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The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow.
J Matern Fetal Neonatal Med. 2009 Jun; 22(6):485-90.JM

Abstract

BACKGROUND

The choice of first-line tocolytic agent is a topic of worldwide debate. The oxytocin receptor antagonist atosiban and the calcium antagonist nifedipine appear to be effective in postponing delivery. However, information is lacking on their possible effects on the fetal biophysical profile.

OBJECTIVE

To study the direct fetal effects of tocolysis with atosiban or nifedipine combined with a course of betamethasone.

METHOD

We performed a randomised controlled study including women with preterm labour requiring tocolytic treatment. Primary outcome measures were the effects on fetal heart rate (FHR) and its variation. Secondary endpoints were the effects on fetal movement and blood flow (pulsatility index - PI) of the umbilical (UA) and medial cerebral arteries (MCA).

RESULTS

One-hour recordings of FHR and fetal movements were made on each of five successive days (days 0-4). Fetal blood flow velocity patterns were studied daily by Doppler ultrasound. Baseline characteristics of 31 women who had not delivered at day 0 and needed no escape tocolysis did not differ between the study groups. Multilevel analysis showed no significant effect of either tocolytic on FHR and movement parameters over the 5-day study period. The use of tocolytics also did not significantly alter the time courses of PI-values for UA (p = 0.37) and MCA (p = 0.62).

CONCLUSION

This study demonstrates for the first time the direct effects of atosiban on fetal movement, heart rate and blood flow. Tocolysis with either atosiban or nifedipine combined with betamethasone administration appears to have no direct fetal adverse effects.

Authors+Show Affiliations

Department of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands. r.deheus-2@umcutrecht.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19479644

Citation

de Heus, Roel, et al. "The Effects of the Tocolytics Atosiban and Nifedipine On Fetal Movements, Heart Rate and Blood Flow." The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 22, no. 6, 2009, pp. 485-90.
de Heus R, Mulder EJ, Derks JB, et al. The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow. J Matern Fetal Neonatal Med. 2009;22(6):485-90.
de Heus, R., Mulder, E. J., Derks, J. B., & Visser, G. H. (2009). The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow. The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 22(6), 485-90. https://doi.org/10.1080/14767050802702349
de Heus R, et al. The Effects of the Tocolytics Atosiban and Nifedipine On Fetal Movements, Heart Rate and Blood Flow. J Matern Fetal Neonatal Med. 2009;22(6):485-90. PubMed PMID: 19479644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow. AU - de Heus,Roel, AU - Mulder,Eduard J H, AU - Derks,Jan B, AU - Visser,Gerard H A, PY - 2009/5/30/entrez PY - 2009/5/30/pubmed PY - 2009/8/26/medline SP - 485 EP - 90 JF - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JO - J. Matern. Fetal. Neonatal. Med. VL - 22 IS - 6 N2 - BACKGROUND: The choice of first-line tocolytic agent is a topic of worldwide debate. The oxytocin receptor antagonist atosiban and the calcium antagonist nifedipine appear to be effective in postponing delivery. However, information is lacking on their possible effects on the fetal biophysical profile. OBJECTIVE: To study the direct fetal effects of tocolysis with atosiban or nifedipine combined with a course of betamethasone. METHOD: We performed a randomised controlled study including women with preterm labour requiring tocolytic treatment. Primary outcome measures were the effects on fetal heart rate (FHR) and its variation. Secondary endpoints were the effects on fetal movement and blood flow (pulsatility index - PI) of the umbilical (UA) and medial cerebral arteries (MCA). RESULTS: One-hour recordings of FHR and fetal movements were made on each of five successive days (days 0-4). Fetal blood flow velocity patterns were studied daily by Doppler ultrasound. Baseline characteristics of 31 women who had not delivered at day 0 and needed no escape tocolysis did not differ between the study groups. Multilevel analysis showed no significant effect of either tocolytic on FHR and movement parameters over the 5-day study period. The use of tocolytics also did not significantly alter the time courses of PI-values for UA (p = 0.37) and MCA (p = 0.62). CONCLUSION: This study demonstrates for the first time the direct effects of atosiban on fetal movement, heart rate and blood flow. Tocolysis with either atosiban or nifedipine combined with betamethasone administration appears to have no direct fetal adverse effects. SN - 1476-4954 UR - https://www.unboundmedicine.com/medline/citation/19479644/The_effects_of_the_tocolytics_atosiban_and_nifedipine_on_fetal_movements_heart_rate_and_blood_flow_ L2 - http://www.tandfonline.com/doi/full/10.1080/14767050802702349 DB - PRIME DP - Unbound Medicine ER -