Evaluation of nifedipine tocolysis in preterm labour

AIM OF THE STUDY: 1. To evaluate the Tocolytic effects of Calcium channel blocker – NIFEDIPINE in preterm labour. 2. To study the maternal and fetal effects of NIFEDIPINE. 3. To compare the efficacy of Nifedipine with control group in delaying delivery for 48 hours in idiopathic spontaneous preterm labour. MATERIALS AND METHODS: STUDY DESIGN: It is prospective study conducted in Government RSRM Lying in Hospital, Stanley Medical College, Chennai, from September 2012 to September 2013 The study population comprised of patients who attended the casuality or outpatient department. There were 100 patients in Nifedipine group and 2 patients were lost to follow-up. There were 100 patients in Control group and 3 patients were lost to follow up. Study group received Nifedipine and control group were observed with bed rest. Both groups received intra muscular corticosteroids.written informed consent obtained. DRUG PROTOCOL: GROUP A: Tab. Nifedipine 20 mg was given orally. If uterine contractions persisted after 90 minutes another 10 mg dose given. If the dosage suppressed uterine activity then maintenance of 10 mg given 6th hourly for 3 days. Dosage is gradually tapered and stopped. GROUP B: Patients observed with bed rest. Both the groups given intramuscular corticosteroids. Success and Failure. There are several studies by various authors suggesting several factors for assessment of success of tocolysis. In our study, successful tocolysis was defined as the delay of delivery with suppression of contractions for more than 48 hours from initiation of therapy. Failure of therapy is said to occur, when patient delivered within 48 hours of initiation of therapy and tocolysis was stopped when cervical dilatation progressed to > 3 cm or when there was spontaneous rupture of membranes. Hence our study is confined to idiopathic spontaneous preterm labour and comparing the efficacy of Nifedipine with that of control in delaying delivery for 48 hours and regarding the maternal and fetal effects of Nifedipine. SUMMARY: The success of Nifedipine as indicated by prolongation of pregnancy beyond 48 hours was observed in 73.4% of cases compared with 57% in controls P value was significant ( 2.5kg compared to 6.5%in control success group P value 0.001 statistically significant. Incidence of Respiratory Distress syndrome is 2.7 % and 15.38% in Nifedipine success and Failure respectively compared to 12.5% and 16.9% in control success and failure groups P value is Significant (0.042). CONCLUSION: Labour inhibiting drugs may not treat the cause of preterm labour but they only treat the symptoms, that is contractions. These agents make the uterus refractory to contractile stimuli for a short time so that the perinatal outcome is improved