Gina R is a bit of a worrywart
and likes to be prepared for any catastrophe. She's already
child-proofed all the cupboards in her apartment, and
she's only 26 weeks into her pregnancy. Granted the 36-year-old
recently went into preterm labour, but thankfully that
was stopped in the nick of time with magnesium tocolysis
treatment. However, Gina is still worried that it might
happen again. According to a press release on February
11 of a study by the Mayo Clinic and the Medical University
of South Carolina, she needn't be too concerned.
The study which hasn't yet been
published established that, in most cases, mothers who
are successfully treated for preterm labour don't have
any problems holding on until the 34th week of their
pregnancy or later. "We found that if you stopped labour
once, only one out of nine women would come back with
a repeat episode," according to researcher Dr Brian
Brost of the Mayo Clinic in Rochester, MN. This is about
the same level of risk as for any other pregnancy.
With the slow but inexorable rise
of preterm labour and delivery rates, possibly due to
a greater number of older mothers, obstetricians have
been turning increasingly to tocolysis to delay premature
birth in otherwise uncomplicated pregnancies. Tocolysis
is achieved through the administration of drugs, such
as nifedipine or atosiban, or chemical agents, like
magnesium sulfate, that inhibit uterine contractions.
However, prior to the Mayo Clinic study, none of these
measures had been shown to definitively prevent preterm
labour, according to Dr Brost.
This study retrospectively examined
the records of 172 preterm labour patients with a gestational
age of 24 to 34 weeks who had received magnesium tocolysis
treatment to prevent delivery. The treatment was considered
to be successful if it prevented birth for at least
another seven days, which was the case for 154 of the
women examined.
STOPS
AND STARTS
Of the 154 women whose initial bout of preterm labour
had been halted for seven days, 87.7% delivered at 34
weeks of gestation or later. Women who achieve 34 weeks'
gestation are considered to be close enough to being
'at term' that labour is not prevented at this stage.
Of the 19 women who experienced another round of preterm
labour, repeat treatment successfully delayed delivery
for 11 of them for another 48 hours. Only eight couldn't
wait and delivered within 24 hours of treatment.
The use of tocolysis is still under
scrutiny by the research community, who believe that
the underlying causes of preterm labour need to be better
understood. For example, tocolysis may not be the best
solution if a previously undetected problem with the
mother or baby is the root cause. In addition, the lack
of large-scale, placebo-controlled trials and the potentially
harmful side effects of some tocolytic agents are concerns.
According to Dr Brost, serious
side effects from magnesium tocolysis are rare and are
usually caused by improper dosage or monitoring of the
patient. "Most babies will do just fine - they're delivered
near term or at term," he adds.
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