isr J Obstet Gynecol, vol. 182(5):1191 9, [12] The Worldwide Atosiban versus h-agonists Study Group. Effectiveness and safety of the oxytocin antagonist atosiban versus β -adrenergic in the treatment of preterm labor. BJOG, vol. 108(1):133 42, [13] Valenzuela GJ, Ramos LS, Romero R, Silver HM, Koltun WD, Millar L, et al. Maintenance treatment of preterm labor with the oxytocin antagonist atosiban. Am J Obstet Gynecol, vol. 182(5):1184 9, [14] Goodwin TM, Millar L, North L, Abrams LS, Weglein RC, Holland ML. The pharmaco kinetics of the oxytocin antagonist atosiban in pregnant women with preterm uterine contractions. Am J Obstet Gynecol, vol. 173(3): , [15] V. Smith, D. Devane, C. M. Begley, M. Clarke, and S. Higgins, A systematic review and quality assessment of systematic reviews of randomized trials of interventions for preventing and treating preterm birth, European Journal of Obstetrics and Gynecology and Reproductive Biology, vol. 142, pp. 3 11, [16] S. Caritis, Adverse effects of tocolytic therapy, British Journal of Obstetrics and Gynaecology, vol. 112, supplement 1, pp , 2005.
13 AAMJ, VOL11, NO4, OCT 2013 SUPLL 2 [17] J. Wex, M. Connolly, and W. Rath, Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation, BMC Pregnancy and Childbirth, vol. 9, article 23, [18] Childress CH, Katz VL. Nifedipine and it s indications in obstetrics and gynecology. Obstet Gynecol, vol. 83(7): 616 9, [19] King JF, Flenady V, Papatsonis D, Dekker G, Carbo B. Calcium channel blockers for inhibiting preterm labor, a systematic review of the evidence and protocol for administration of Nifedipine. Aust N Z J Obstet Gynaecol, vol. 43(3):192 8, [20] Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD. Williams s obstetrics. New York7 McGraw-Hill; P , [21] Papatsonis DN, Van Geijn HP, Ader HJ, Lande FM, Bleker OP, Dekker GA. Nifedipin and ritodrin in the management of preterm labor: a randomized multicenter trial. Obstet Gynecol, vol. 90(3):230 4, [22] H. P. Van Geijn, J. E. Lenglet, and A. C. Bolte, Nifedipine trials: effectiveness and safety aspects, British Journal of Obstetrics and Gynaecology, vol. 112, supplement 1, pp , [23] J. F.King, V. J. Flenady, D. N. M. Papatsonis, G. A. Dekker, and B. Carbonne, Calcium channel blockers for inhibiting preterm labour, Cochrane Database of Systematic Reviews, no. 1, article CD002255, [24]Melin P. Development of an oxytocin antagonist atosiban. Research Clinical Forums, vol. 16:155-68, [25]Goodwin TM, Paul R, Silver H, Spellacy W, Parsons M, Chez R et al. The effect of the oxytocin antagonist atosiban on preterm uterine activity in the human. Am J Obstet Gynaecol, vol. 170:474-8,
14 Tarek R. Abbas [26]Papatsonis D, Flenady V, Cole S, Liley H. Oxytocin receptor antagonists for inhibiting preterm labour. Cochrane Database Syst Rev, vol. 3:CD004452, [27] Coomarasamy A, Knox EM, Gee H, Song F, Khan F. Effectiveness of nifedipin versus atosiban for tocolysis in preterm labor: a meta-analysis with indirect comparison of randomized trials. BJOG, vol. 110(12):1045 9, [28] European Atosiban Study Group. The oxytocin antagonist atosiban versus the beta agonist terbutalin in the treatment of preterm labor. A randomized, double blind, controlled study. Acta Obstet Gynecol Scand, vol. 80(5):413 22, [29] French Australian Atosiban Investigator Group. Treatment of Preterm labor with the Oxytocin antagonist atosiban: a double-blind, randomized controlled comparison with salbutamol. Eur J Obstet Gynecol Reprod Biol vol. 98(2):177 85, [30] Lurie S, Sadan O, Ben Aroya Z, Glezerman M. Atosiban treatment for uterine hyperactivity during active labor: a pilot study. J Perinat Med, vol. 32(2):137 9, [31] Afschar P, Scholl W, Bader A, Bauer M, Winter R. A prospective randomized trial of Atosiban versus hexoprenaline for acute tocolysis and intrauterine resuscitation. BJOG, vol. 111(4):316 8, `
By Dr.Asmaa Al sanjary
By Dr.Asmaa Al sanjary Preterm delivery is defined by a birth occurring before 37 completed weeks of gestation. Prematurity is multifactorial and its incidence has increased during the last decade in most
More informationNifedipine Tocolysis Regime Policy
Document ID: MATY072 Version: 1.0 Facilitated by: Karen Wakelin, ACMM Issue Date: August 2010 Approved by: Maternity Quality Committee Review date: October 2017 Nifedipine Tocolysis Regime Policy Policy
More informationTOCOLYTIC DRUGS FOR WOMEN IN PRETERM LABOUR
Clinical Guideline No. 1(B) October 2002 (Replaces Guideline No.1 Beta-agonists and No.1 Ritodrine) TOCOLYTIC DRUGS FOR WOMEN IN PRETERM LBOUR 1. Purpose and scope Preterm birth is the most important single
More informationOriginal Article Clinical efficacy of atosiban treatment in late abortion and preterm labour of twin pregnancy
Int J Clin Exp Med 2016;9(2):3946-3952 www.ijcem.com /ISSN:1940-5901/IJCEM0016466 Original Article Clinical efficacy of atosiban treatment in late abortion and preterm labour of twin pregnancy Ya-Juan
More informationTocolytics. Tocolytics (terbutaline, magnesium sulfate injection) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.06 Subject: Tocolytics Page: 1 of 5 Last Review Date: September 15, 2016 Tocolytics Description Tocolytics
More informationPreterm birth is the leading cause of perinatal morbidity
Nifedipine Compared With Atosiban for Treating Preterm Labor A Randomized Controlled Trial Raed Salim, MD, Gali Garmi, MD, Zohar Nachum, MD, Noah Zafran, MD, Shira Baram, MD, and Eliezer Shalev, MD OBJECTIVE:
More informationA clinical study of feto-maternal outcome of. Isoxsuprine Hydrochloride in preterm labour
Original Research Article A clinical study of feto-maternal outcome of tocolytic agent nifedipine as compared to Isoxsuprine Hydrochloride in preterm labour Farzana Zahir 1*, Kalyan Kumar Nath 2, H H Choudhury
More informationMedical Policy An Independent Licensee of the Blue Cross and Blue Shield Association
Acute and Maintenance Page 1 of 11 Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association Title: Acute and Maintenance Subcutaneous and Intravenous Tocolysis Professional
More informationMedical Policy. MP Acute and Maintenance Tocolysis
Medical Policy MP 5.01.07 BCBSA Ref. Policy: 5.01.07 Last Review: 08/30/2017 Effective Date: 08/30/2017 Section: Prescription Drugs End Date: 08/19/2018 Related Policies 4.01.16 Progesterone Therapy as
More informationTO COMPARE THE EFFECTIVENESS OF NIFEDIPINE AND GLYCERYL TRINITRATE PATCH IN PREVENTION OF PRETERM LABOUR ABSTRACT
ORIGINAL ARTICLE TO COMPARE THE EFFECTIVENESS OF NIFEDIPINE AND GLYCERYL TRINITRATE PATCH IN PREVENTION OF PRETERM LABOUR 1-3 Department of Gynae & Obstetrics, Lady Reading Hospital, Peshawar - Pakistan.
More informationPreterm Labour and Tocolysis
Title: CLINICAL GUIDELINES ID TAG Preterm Labour and Tocolysis Authors: Designation: Speciality / Division: Directorate: Dr L Bell, Dr K Price, Dr G McKeown, Mr D Sim Trainee, Trainee, CAH Consultant,
More informationMedical Policy An Independent Licensee of the Blue Cross and Blue Shield Association
Acute and Maintenance Tocolysis Page 1 of 14 Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association Title: Acute and Maintenance Tocolysis Professional Institutional Original
More informationPOLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
Original Issue Date (Created): December 8, 2003 Most Recent Review Date (Revised): July 22, 2014 Effective Date: October 1, 2014 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT
More informationCOMPARISON OF NEFIDIPINE WITH SOLBUTAMOL AS TOCOLYTIC AGENTS IN PRETERM LABOUR
E:/Biomedica Vol.23 Jul. Dec. 2007/Bio-10 (A) COMPARISON OF NEFIDIPINE WITH SOLBUTAMOL AS TOCOLYTIC AGENTS IN PRETERM LABOUR KIREN K. MALIK Department of Obstetrics and Gynaecology, Fatima Jinnah Medical
More informationMedical Policy An Independent Licensee of the Blue Cross and Blue Shield Association
Acute and Maintenance Tocolysis Page 1 of 17 Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association Title: Acute and Maintenance Tocolysis Professional Institutional Original
More informationAdverse effects of tocolytic therapy
BJOG: an International Journal of Obstetrics and Gynaecology March 2005, Vol. 112, Supplement 1, pp. 74 78 Adverse effects of tocolytic therapy Steve Caritis The rationale for using tocolytics in preterm
More informationKofinas Perinatal Providing Care to the Unborn
Alexander D. Kofinas, MD Director, Kofinas Perinatal Associate Professor, Clinical Obstetrics and Gynecology Cornell University, College of Medicine Patient instructions for the use of Indomethacin and
More informationCOMPARISON BETWEEN NIFEDIPINE AND RITODRINE AS AN EFFECTIVE TOCOLYTIC AGENT FOR PRETERM LABOUR
Original Article COMPARISON BETWEEN NIFEDIPINE AND RITODRINE AS AN EFFECTIVE TOCOLYTIC AGENT FOR PRETERM LABOUR Nadeem Shahzad, 1 Faiqa Saleem, 2 Muhammad Shahid, 3 Aisha Malik 4 Abstract Background: Preterm
More informationDrugs used in obstetrics
Drugs used in obstetrics Drugs used in obstetrics Drugs may be used to modify uterine contractions. These include oxytocic drugs used to stimulate uterine contractions both in induction of labour and to
More information2. Name of the focal point in WHO submitting or supporting the application
NIFEDIPINE Application 1. Summary statement of the proposal for inclusion Nifedipine, a calcium channel blocker already available in WHO Model Formulary 2004, needs an indication for threatened preterm
More informationcardiovascular events when in use in these indications and the outcome of the review is summarised below.
Annex II Scientific conclusions and grounds for revocation or variation as applicable to the terms of the marketing authorisations and detailed explanation for the differences from the PRAC recommendation
More informationAtosiban versus usual care for the management of preterm labor
J. Perinat. Med. 35 (2007) 305 33 Copyright by Walter de Gruyter Berlin New York. DOI 0.55/JPM.2007.078 Atosiban versus usual care for the management of preterm labor Peter Husslein, *, Luis Cabero Roura
More informationClinical practice evaluation of atosiban in preterm labour management in six European countries
DOI: 10.1111/j.1471-0528.2006.01134.x www.blackwellpublishing.com/bjog Original article Clinical practice evaluation of atosiban in preterm labour management in six European countries P Husslein, a LC
More informationPre-term birth occurs when a neonate is birthed or
Susan L. Rideout, RN-C, BSN Pre-term birth occurs when a neonate is birthed or delivered prior to the completion of the 37th week of pregnancy. It s the leading cause of morbidity and the second leading
More informationEfficacy and side effect of ritodrine and magnesium sulfate in threatened preterm labor
Original Article Obstet Gynecol Sci 2018;61(1):63-70 https://doi.org/10.5468/ogs.2018.61.1.63 pissn 2287-8572 eissn 2287-8580 Efficacy and side effect of ritodrine and magnesium sulfate in threatened preterm
More informationAtosiban vs. ritodrine as a tocolytic in external cephalic version at term: a prospective cohort study
J. Perinat. Med. 38 (2010) 23 28 Copyright by Walter de Gruyter Berlin New York. DOI 10.1515/JPM.2010.010 Atosiban vs. ritodrine as a tocolytic in external cephalic version at term: a prospective cohort
More information2 QUALITATIVE AND QUANTITATIVE COMPOSITION
SUMMARY OF PRODUCT CHARACTERISTICS 1 NAME OF THE MEDICINAL PRODUCT Atosiban 6.75 mg/0.9 ml solution for injection. 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each ampoule (0.9 ml solution) contains 6.75
More informationUterine Contractility Symposium. Oxytocin antagonists: clinical and scientific considerations
Uterine Contractility Symposium Oxytocin antagonists: clinical and scientific considerations Steven Thornton *, Manu Vatish and Donna Slater Department of Biological Sciences, University of Warwick, Coventry
More informationNifedipine trials: effectiveness and safety aspects
BJOG: an International Journal of Obstetrics and Gynaecology March 2005, Vol. 112, Supplement 1, pp. 79 83 Nifedipine trials: effectiveness and safety aspects Herman P. van Geijn, Joris E. Lenglet, Annemieke
More informationPACKAGE INSERT TEMPLATE FOR SALBUTAMOL TABLET & SALBUTAMOL SYRUP
PACKAGE INSERT TEMPLATE FOR SALBUTAMOL TABLET & SALBUTAMOL SYRUP Brand or Product Name [Product name] Tablet 2mg [Product name] Tablet 4mg [Product name] Syrup 2mg/5ml Name and Strength of Active Substance(s)
More informationBased on 2014 SOGC Guidelines
Based on 2014 SOGC Guidelines 22nd Edition 2015 1 ICH + gestational hypertension by far the biggest cause of direct maternal deaths New stats coming in 2013 OCR 22nd Edition 2015 2 Diastolic 90 mmhg is
More informationEfficacy of Oxytocin Receptors Antagonist, Magnesium Sulfate and Calcium Channel Blockers in Treatment of Preterm Labour
Med. J. Cairo Univ., Vol. 84, No. 1, June: 609-619, 2016 www.medicaljournalofcairouniversity.net Efficacy of Oxytocin Receptors Antagonist, Magnesium Sulfate and Calcium Channel Blockers in Treatment of
More informationCHAPTER 12 HYPERTENSION IN SPECIAL GROUPS HYPERTENSION IN PREGNANCY
CHAPTER 12 HYPERTENSION IN SPECIAL GROUPS HYPERTENSION IN PREGNANCY v Mild preeclampsia is managed by close observation of the mother and fetus preferably in hospital. If the diastolic blood pressure remains
More informationThe Treatment of Preterm Labor Using a Portable Subcutaneous Terbutaline Pump
The Treatment of Preterm Labor Using a Portable Subcutaneous Terbutaline Pump D. JEAN SALA, RN, MSN, AND KENNETH J. MOISE, JR., MD The perinatal mortality rate related to preterm delivery has led researchers
More informationPreeclampsia: What s old is new again. Gene Chang, MD Maternal Fetal Medicine
Preeclampsia: What s old is new again Gene Chang, MD Maternal Fetal Medicine Objectives Define Preeclampsia Review current guidelines Role of proteinuria Timing of delivery Seizure prevention Severe Hypertension
More informationComparison of perinatal outcomes between long-term and short-term use of tocolytic agent: a historical cohort study in a single perinatal hospital
doi:10.1111/jog.13104 J. Obstet. Gynaecol. Res. Vol. 42, No. 12: 1680 1685, December 2016 Comparison of perinatal outcomes between long-term and short-term use of tocolytic agent: a historical cohort study
More informationMANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM
MANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM Are Particular Anti-hypertensives More Effective or Harmful Than Others in Hypertension in Pregnancy? Existing data is inadequate Methyldopa and
More informationAcute Postpartum Pulmonary Edema: A Case Report
Postpartum pulmonary edema 157 Acute Postpartum Pulmonary Edema: A Case Report Min-Po Ho 1, Wing-Keung Cheung 2, Kaung-Chau Tsai 1 Acute pulmonary edema after pregnancy is rare. Pulmonary emobolism, pneumonia,
More informationTocolytics for preterm premature rupture of membranes (Review)
(Review) Mackeen AD, Seibel-Seamon J, Grimes-Dennis J, Baxter JK, Berghella V This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane
More informationComparison of Efficacy and Safety of Intravenous Labetalol Versus Hydralazine for Management of Severe Hypertension in Pregnancy
https://doi.org/10.1007/s13224-017-1053-9 ORIGINAL ARTICLE Comparison of Efficacy and Safety of Intravenous Labetalol Versus Hydralazine for Management of Severe Hypertension in Pregnancy Purvi Patel 1
More information1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece.
HJOG An Obstetrics and Gynecology International Journal HJOG 2019, 18 (1), 21-25 Christos Kalantzis, Kalliopi Pappa 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and
More informationCost-Effectiveness of Ritodrine and Fenoterol for Treatment of Preterm Labor in a Low Middle-Income Country:A Case Study
Volume 11 Number 2 2008 VALUE IN HEALTH Cost-Effectiveness of Ritodrine and Fenoterol for Treatment of Preterm Labor in a Low Middle-Income Country:A Case Study Mihajlo Jakovljevic, MD, Mirjana Varjacic,
More informationPolicy REVISED: 6/30/2016 3:30 PM. Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016
Title: Antihypertensive Treatment for Severe Hypertension During Pregnancy Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016 Policy POLICY STATEMENT: Pregnant or postpartum patients
More informationINTRAVENOUS HYDRALAZINE POLICY
PURPOSE INTRAVENOUS HYDRALAZINE POLICY The purpose of this policy is to: provide safe and effective care for women establish a local approach to care that is evidence based and consistent inform good decision
More informationKey words: Preterm labor, oxytocin, oxytocin receptor antagonist, atosiban, randomized clinical trial, tocolysis, prematurity
An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: A randomized, double-blind, placebo-controlled trial with tocolytic rescue Roberto Romero, MD, Baha M. Sibai, MD, Luis Sanchez-Ramos,
More informationMaternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
ISPUB.COM The Internet Journal of Gynecology and Obstetrics Volume 19 Number 1 Maternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
More informationThe short-term effect of nifedipine tocolysis on placental, fetal cerebral and atrioventricular Doppler waveforms
Ultrasound Obstet Gynecol 004; 4: 761 765 Published online 6 October 004 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.100/uog.1770 The short-term effect of nifedipine tocolysis on placental,
More informationThe Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer**
THE VALVULAR IRAQI POSTGRADUATE HEART DISEASES MEDICAL AND JOURNAL PREGNANCY The Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer** ABSTRACT:
More informationMedication Policy Manual. Topic: Makena, hydroxyprogesterone caproate Date of Origin: March 28, 2011
Independent licensees of the Blue Cross and Blue Shield Association Medication Policy Manual Policy No: dru255 Topic: Makena, hydroxyprogesterone caproate Date of Origin: March 28, 2011 Revised Date: August
More informationCASE 5 - Toy et al. CASE FILES: Obstetrics & Gynecology
z CASE 5 - Toy et al. CASE FILES: Obstetrics & Gynecology A 28-year-old woman is brought into the emergency room with a blood pressure of 60/40. The patient s husband states that she had 2 days of nausea
More informationDeclaration of conflict of interest
Declaration of conflict of interest Claudio Borghi Lectures fees: Menarini International, Servier International, Recordati International, Ely-Lilly USA, BMS, Boheringer Ingelheim, Novartis Pharma Research
More informationEQUIPMENT: Nitrous Oxygen Delivery System:
Policy: Nitrous Oxide Use in the Intrapartum and Immediate Postpartum Period for Obstetrical Patients in the Family Birth Place Approvers: CEO. CNO, Medical Staff President, Anesthesia Chair, OB Medical
More informationPost - caesarean section pyrexia and its relation of rupture of membranes and prophylactic antibiotics
MOJ Women s Health Research Article Open Access Post - caesarean section pyrexia and its relation of rupture of membranes and prophylactic antibiotics Abstract Objectives: To determine the incidence of
More informationMaternal Cardiac Disease Diagnosis and Management
Maternal Cardiac Disease Diagnosis and Management Dr. Şevki ÇELEN ZTB Maternity and Teaching Hospital Department of Perinatology Heart diseases in pregnancy Today, 0.2-4% of all pregnancies are accompanied
More informationPrevalence of thyroid disorder in pregnancy and pregnancy outcome
Original Research Article Prevalence of thyroid disorder in pregnancy and pregnancy outcome Praveena K.R. 1, Pramod Kumar K.R. 2*, Prasuna K.R. 3, Krishna Kumar TV 4 1 Assistant Professor, Department of
More informationOutcomes of Pregnancies at Risk for Hypertensive Complications Managed Using Impedance Cardiography
Outcomes of Pregnancies at Risk for Hypertensive Complications Managed Using Impedance Cardiography David G. Chaffin, M.D., 1 and Denise G. Webb, RNC, BSN 2 ABSTRACT We assessed the effect of antihypertensive
More informationVentolin Injection 500 micrograms (0.5mg), salbutamol, as sulphate, in 1ml (500 micrograms/ml).
Ventolin parenteral preparations Salbutamol QUALITATIVE AND QUANTITATIVE COMPOSITION Ventolin Injection 500 micrograms (0.5mg), salbutamol, as sulphate, in 1ml (500 micrograms/ml). Ventolin Solution for
More informationMaternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes: a systematic review
Bain et al. BMC Pregnancy and Childbirth 2013, 13:195 RESEARCH ARTICLE Open Access Maternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes:
More informationSalapin: Salbutamol BP 2mg as sulphate in each 5mL of a raspberry cola flavoured, sugar free syrup.
Salapin Salbutamol Syrup 2mg/5mL Qualitative and quantitative composition Salapin: Salbutamol BP 2mg as sulphate in each 5mL of a raspberry cola flavoured, sugar free syrup. Clinical particulars Therapeutic
More informationVishwanath Pattan Endocrinology Wyoming Medical Center
Vishwanath Pattan Endocrinology Wyoming Medical Center Disclosure Holdings in Tandem Non for this Training Introduction In the United States, 5 to 6 percent of pregnancies almost 250,000 women are affected
More informationCMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan
CMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth New! Improving Health Care Response to Preeclampsia:
More informationLong-term follow up of children exposed in utero to nifedipine or ritodrine for the management of preterm labour
DOI: 10.1111/j.1471-0528.2006.00851.x www.blackwellpublishing.com/bjog General obstetrics Long-term follow up of children exposed in utero to nifedipine or ritodrine for the management of preterm labour
More informationManagement of Pregestational and Gestational Diabetes Mellitus
Background and Prevalence Management of Pregestational and Gestational Diabetes Mellitus Pregestational Diabetes - 8 million women in the US are affected, complicating 1% of all pregnancies. Type II is
More informationAsthma in Pregnancy, Labour and Postnatal Guidelines
Asthma in Pregnancy, Labour and Postnatal Guidelines N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed versions of the document. The Intranet
More informationJMSCR Vol 05 Issue 11 Page November 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i11.51 Anchovy Fish as a Source of Calcium in
More informationBRICANYL INJECTION. terbutaline sulfate PRODUCT INFORMATION
BRICANYL INJECTION terbutaline sulfate PRODUCT INFORMATION NAME OF THE MEDICINE Terbutaline sulfate, 2-(tert-butylamino)-1-(3,5-dihydroxyphenyl) ethanol sulfate, a sympathomimetic bronchodilator with a
More informationStroke in Pregnancy. Stroke in Pregnancy 6/23/13
G5#$#Preven*ng#Maternal#Morbidity#and#Mortality#Via# Expanded#Scope#of#Nursing#Prac*ce#As#First#Responder# in#hypertensive#crisis#of#preeclampsia# The$presenter$reports$no$relevant,$influencing$financial$rela5onships.$
More informationDiabetes in obstetric patients
Diabetes in obstetric patients Swedish Society of Obstetric Anaesthesia & Intensive Care Anita Banerjee Obstetric Physician Diabetes & Endocrinology Consultant Outline Scope of the problem Diabetes and
More informationPUBLISHED VERSION.
PUBLISHED VERSION Roel de Heus, Ben Willem Mol, Jan-Jaap H M Erwich, Herman P van Geijn, Wilfried J Gyselaers, Myriam Hanssens, Linda Härmark, Caroline D van Holsbeke, Johannes J Duvekot, Fred F A M Schobben,
More informationAWHONN Oregon Section 2014
AWHONN Oregon Section 2014 Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth Hypertensive in Pregnancy Carol J Harvey, MS, RNC-OB, C-EFM Clinical Specialist Northside
More informationEffect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome
ORIGINAL ARTICLE Effect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome ABSTRACT Shagufta Tahir, Shaheen Zafar, Savita Thontia Objective Study design Place & Duration of study Methodology
More informationA descriptive study of the prevalence of hypothyroidism among antenatal women and foetal outcome in treated hypothyroid women
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Prasad DR et al. Int J Reprod Contracept Obstet Gynecol. 2016 Jun;5(6):1892-1896 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationCounseling and Long-term Follow up After Gestational Disorders
Counseling and Long-term Follow up After Gestational Disorders Tanya Melnik, MD Assistant Professor, University of Minnesota Sarina Martini, MD Ob/Gyn Resident, PGY4 University of Minnesota Counseling
More informationCore Safety Profile. Pharmaceutical form(s)/strength: Sterile eye drops 1%, 2% Date of FAR:
Core Safety Profile Active substance: Carteolol Pharmaceutical form(s)/strength: Sterile eye drops 1%, 2% P - RMS: SK/H/PSUR/0002/002 Date of FAR: 16.03.2012 4.1 THERAPEUTIC INDICATIONS Ocular hypertension
More informationResearch Article Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes
Respiratory Medicine, Article ID 209583, 7 pages http://dx.doi.org/10.1155/2014/209583 Research Article Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes
More informationResearch Article Magnesium Sulfate as a Second-Line Tocolytic Agent for Preterm Labor: A Randomized Controlled Trial in Kyushu Island
Pregnancy Volume 2011, Article ID 965060, 6 pages doi:10.1155/2011/965060 Research Article Magnesium Sulfate as a Second-Line Tocolytic Agent for Preterm Labor: A Randomized Controlled Trial in Kyushu
More informationCyclo-oxygenase (COX) inhibitors for treating preterm labour (Review)
Cyclo-oxygenase (COX) inhibitors for treating preterm labour (Review) King JF, Flenady V, Cole S, Thornton S This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration
More informationComposition Each ml of Ventol solution for inhalation contains 5 mg Salbutamol (as sulphate).
VENTOL Composition Each ml of Ventol solution for inhalation contains 5 mg Salbutamol (as sulphate). Respiratory Solution Action Salbutamol is a short-acting, relatively selective beta2-adrenoceptor agonist.
More informationPeripartum kardiomyopati
Fall 3 Peripartum kardiomyopati Roman A roch 2017 01 26 2 3 Dg. PPCM Symptoms ECG, pro-bnp echocardiography 4 Peripartum cardiomyopathy: a systematic literature review Acta Obstetricia et Gynecologica
More informationMagnesium sulfate has an antihypertensive effect on severe pregnancy induced hypertension
Hypertension Research In Pregnancy 11 S. Takenaka et al. ORIGINAL ARTICLE Magnesium sulfate has an antihypertensive effect on severe pregnancy induced hypertension Shin Takenaka 1, Ryu Matsuoka 2, Daisuke
More informationIsolated proteinuria in Chinese pregnant women with pre-eclampsia: Results of retrospective observational study
Biomedical Research 2017; 28 (11): 5162-5166 ISSN 0970-938X www.biomedres.info Isolated proteinuria in Chinese pregnant women with pre-eclampsia: Results of retrospective observational study Jing Cai 1,
More information39 th Annual Perinatal Conference Vanderbilt University December 6, 2013 IUGR. Diagnosis and Management
39 th Annual Perinatal Conference Vanderbilt University December 6, 2013 IUGR Diagnosis and Management Giancarlo Mari, M.D., M.B.A. Professor and Chair Department of Obstetrics and Gynecology University
More informationMFMU - Background. MFMU - Background MFMU GOALS
MFMU - Background Highlights From The MFM Units Network Ronald Wapner, MD Modern OB management (especially high risk pregnancies) has adopted principles of care, employed pharmaceuticals, applied methodologies
More informationAssessment of knowledge and education relating to asthma during pregnancy among women of childbearing age
Al Ghobain et al. Asthma Research and Practice (2018) 4:2 DOI 10.1186/s40733-017-0038-x RESEARCH Open Access Assessment of knowledge and education relating to asthma during pregnancy among women of childbearing
More informationPharmaceutical form(s)/strength: Solution: 5 mg/ml Suspensions: 2.5 and 5 mg/ml P-RMS:
0BCore Safety Profile Active substance: Betaxolol eyedrops Pharmaceutical form(s)/strength: Solution: 5 mg/ml Suspensions: 2.5 and 5 mg/ml P-RMS: HU/H/PSUR/0010/002 Date of FAR: 20.03.2013 4.2 Posology
More informationAutonomic Nervous System (ANS) وحدة اليوزبكي Department of Pharmacology- College of Medicine- University of Mosul
Autonomic Nervous System (ANS) د. م. أ. وحدة اليوزبكي Department of Pharmacology- College of Medicine- University of Mosul Sympathetic (Adrenergic) nervous system 3 Objectives At end of this lecture, the
More informationSri Lankan Journal of Anaesthesiology 17(2) : (2009)
Sri Lankan Journal of Anaesthesiology 17(2) : 55-60 (2009) COMPARISON OF PROPHYLACTIC INTRAMUSCULAR EPHEDRINE WITH PRELOADING VERSUS PRELOADING ALONE IN PREVENTION OF HYPOTENSION DURING ELECTIVE CAESAREAN
More informationRETIRED: REVIEWED/Revised: 12/14; 10/15; 1/16; 9/16, 10/16, 5/17, 5/18, 9/18
PAGE: 1 of 9 Scope Louisiana Healthcare Connections (LHCC) Medical Department Purpose To provide medical necessity criteria for obstetrical Home Health programs offered by vendors such as Optum Obstetrical
More informationANNEX I SUMMARY OF PRODUCT CHARACTERISTICS
ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Tractocile 6.75 mg/0.9 ml solution for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each vial of 0.9 ml solution contains
More informationHuman immunodeficiency virus (HIV) can be HJOG. HIV infection in pregnancy: Analysis of twenty cases. Research. Abstract
HJOG An Obstetrics and Gynecology International Journal Research HIV infection in pregnancy: Analysis of twenty cases Kasioni Spiridoula 1, Pappas Stefanos 2, Vlachadis Nikolaos 3, Valsamidi Irene 1, Stournaras
More informationA comparison of tramadol and pethidine analgesia on the duration of labour: A randomised clinical trial
Australian and New Zealand Journal of Obstetrics and Gynaecology 2009; 49: 59 63 DOI: 10.1111/j.1479-828X.2009.00949.x Blackwell Publishing Asia Original Article A comparison of tramadol and pethidine
More informationDentistry and Pharmaceutical Sciences, Shikata, Kita-ku, Okayama , Japan
Case Reports in Obstetrics and Gynecology Volume 2016, Article ID 4690790, 5 pages http://dx.doi.org/10.1155/2016/4690790 Case Report A Pregnancy with Severe Hypertrophic Obstructive Cardiomyopathy after
More informationA Proposal for Standardized Management of FHR Patterns. Prior Approaches to Consensus
A Proposal for Standardized Management of FHR Patterns J T Parer, MD, PhD Maternal Fetal Medicine Department of Obstetrics, Gynecology & Reprod Sci University of California San Francisco Obstetrics & Gynecology
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Crinone, Endometrin) Reference Number: CP.CPA.03 Effective Date: 11.16.16 Last Review Date: 08.18 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy
More informationFigure 1. Diagram of the study. Group P = 200 Phenytoin. Group M = 200 MgSO 4. Group A = 175 Preeclampsia. Group B = 25 Eclampsia
Preeclampsia is a prevalent multisystem disorder. It is associated with systolic blood pressure of 140 mmhg and/or diastolic blood pressure of 90 mmhg after 20 weeks of gestation and occurrence of proteinuria
More informationCombined spinalepidural. epidural analgesia in labour (review) By Neda Taghizadeh
Combined spinalepidural versus epidural analgesia in labour (review) By Neda Taghizadeh Cochrane review Cochrane collaboration was founded in 1993 and is named after Archie Cochrane (1909-1988), British
More informationYou admitted a previously healthy nullipara at 36 weeks gestation who presented with new-onset periorbital edema and is found to have blood pressure
Preeclampsia Case report You admitted a previously healthy nullipara at 36 weeks gestation who presented with new-onset periorbital edema and is found to have blood pressure readings of 150/100 to 155/105
More informationValve Disease in the Pregnant Patient
Valve Disease in the Pregnant Patient Julie B. Damp, MD December 6, 2012 VanderbiltHeart.com If single, do not allow marriage. If fertile, do not allow pregnancy. If pregnant, do not allow delivery. If
More informationInt J Adv Pharm Biol Sci Vol.2, Issue 3, COMPARISON BETWEEN NIFEDIPINE AND METHYLDOPA ON BLOOD PRESSURE AND FETAL OUTCOME IN PRE-ECLAMPSIA
Int J Adv Pharm Biol Sci Vol.2, Issue 3, 191-198 INTERNATIONAL JOURNAL OF ADVANCE PHARMACEUTICAL AND BIOLOGICAL SCIENCES Vol. 2, Issue. 3, July-September 2012 ISSN 2249 8966 Research Article Available
More informationSlow-Release Theophylline in Pregnant Asthmatics*
Slow-Release in Pregnant Asthmatics* Brita Stenius-Aarniala, MD, FCCP; Seija Riikonen, MD; and Kari Teramo, MD Study objective: Oral theophylline treatment may be helpful in controlling severe asthma during
More information