Atosiban Combined with Ritodrine for Late Threatened Abortion or Threatened Premature Labor Patients with No Response to Ritodrine: A Clinical Trial

Comparison of the efficacy of phloroglucinol versus ritodrine hydrochloride in preventing miscarriage and adverse reactions

OBJECTIVE

To analyze the efficacy of phloroglucinol versus ritodrine hydrochloride in preventing miscarriage and adverse reactions (ARs).

METHODS

A retrospective analysis was conducted on 211 patients with threatened abortion or premature birth who were admitted to the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine between July 2019 and July 2021. The control group (n=57) received ritodrine hydrochloride, while the observation group (n=154) was treated with phloroglucinol. We compared the overall therapeutic efficacy, time to symptom resolution, cessation of uterine contractions, success rate of miscarriage prevention, and full-term pregnancy rate between the two groups. Estrogen levels, including serum progesterone (P), estradiol (E2), and human chorionic gonadotropin (hCG), were measured and compared before and after treatment using ELISA. Additionally, neonatal outcomes, such as birth weight, Apgar scores, and umbilical arterial blood gas parameters [pH value, partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2)], were evaluated and compared between the groups. Finally, the incidence of ARs during treatment was assessed and compared.

RESULTS

Compared to the control group, the observation group had higher effective rate of treatment, success rate of miscarriage prevention, and a full-term pregnancy rate (all P<0.05). The times to symptom resolution and cessation of uterine contractions were markedly shorter in the observation group than those in the control group (both P<0.05). After treatment, levels of serum P, E2, and hCG in the observation group were significantly higher than those of the control group (all P<0.05). Additionally, the body weight, Apgar scores, pH value, and PaO2 of the neonates in the observation group were higher, while PaCO2 and the incidence of ARs were lower compared to the control group (all P<0.05).

CONCLUSION

For threatened abortion or threatened premature labor, phloroglucinol is more effective than ritodrine hydrochloride for clinical intervention and treatment.

A singleton pregnancy with placental chorioangioma and hydrops fetalis complicated with mirror syndrome and ritodrine-induced side effects: a case report

BACKGROUND

Ritodrine hydrochloride is a widely used beta-adrenergic agonist used to stop preterm labor in Taiwan. Many side effects causing maternal morbidity and mortality have been reported. We report a case complicated with ritodrine-induced side effects and mirror syndrome that was associated with placental chorioangioma.

CASE PRESENTATION

A 36-year-old singleton pregnant woman at 25 6/7 weeks of gestation, with an undiagnosed placental chorioangioma, underwent tocolysis due to preterm uterine contractions. Her clinical condition deteriorated, attributed to mirror syndrome and adverse events induced by ritodrine. An emergency cesarean section was performed at 27 1/7 weeks of gestation, delivering an infant with generalized subcutaneous edema. A placental tumor measuring 8.5 cm was discovered during the operation, and pathology confirmed chorioangioma. Gradual improvement in her symptoms and laboratory data was observed during the postpartum period. Identifying mirror syndrome and ritodrine-induced side effects poses challenges. Therefore, this case is educational and warrants discussion.

CONCLUSION

Our case demonstrates mirror syndrome induced by chorioangioma, which is rare, and ritodrine-induced side effects. The cessation of intravenous ritodrine and delivery are the best methods to treat maternal critical status due to fluid overload.

Efficacy of atosiban combined with ritodrine on spontaneous threatened preterm birth and its effect on PAF and fFN levels

OBJECTIVE

To explore the efficacy of Atosiban combined with Ritodrine treatment on spontaneous threatened preterm birth and its effect on platelet-activating factor (PAF) and fetal fibronectin levels.

METHODS

Medical records from 120 patients with threatened preterm birth admitted to Baoji Maternal and Child Health Hospital from October 2020 to December 2021 were collected for this retrospective analysis. A total of 56 patients treated with Ritodrine alone were taken as the control group (CG), and the other 64 patients given combined treatment of Atosiban and Ritodrine were seen as the observation group (OG). Indexes of uterine contraction inhibition rate, pregnancy prolongation time, onset time, adverse reactions and pregnancy outcomes were compared between the two groups; in addition, the levels of inflammatory factors as well as PAF and fFN before and after treatment were detected and compared between two groups.

RESULTS

Compared with the CG, the uterine contraction inhibition rate as well as the pregnancy prolongation time in the OG were evidently higher (all P<0.05); the time of the disappearance of uterine contraction in the OG was significantly shorter (P<0.05); the rate of full-term delivery and neonatal 1-min Apgar score in the OG were obviously higher (P<0.05); and the incidence of total adverse reactions in the OG was markedly lower (P<0.05). However, there was no significant difference observed in the neonatal asphyxia rate and the number of fetuses between the two groups (P>0.05). After treatment, the OG was observed with markedly lower level of inflammatory factors C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) than the CG (P<0.05); levels of PAF and fFN decreased significantly in both two groups (P<0.05), and the levels in the OG were comparatively lower as compared to the CG (P<0.05). The areas under the ROC curve for PAF and fFN to predict pregnancy outcome were 0.766 and 0.757, respectively.

CONCLUSION

Atosiban combined with Ritodrine evidently improves the therapeutic efficacy in patients with threatened preterm labor, reduces the occurrence of adverse pregnancy outcomes as well as the levels of PAF and fFN.

Efficacy of atosiban combined with ritodrine in the treatment of threatened preterm labor and related risk factors of different pregnancy outcomes

OBJECTIVE

To investigate the efficacy of atosiban combined with ritodrine in threatened preterm labor (TPL) treatment and analysis of related risk factors of different pregnancy outcomes.

METHODS

A retrospective study was conducted on the clinical data of 127 patients with TPL who were hospitalized in the Children's Hospital of Shanxi and Women's Health Center of Shanxi from January 2020 to November 2021. There from, 58 patients treated with ritodrine were seen as the control group (CG), and 69 treated with atosiban and ritodrine were regarded as the joint group (JG). The inhibition rate after treatment was compared, and the changes of tissue inhibitor of metalloproteinase-1 (TIMP-1), nitric oxide (NO), interleukin-6 (IL-6), and prostaglandin E2 (PGE2) in the amniotic fluid before and after treatment were assessed. The pregnancy outcomes of patients were recorded, and the risk factors of adverse pregnancy outcomes were analyzed. The full-term delivery rate, cesarean section rate and neonatal Apgar score >7 were compared, and their adverse reactions were evaluated.

RESULTS

Compared with the JG, the improvement of uterine contraction in the CG was obviously lower, and so was the inhibition rate (P<0.05). The rates of full-term delivery and neonatal Apgar score >7 in the CG were lower than those in the JG, while that of cesarean section was higher (P<0.01). After treatment, the TIMP-1 level in the amniotic fluid in the CG was markedly lower (P<0.001), while the NO, IL-6 and PGE2 levels were higher (P<0.001) as compared with the joint group. The total incidence of adverse reactions in the JG was lower than that in the CG (P<0.05). Logistics regression analysis revealed that age<26 and use of Atosiban combined with Ritodrine are protective factors for pregnancy outcomes, while BMI≥20 before pregnancy is a risk factor for adverse pregnancy.

CONCLUSION

Atosiban combined with ritodrine can improve the condition of TPL patients, enhance the treatment efficacy, and reduce the occurrence of adverse pregnancy outcomes.