SlideShare ist ein Scribd-Unternehmen logo
1 von 18
Downloaden Sie, um offline zu lesen
Tocolysis for Women
in Preterm Labour
Green-top Guideline
RCOG, 2011
Prof Aboubakr Elnashar
Aboubakr Elnashar
Use of a tocolytic drug is associated with a
prolongation of pregnancy for up to 7 days but with
no significant effect on preterm birth and no clear
effect on perinatal or neonatal morbidity.
There is no clear evidence that tocolytic drugs
improve outcome and therefore it is reasonable not
to use them.
However, tocolysis should be considered if the few
days gained would be put to good use, such as
completing a course of corticosteroids or in utero
transfer.
Aboubakr Elnashar
Use of a tocolytic drug is not associated with a
clear reduction in perinatal or neonatal mortality, or
neonatal morbidity.
Aboubakr Elnashar
Tocolysis may be considered for women with
suspected preterm labour who have had an
otherwise uncomplicated pregnancy.
It is reasonable not to use any tocolytic drug.
Women most likely to benefit from use of a
tocolytic drug are those who are in
very preterm labour,
those needing transfer to a hospital which can
provide neonatal intensive care and
those who have not yet completed a full course of
corticosteroids.
Tocolysis should not be used where there is a
contraindication to prolonging pregnancy.
Aboubakr Elnashar
Nifedipine and atosiban have comparable
effectiveness in delaying birth for up to 7 days.
Compared with beta-agonists, nifedipine is
associated with improvement in neonatal outcome,
although there are no long-term data.
Aboubakr Elnashar
Beta-agonists have a high frequency of adverse
effects.
Nifedipine, atosiban and the COX inhibitors have
fewer types of adverse effects, and they occur less
frequently than for beta-agonists but how they
compare with each other is unclear.
Using multiple tocolytic drugs appears to be
associated with a higher risk of adverse effects and
so should be avoided.
Aboubakr Elnashar
The comparative effects for the baby of
alternative drugs are unclear. Most drugs have
been compared with beta-agonists.
There are insufficient data on long-term follow-up
for reliable conclusions about the effects on the
baby for any of these tocolytic drugs.
Aboubakr Elnashar
Dose of nifedipine:
an initial oral dose of 20 mg followed by 10–20 mg
three to four times daily, adjusted according to
uterine activity for up to 48 hours.
A total dose above 60 mg appears to be
associated with a three- to four-fold increase in
adverse events.
Dose of atosiban
an initial bolus dose of 6.75 mg over 1 minute,
followed by an infusion of 18 mg/hour for 3 hours,
then 6 mg/hour for up to 45 hours (to a maximum
of 330 mg).
Aboubakr Elnashar
Cost effectiveness has not been reported but the
purchase price of atosiban is nearly ten times that
of nifedipine.
Aboubakr Elnashar
There is insufficient evidence for any firm
conclusions about whether or not tocolysis leads
to any benefit in preterm labour in multiple
pregnancy.
Aboubakr Elnashar
There is insufficient evidence for any firm
conclusions about whether or not maintenance
tocolytic therapy following threatened preterm
labour is worthwhile. Thus, maintenance therapy is
not recommended.
Aboubakr Elnashar
Summary
Use of a tocolytic drug is not associated with a
clear reduction in perinatal or neonatal mortality or
neonatal morbidity.
The main effect of tocolytic drugs when used for
women in preterm labour is to reduce the numbers
who deliver within 48 hours or within 7 days of
commencing the drug.
Aboubakr Elnashar
Data on long-term outcome are sparse. It
remains plausible that, for selected women, such
as those who require transfer for neonatal care or
time to complete a course of corticosteroids, there
may be benefit associated with tocolysis. However,
this benefit has not been formally evaluated in
randomised trials.
Aboubakr Elnashar
If reliable prediction of which women in suspected
preterm labour are likely to have a preterm birth
were possible, the use of tocolysis could be
reserved for these women. Unfortunately, few tests
offer useful predictive value. Fetal fibronectin has
been advocated as a promising predictive test but it
may have limited accuracy in predicting preterm
birth within 7 days for women with symptoms of
preterm labour.
Aboubakr Elnashar
Ultrasound assessment of cervical length is also
a promising predictive test for symptomatic women.
It remains unclear whether any predictive test, or
combination of tests, is sufficiently accurate to be
cost effective.
Aboubakr Elnashar
If the decision is made to use a tocolytic drug,
nifedipine and atosiban appear to have comparable
effectiveness in delaying delivery, with fewer
maternal adverse effects and less risk of rare
serious adverse events than alternatives such as
ritodrine or indomethacin.
There is limited evidence that use of nifedipine,
rather than a beta-agonist, is associated with
improved short-term neonatal outcome. There is
little information about the long-term growth and
development of the child for any of the drugs.
Aboubakr Elnashar
Ritodrine and atosiban are licensed in the UK for
the treatment of threatened preterm labour.
Although the use of nifedipine for preterm labour is
an unlicensed indication, it has the advantages of
oral administration and a low purchase price.
Aboubakr Elnashar
Thanks
Aboubakr Elnashar

Weitere ähnliche Inhalte

Was ist angesagt?

Thyroid diseases with pregnancy RCOG vs ACOG
Thyroid diseases with pregnancy RCOG vs ACOGThyroid diseases with pregnancy RCOG vs ACOG
Thyroid diseases with pregnancy RCOG vs ACOGBasem Hamed
 
OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE, Mob: 7289915...
OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE,  Mob: 7289915...OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE,  Mob: 7289915...
OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE, Mob: 7289915...Pradeep Garg
 
Medical Management of Fibroids
Medical Management of FibroidsMedical Management of Fibroids
Medical Management of FibroidsSujoy Dasgupta
 
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIREDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIDR SHASHWAT JANI
 
Management of ovarian cysts in postmenopausal women
Management of ovarian cysts in postmenopausal womenManagement of ovarian cysts in postmenopausal women
Management of ovarian cysts in postmenopausal womenHesham Gaber
 
Recurrent pregnancy loss Presentation by Dr.Laxmi Shrikhande
Recurrent pregnancy loss Presentation by Dr.Laxmi ShrikhandeRecurrent pregnancy loss Presentation by Dr.Laxmi Shrikhande
Recurrent pregnancy loss Presentation by Dr.Laxmi ShrikhandeDr.Laxmi Agrawal Shrikhande
 
Laparoscopic Tubal Recanalization Mob: 7289915430, www.drpradeepgarg
Laparoscopic Tubal Recanalization  Mob: 7289915430, www.drpradeepgargLaparoscopic Tubal Recanalization  Mob: 7289915430, www.drpradeepgarg
Laparoscopic Tubal Recanalization Mob: 7289915430, www.drpradeepgargPradeep Garg
 
Cervical and broad ligament fibroid
Cervical and broad ligament fibroidCervical and broad ligament fibroid
Cervical and broad ligament fibroidNiranjan Chavan
 
FIGO guidelines on Placenta Accreta Spectrum Disorders: Conservative manage...
FIGO guidelines on  Placenta Accreta Spectrum Disorders:  Conservative manage...FIGO guidelines on  Placenta Accreta Spectrum Disorders:  Conservative manage...
FIGO guidelines on Placenta Accreta Spectrum Disorders: Conservative manage...Aboubakr Elnashar
 
Vaginal birth after cesarean section
Vaginal  birth after cesarean sectionVaginal  birth after cesarean section
Vaginal birth after cesarean sectionhemnathsubedii
 
Recurrent pregnancy loss panel discussion
Recurrent pregnancy loss  panel discussionRecurrent pregnancy loss  panel discussion
Recurrent pregnancy loss panel discussionNiranjan Chavan
 

Was ist angesagt? (20)

Thyroid diseases with pregnancy RCOG vs ACOG
Thyroid diseases with pregnancy RCOG vs ACOGThyroid diseases with pregnancy RCOG vs ACOG
Thyroid diseases with pregnancy RCOG vs ACOG
 
OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE, Mob: 7289915...
OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE,  Mob: 7289915...OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE,  Mob: 7289915...
OPERATIONS FOR NULLIPAROUS PROLAPSE AND VAGINAL VAULT PROLAPSE, Mob: 7289915...
 
Ovarian hyper stimulation syndrome ohss
Ovarian hyper stimulation syndrome ohssOvarian hyper stimulation syndrome ohss
Ovarian hyper stimulation syndrome ohss
 
Hysteroscopy
HysteroscopyHysteroscopy
Hysteroscopy
 
Medical Management of Fibroids
Medical Management of FibroidsMedical Management of Fibroids
Medical Management of Fibroids
 
WHO labour guide.pdf
WHO labour guide.pdfWHO labour guide.pdf
WHO labour guide.pdf
 
Cervical stitches
Cervical stitchesCervical stitches
Cervical stitches
 
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIREDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
 
Cholestasis of pregnancy
Cholestasis of pregnancyCholestasis of pregnancy
Cholestasis of pregnancy
 
Management of ovarian cysts in postmenopausal women
Management of ovarian cysts in postmenopausal womenManagement of ovarian cysts in postmenopausal women
Management of ovarian cysts in postmenopausal women
 
Recurrent pregnancy loss Presentation by Dr.Laxmi Shrikhande
Recurrent pregnancy loss Presentation by Dr.Laxmi ShrikhandeRecurrent pregnancy loss Presentation by Dr.Laxmi Shrikhande
Recurrent pregnancy loss Presentation by Dr.Laxmi Shrikhande
 
Laparoscopic Tubal Recanalization Mob: 7289915430, www.drpradeepgarg
Laparoscopic Tubal Recanalization  Mob: 7289915430, www.drpradeepgargLaparoscopic Tubal Recanalization  Mob: 7289915430, www.drpradeepgarg
Laparoscopic Tubal Recanalization Mob: 7289915430, www.drpradeepgarg
 
Maternal Near Miss
Maternal Near MissMaternal Near Miss
Maternal Near Miss
 
Cervical and broad ligament fibroid
Cervical and broad ligament fibroidCervical and broad ligament fibroid
Cervical and broad ligament fibroid
 
FIGO guidelines on Placenta Accreta Spectrum Disorders: Conservative manage...
FIGO guidelines on  Placenta Accreta Spectrum Disorders:  Conservative manage...FIGO guidelines on  Placenta Accreta Spectrum Disorders:  Conservative manage...
FIGO guidelines on Placenta Accreta Spectrum Disorders: Conservative manage...
 
Vaginal birth after cesarean section
Vaginal  birth after cesarean sectionVaginal  birth after cesarean section
Vaginal birth after cesarean section
 
Recurrent pregnancy loss panel discussion
Recurrent pregnancy loss  panel discussionRecurrent pregnancy loss  panel discussion
Recurrent pregnancy loss panel discussion
 
PPPP00P
PPPP00PPPPP00P
PPPP00P
 
Pop q (new)
Pop q (new)Pop q (new)
Pop q (new)
 
SCAR ECTOPIC
SCAR ECTOPICSCAR ECTOPIC
SCAR ECTOPIC
 

Andere mochten auch (20)

Tocolytic drug
Tocolytic drugTocolytic drug
Tocolytic drug
 
Gestational trophoblastic disease
Gestational trophoblastic diseaseGestational trophoblastic disease
Gestational trophoblastic disease
 
Eclampsia
EclampsiaEclampsia
Eclampsia
 
Dr. minnu panditrao's oxytocics & tocolytics
Dr. minnu panditrao's oxytocics & tocolyticsDr. minnu panditrao's oxytocics & tocolytics
Dr. minnu panditrao's oxytocics & tocolytics
 
Uterine relaxants (tocolytics)
Uterine relaxants (tocolytics)Uterine relaxants (tocolytics)
Uterine relaxants (tocolytics)
 
Eclampsia
 		Eclampsia		 		Eclampsia
Eclampsia
 
Postpartum Haemorrhage
Postpartum HaemorrhagePostpartum Haemorrhage
Postpartum Haemorrhage
 
Oxytocics & Tocolytics
Oxytocics & TocolyticsOxytocics & Tocolytics
Oxytocics & Tocolytics
 
Postpartum Haemorrhage
Postpartum HaemorrhagePostpartum Haemorrhage
Postpartum Haemorrhage
 
Third stage of labor for undergraduate
Third stage of labor for undergraduateThird stage of labor for undergraduate
Third stage of labor for undergraduate
 
Preterm
PretermPreterm
Preterm
 
Third stage of labour
Third stage of labourThird stage of labour
Third stage of labour
 
Eclampsia
EclampsiaEclampsia
Eclampsia
 
Gestational trophoblastic disease for undergraduate
Gestational trophoblastic disease for undergraduateGestational trophoblastic disease for undergraduate
Gestational trophoblastic disease for undergraduate
 
Vesicular mole for undergraduate
Vesicular mole for undergraduateVesicular mole for undergraduate
Vesicular mole for undergraduate
 
Eclampsia
EclampsiaEclampsia
Eclampsia
 
Postpartum Hemorrhage Lecture Notes
Postpartum Hemorrhage Lecture NotesPostpartum Hemorrhage Lecture Notes
Postpartum Hemorrhage Lecture Notes
 
Eclampsia ppt
Eclampsia pptEclampsia ppt
Eclampsia ppt
 
Management of Post-partum hemorrhage (PPH)
Management of Post-partum hemorrhage (PPH)Management of Post-partum hemorrhage (PPH)
Management of Post-partum hemorrhage (PPH)
 
Postpartum haemorrhage
Postpartum haemorrhagePostpartum haemorrhage
Postpartum haemorrhage
 

Ähnlich wie Tocolysis for preterm labour: RCOG Guidelines

Progesterone in clinical practice
Progesterone in clinical practiceProgesterone in clinical practice
Progesterone in clinical practiceAboubakr Elnashar
 
Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...
Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...
Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...Riffat Bibi
 
The comparison of dinoprostone and vagiprost for induction of lobar in post t...
The comparison of dinoprostone and vagiprost for induction of lobar in post t...The comparison of dinoprostone and vagiprost for induction of lobar in post t...
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
 
Role of Atosiban In ART ,Dr Jyoti Agarwal, Dr. Sharda Jain
Role of Atosiban In ART,Dr Jyoti Agarwal, Dr. Sharda Jain Role of Atosiban In ART,Dr Jyoti Agarwal, Dr. Sharda Jain
Role of Atosiban In ART ,Dr Jyoti Agarwal, Dr. Sharda Jain Lifecare Centre
 
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVF
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVFCURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVF
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVFAboubakr Elnashar
 
Progesterone in preterm birth
Progesterone in preterm birthProgesterone in preterm birth
Progesterone in preterm birthfaheta
 
Therapeutic uses of Progestagen in infertility and IVF
Therapeutic uses of  Progestagen  in infertility and IVF Therapeutic uses of  Progestagen  in infertility and IVF
Therapeutic uses of Progestagen in infertility and IVF Aboubakr Elnashar
 
Pprom ho presentation
Pprom ho presentationPprom ho presentation
Pprom ho presentationlimgengyan
 
Letrozole stimulation protocol for non ivf cycle
Letrozole stimulation protocol for non ivf cycleLetrozole stimulation protocol for non ivf cycle
Letrozole stimulation protocol for non ivf cycleDr.Laxmi Agrawal Shrikhande
 
Role of Atosiban In ART Dr. Jyoti Agarwal
Role of Atosiban In ART Dr. Jyoti Agarwal Role of Atosiban In ART Dr. Jyoti Agarwal
Role of Atosiban In ART Dr. Jyoti Agarwal DGFPublicAwareness
 
Management of first trimester miscarriage
Management of first trimester miscarriageManagement of first trimester miscarriage
Management of first trimester miscarriageAboubakr Elnashar
 
Management of poor ovarian response
Management of poor ovarian responseManagement of poor ovarian response
Management of poor ovarian responseHesham Gaber
 
IVF Procedure - Step by Step
IVF Procedure - Step by StepIVF Procedure - Step by Step
IVF Procedure - Step by Steprinku987
 
Best Infertility treatment in India
Best Infertility treatment in IndiaBest Infertility treatment in India
Best Infertility treatment in Indiarinku987
 
Fertility Challenges In Women With Biologically challenged Ovaries poor respo...
Fertility Challenges In Women With Biologically challenged Ovariespoor respo...Fertility Challenges In Women With Biologically challenged Ovariespoor respo...
Fertility Challenges In Women With Biologically challenged Ovaries poor respo...Rupal Shah
 

Ähnlich wie Tocolysis for preterm labour: RCOG Guidelines (20)

Baev2018
Baev2018Baev2018
Baev2018
 
Progesterone in clinical practice
Progesterone in clinical practiceProgesterone in clinical practice
Progesterone in clinical practice
 
Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...
Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...
Fertility in-vitro-fertilisation-treatment-for-people-with-fertility-problems...
 
The comparison of dinoprostone and vagiprost for induction of lobar in post t...
The comparison of dinoprostone and vagiprost for induction of lobar in post t...The comparison of dinoprostone and vagiprost for induction of lobar in post t...
The comparison of dinoprostone and vagiprost for induction of lobar in post t...
 
Role of Atosiban In ART ,Dr Jyoti Agarwal, Dr. Sharda Jain
Role of Atosiban In ART,Dr Jyoti Agarwal, Dr. Sharda Jain Role of Atosiban In ART,Dr Jyoti Agarwal, Dr. Sharda Jain
Role of Atosiban In ART ,Dr Jyoti Agarwal, Dr. Sharda Jain
 
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVF
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVFCURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVF
CURRENT EVIDENCE ON MEDICAL ADD-ONS IN IVF
 
Progesterone in preterm birth
Progesterone in preterm birthProgesterone in preterm birth
Progesterone in preterm birth
 
Therapeutic uses of Progestagen in infertility and IVF
Therapeutic uses of  Progestagen  in infertility and IVF Therapeutic uses of  Progestagen  in infertility and IVF
Therapeutic uses of Progestagen in infertility and IVF
 
Pprom ho presentation
Pprom ho presentationPprom ho presentation
Pprom ho presentation
 
Letrozole stimulation protocol for non ivf cycle
Letrozole stimulation protocol for non ivf cycleLetrozole stimulation protocol for non ivf cycle
Letrozole stimulation protocol for non ivf cycle
 
Role of Atosiban In ART Dr. Jyoti Agarwal
Role of Atosiban In ART Dr. Jyoti Agarwal Role of Atosiban In ART Dr. Jyoti Agarwal
Role of Atosiban In ART Dr. Jyoti Agarwal
 
Management of first trimester miscarriage
Management of first trimester miscarriageManagement of first trimester miscarriage
Management of first trimester miscarriage
 
Management of poor ovarian response
Management of poor ovarian responseManagement of poor ovarian response
Management of poor ovarian response
 
Threatened abortion
Threatened abortion Threatened abortion
Threatened abortion
 
Emergency Contraception
Emergency ContraceptionEmergency Contraception
Emergency Contraception
 
Iui - newer concepts
Iui  - newer conceptsIui  - newer concepts
Iui - newer concepts
 
IVF Procedure - Step by Step
IVF Procedure - Step by StepIVF Procedure - Step by Step
IVF Procedure - Step by Step
 
Best Infertility treatment in India
Best Infertility treatment in IndiaBest Infertility treatment in India
Best Infertility treatment in India
 
ART options for poor responders.pdf
ART options for poor responders.pdfART options for poor responders.pdf
ART options for poor responders.pdf
 
Fertility Challenges In Women With Biologically challenged Ovaries poor respo...
Fertility Challenges In Women With Biologically challenged Ovariespoor respo...Fertility Challenges In Women With Biologically challenged Ovariespoor respo...
Fertility Challenges In Women With Biologically challenged Ovaries poor respo...
 

Mehr von Aboubakr Elnashar

WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTWHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTAboubakr Elnashar
 
Adenomyosis associated infertility
Adenomyosis associated  infertilityAdenomyosis associated  infertility
Adenomyosis associated infertilityAboubakr Elnashar
 
Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Aboubakr Elnashar
 
Aesthetic gynecology controversy
Aesthetic gynecology controversyAesthetic gynecology controversy
Aesthetic gynecology controversyAboubakr Elnashar
 
Hormonal assay in clinical gyn
Hormonal assay in clinical gynHormonal assay in clinical gyn
Hormonal assay in clinical gynAboubakr Elnashar
 
Unnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineUnnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineAboubakr Elnashar
 
Individualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationIndividualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationAboubakr Elnashar
 
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA Aboubakr Elnashar
 
cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021  cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021 Aboubakr Elnashar
 
Management of pregnancy of unknown location
Management of pregnancy of unknown locationManagement of pregnancy of unknown location
Management of pregnancy of unknown locationAboubakr Elnashar
 
COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021Aboubakr Elnashar
 

Mehr von Aboubakr Elnashar (20)

WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTWHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
 
hepatitis B.pdf
hepatitis B.pdfhepatitis B.pdf
hepatitis B.pdf
 
hepatitis c2022.pdf
hepatitis c2022.pdfhepatitis c2022.pdf
hepatitis c2022.pdf
 
Adenomyosis associated infertility
Adenomyosis associated  infertilityAdenomyosis associated  infertility
Adenomyosis associated infertility
 
Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022
 
Adenxal mass guidelines2020
Adenxal mass guidelines2020Adenxal mass guidelines2020
Adenxal mass guidelines2020
 
Aesthetic gynecology controversy
Aesthetic gynecology controversyAesthetic gynecology controversy
Aesthetic gynecology controversy
 
Hormonal assay in clinical gyn
Hormonal assay in clinical gynHormonal assay in clinical gyn
Hormonal assay in clinical gyn
 
FIRST TRIMESTER ANC OF IVF
FIRST TRIMESTER ANC OF IVFFIRST TRIMESTER ANC OF IVF
FIRST TRIMESTER ANC OF IVF
 
Unnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineUnnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicine
 
Infertility prevention
Infertility prevention Infertility prevention
Infertility prevention
 
Individualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationIndividualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulation
 
Female infertility
Female infertility Female infertility
Female infertility
 
Maternal near miss
Maternal near missMaternal near miss
Maternal near miss
 
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
 
cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021  cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021
 
CAESAREAN SCAR DEFECT
CAESAREAN SCAR DEFECT  CAESAREAN SCAR DEFECT
CAESAREAN SCAR DEFECT
 
Management of pregnancy of unknown location
Management of pregnancy of unknown locationManagement of pregnancy of unknown location
Management of pregnancy of unknown location
 
Aerobic Vaginitis
Aerobic Vaginitis Aerobic Vaginitis
Aerobic Vaginitis
 
COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021
 

Kürzlich hochgeladen

SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 

Kürzlich hochgeladen (20)

SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 

Tocolysis for preterm labour: RCOG Guidelines

  • 1. Tocolysis for Women in Preterm Labour Green-top Guideline RCOG, 2011 Prof Aboubakr Elnashar Aboubakr Elnashar
  • 2. Use of a tocolytic drug is associated with a prolongation of pregnancy for up to 7 days but with no significant effect on preterm birth and no clear effect on perinatal or neonatal morbidity. There is no clear evidence that tocolytic drugs improve outcome and therefore it is reasonable not to use them. However, tocolysis should be considered if the few days gained would be put to good use, such as completing a course of corticosteroids or in utero transfer. Aboubakr Elnashar
  • 3. Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality, or neonatal morbidity. Aboubakr Elnashar
  • 4. Tocolysis may be considered for women with suspected preterm labour who have had an otherwise uncomplicated pregnancy. It is reasonable not to use any tocolytic drug. Women most likely to benefit from use of a tocolytic drug are those who are in very preterm labour, those needing transfer to a hospital which can provide neonatal intensive care and those who have not yet completed a full course of corticosteroids. Tocolysis should not be used where there is a contraindication to prolonging pregnancy. Aboubakr Elnashar
  • 5. Nifedipine and atosiban have comparable effectiveness in delaying birth for up to 7 days. Compared with beta-agonists, nifedipine is associated with improvement in neonatal outcome, although there are no long-term data. Aboubakr Elnashar
  • 6. Beta-agonists have a high frequency of adverse effects. Nifedipine, atosiban and the COX inhibitors have fewer types of adverse effects, and they occur less frequently than for beta-agonists but how they compare with each other is unclear. Using multiple tocolytic drugs appears to be associated with a higher risk of adverse effects and so should be avoided. Aboubakr Elnashar
  • 7. The comparative effects for the baby of alternative drugs are unclear. Most drugs have been compared with beta-agonists. There are insufficient data on long-term follow-up for reliable conclusions about the effects on the baby for any of these tocolytic drugs. Aboubakr Elnashar
  • 8. Dose of nifedipine: an initial oral dose of 20 mg followed by 10–20 mg three to four times daily, adjusted according to uterine activity for up to 48 hours. A total dose above 60 mg appears to be associated with a three- to four-fold increase in adverse events. Dose of atosiban an initial bolus dose of 6.75 mg over 1 minute, followed by an infusion of 18 mg/hour for 3 hours, then 6 mg/hour for up to 45 hours (to a maximum of 330 mg). Aboubakr Elnashar
  • 9. Cost effectiveness has not been reported but the purchase price of atosiban is nearly ten times that of nifedipine. Aboubakr Elnashar
  • 10. There is insufficient evidence for any firm conclusions about whether or not tocolysis leads to any benefit in preterm labour in multiple pregnancy. Aboubakr Elnashar
  • 11. There is insufficient evidence for any firm conclusions about whether or not maintenance tocolytic therapy following threatened preterm labour is worthwhile. Thus, maintenance therapy is not recommended. Aboubakr Elnashar
  • 12. Summary Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality or neonatal morbidity. The main effect of tocolytic drugs when used for women in preterm labour is to reduce the numbers who deliver within 48 hours or within 7 days of commencing the drug. Aboubakr Elnashar
  • 13. Data on long-term outcome are sparse. It remains plausible that, for selected women, such as those who require transfer for neonatal care or time to complete a course of corticosteroids, there may be benefit associated with tocolysis. However, this benefit has not been formally evaluated in randomised trials. Aboubakr Elnashar
  • 14. If reliable prediction of which women in suspected preterm labour are likely to have a preterm birth were possible, the use of tocolysis could be reserved for these women. Unfortunately, few tests offer useful predictive value. Fetal fibronectin has been advocated as a promising predictive test but it may have limited accuracy in predicting preterm birth within 7 days for women with symptoms of preterm labour. Aboubakr Elnashar
  • 15. Ultrasound assessment of cervical length is also a promising predictive test for symptomatic women. It remains unclear whether any predictive test, or combination of tests, is sufficiently accurate to be cost effective. Aboubakr Elnashar
  • 16. If the decision is made to use a tocolytic drug, nifedipine and atosiban appear to have comparable effectiveness in delaying delivery, with fewer maternal adverse effects and less risk of rare serious adverse events than alternatives such as ritodrine or indomethacin. There is limited evidence that use of nifedipine, rather than a beta-agonist, is associated with improved short-term neonatal outcome. There is little information about the long-term growth and development of the child for any of the drugs. Aboubakr Elnashar
  • 17. Ritodrine and atosiban are licensed in the UK for the treatment of threatened preterm labour. Although the use of nifedipine for preterm labour is an unlicensed indication, it has the advantages of oral administration and a low purchase price. Aboubakr Elnashar