Management of preterm labor

Abstract

Aims and Objectives of Study: To compare the safety and efficacy of Ritodrine and Salbutamol in the management of preterm labour. Study Design: It was an interventional study in which the comparison between Salbutamol and Ritodrine was carried out for the prevention of preterm labour. Study Setting: Department of Obstetrics & Gynaecology, AIMC/ Jinnah Hospital, Lahore. Patients and methods: 50 patients admitted for prevention of preterm labour were randomly assigned to two groups having 25 patients in each group. One group was given 100mg Ritodrine (group I) in 500ml of 5% Dextose water, starting at a dose of 50µg/min and increased by 50µg/min every 15-30min till uterine activity ceased or dose of 350µg/min reached or other in tolerable side effects appeared. The effective tocolytic dose without side effects was maintained for 24 hours during this period steroid cover was given. Another group was given 5mg Salbutamol (group-II) in 500ml of 5% D/S, at a dose of 10µg/min to a maximum of 45µg/min until contraction ceased or side effects started. Continuous maternal and fetal monitoring was carried out in both groups. Results: Fifty patients presenting with preterm labour were studied. The maximum numbers of patients were in the age group of 30-34 years. Mean gestational age in group-I was 30.56weeks and group-II was 30.60weeks. 88% were with cephalic presentation, 8% had breech presentation and 4% presented with transverse lie in both groups. In group-I, 80%cases were < 32weeks of gestation and in group-II, 72% cases were <32 weeks of gestation. 52% in group-I and 56% in group-II were primigravida. Dilatation of the cervix at the time of first examination in group-I was 2cm in 22(88%) patients and 2-4cm in 3(12%) patients. In group-II 2cm in 20(80%) patients and 2-4cm in 5(20%) patients. The effacement of the cervix at the first examination was < 40% in 16 patients (64%). 40-50 in 6 (24%) patients and 60% in 3 (12%) patients in group-I and in group-II < 40% in 14 (56%) patients, 6(24%) patients 40-50% effacement and 5(20%) patients had 60% effacement. Successful tocolysis was achieved in 76% of the cases with Ritodrine hydrochloride (Group-I) and in 72% of the cases with Salbutamol (Group-II). The delay in the delivery for 48 hours, 7 days and till 36 weeks of gestation were 76%, 64%, and 52% of patient respectively for Ritodrine and 72%, 56% and 40% respectively for Salbutamol. Headache, nausea and vomiting were complained in 6(24%), 2(8%) and 1(4%) patient in group-I and 4(16), 3(12%), and 2(8%) in group-II respectively. Conclusion: This study shows that Ritodrine hydrochloride and Salbutamol are equally effective regarding delay of delivery and prolongation of gestation.