Main Article Content
Background: Preterm labor (PTL) is one of the most serious complications of pregnancy and major cause of mortality in neonates. The present study aimed to compare the effectiveness of nifedipine and transdermal nitroglycerin in the treatment of PTL.
Materials and Methods: This randomized clinical trial was carried out on a total of women with PTL referring to Imam Reza Hospital of Mashhad University of Medical Sciences, Iran, during September 2016 to October 2017. The study participants were randomly divided into groups I and II with the administration of nifedipine and transdermal nitroglycerin. All the vital signs, fetal heart rates, contractions, dilation, and effacement, and Gestational Age (GA) at the time of delivery were monitored and evaluated in both groups. The main goal of this study was the postponement of delivery to secure the most beneficial effect of primary corticosteroid administration on the fetus.
Results: This study was conducted on a total of 112 women with a mean age of 27.12±3.37 years. There was a significant association between the average of GA in two groups (P=0.012), indicating group I with lower mean GA than that reported for group II at delivery. The difference regarding the average of labor suppression was statistically significant between the two groups (P=0.002). The obtained results of this study showed the neonates in the transdermal nitroglycerin group with higher Apgar scores of the first and fifth minutes than those in the nifedipine group. Moreover, the number of side effects of the transdermal nitroglycerin group (i.e., tachycardia and nausea) was higher than those reported for the nifedipine group (P=0.019).
Conclusion: The obtained results of this study demonstrated that the administration of transdermal nitroglycerin was more effective than that of nifedipine to stop the uterine contractions and consequently could slow the progression of delivery more efficiently. Furthermore, both medications were reported with some side effects for mothers; however, the number of the side effects of nifedipine was lower than that reported for transdermal nitroglycerin.
Ali AA, Sayed AK, El Sherif La, Loutfi GO, Ahmed AMM, Mohamed HB, et al. Systematic review and meta‐analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor. International Journal of Gynecology & Obstetrics. 2019;145(2):139-48.
Patel SS, Ludmir J. Drugs for the treatment and prevention of preterm labor. Clinics in Perinatology. 2019;46:159-72.
Sankaran S. Creasy and Resnik's Maternal–Fetal Medicine: Principles and Practice Sixth edition. SAGE Publications Sage UK: London, England; 2012.
Crump C, Sundquist J, Winkleby MA, Sundquist K. Gestational age at birth and mortality from infancy into mid-adulthood: a national cohort study. The Lancet Child & Adolescent Health. 2019;3(6):408-17.
Bilgin A, Mendonca M, Wolke D. Preterm birth/low birth weight and markers reflective of wealth in adulthood: A meta-analysis. Pediatrics. 2018;142(1): e20173625.
Conde-Agudelo A, Romero R, Kusanovic JP. Nifedipine in the management of preterm labor: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2011;204(2): 134. e1-.e20.
Kashanian M, Shirvani S, Sheikhansari N, Javanmanesh F. A comparative study on the efficacy of nifedipine and indomethacin for prevention of preterm birth as monotherapy and combination therapy: A randomized clinical trial. The Journal of Maternal-Fetal & Neonatal Medicine. 2019; 1-6.
De Heus R, Mol BW, Erwich J-JH, Van Geijn HP, Gyselaers WJ, Hanssens M, et al. Adverse drug reactions to tocolytic treatment for preterm labour: Prospective cohort study. BMJ. 2009;338:b744.
Smith GN, Guo Y, Wen SW, Walker MC, Group CPLNT. Secondary analysis of the use of transdermal nitroglycerin for preterm labor. American Journal of Obstetrics and Gynecology. 2010;203(6):565.e1-.e6.
Balasubramani SR, Kamatchi K. Transdermal nitroglycerin versus oral nifedipine administration for tocolysis in preterm labour. J Evolution Med Dent Sci. 2017;6(52):3967-74.
Bashir B, Shafiq M, Nazir A, Alam MA, Taimoor A, Munazza B. Effectiveness of transdermal nitroglycerine compared to oral nifedipine in prevention of preterm labour. Pakistan Journal of Physiology. 2019;15(4):7-10.
López Gómez L, Marín Gabriel MA, Encinas B, de la Cruz Troca JJ, Rodríguez Marrodán B. Oxytocin Receptor Antagonist (Atosiban) in the Threat of Preterm Birth: Does It Have Any Effect on Breastfeeding in the Term Newborn? Breastfeeding medicine: The official journal of the Academy of Breastfeeding Medicine. 2018; 13(2):123-8.
Haas DM, Benjamin T, Sawyer R, Quinney SK. Short-term tocolytics for preterm delivery–current perspectives. International journal of women's health. 2014;6:343.
Ishaq N, Ishaq Z, Mushtaq A, Ishaque I, Ishaq A. Comparative Study of Tocolytic Efficacy of Nifedipine and Nitroglycerine. Journal of the Society of Obstetrics and Gynaecologists of Pakistan. 2017;7(2).
Practice CoO. The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. Obstetrics and Gynecology. 2015;125(5):1268.
King JF. Tocolysis and preterm labour. Current Opinion in Obstetrics and Gynecology. 2004;16(6):459-63.
Kam KY, Lamont RF. Developments in the pharmacotherapeutic management of spontaneous preterm labor. Expert Opinion on Pharmacotherapy. 2008;9(7):1153-68.
Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: Systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110-20.e6.
Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC, Giguère Y. Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery Doppler: A systematic review and meta-analysis. Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC. 2009;31(9):818-26.
Vogel JP, Nardin JM, Dowswell T, West HM, Oladapo OT. Combination of tocolytic agents for inhibiting preterm labour. Cochrane Database of Systematic Reviews. 2014(7):14.
Flenady V, Wojcieszek AM, Papatsonis DN, Stock OM, Murray L, Jardine LA, et al. Calcium channel blockers for inhibiting preterm labour and birth. Cochrane Database of Systematic Reviews. 2014(6): CD002255.
Modzelewska B, Jóźwik M, Jóźwik M, Tylicka M, Kleszczewski T. The effects of extended nitric oxide release on responses of the human non- pregnant myometrium to endothelin-1 or vasopressin. Pharmacological Reports. 2019;71(5):892-8.
Leszczynska-Gorzelak B, Laskowska M, Marciniak B, Oleszczuk J. Nitric oxide for treatment of threatened preterm labor. International Journal of Gynecology & Obstetrics. 2001;73(3):201-6.
Shaikh S, Shaikh AH, Akhter S, Isran B. Efficacy of transdermal nitroglycerine in idiopathic pre-term labour. JPMA-Journal of the Pakistan Medical Association. 2012; 62(1):47.
Lamont RF, Jørgensen JS. Safety and efficacy of tocolytics for the treatment of spontaneous preterm labour. Current pharmaceutical design. 2019;25(5):577-92.
Ghomian N, Vahedalain SH, Tavassoli F, Pourhoseini SA, Heydari ST. Transdermal Nitroglycerin Versus Oral Nifedipine for Suppression of Preterm Labor. Shiraz E-Medical Journal. 2015;16:11-2.
Kashanian M, Zamen Z, Sheikhansari N. Comparison between nitroglycerin dermal patch and nifedipine for treatment of preterm labor: A randomized clinical trial. Journal of Perinatology. 2014;34(9):683-7.
Smith GN, Walker MC, Ohlsson A, O’Brien K, Windrim R, Group CPLNT. Randomized double-blind placebo-controlled trial of transdermal nitroglycerin for preterm labor. American Journal of Obstetrics and Gynecology. 2007;196(1):37:e1-.e8.