The effect of tocolytic use in the management of symptomatic placenta previa

Richard E. Besinger, Charles W. Moniak, Linda S. Paskiewicz, Susan G. Fisher, Paul G. Tomich

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: The null hypothesis is that tocolysis has no effect on pregnancy prolongation in the aggressive expectant management of symptomatic preterm placenta previa. Study design: One hundred twelve preterm pregnancies with confirmed placenta previa and an initial episode of acute vaginal bleeding were selected for this retrospective analysis. Exclusion criteria included gestational age ≥ 35 weeks, delivery within 24 hours of admission, prior treatment for bleeding or preterm labor, and containdications to tocolytic use. Tocolysis was prescribed, at the discretion of the treating clinical staff, in selected pregnancies with significant uterine contractions after admission of the patient. The majority of treated patients (85%) received intravenous magnesium sulfate and/or oral or subcutaneous β-sympathormimetics within 24 hours of admission. Most patients remained hospitalized until delivery under this aggressive expectant management protocol. Both treated and untreated control study groups were similar at inclusion with regard to parity, gestational age, contraction frequency, and degree of initial bleeding. Outcome variables for each treatment group were obtained from final chart review. Continuous and categoric variables were compared with Student t test or x2 analysis—Fisher's exact test, respectively. Results: The clinical use of tocolysis in symptomatic placenta previa was associated with a clinically significant delay of preterm delivery. Significant improvement in clinical parameters such as interval from admission to delivery (39.2 vs 26.9 days, p < 0.02) and birth weight (2520 vs 2124 gm, p < 0.03) was observed in the tocolysis group. There was no observed statistical difference between the two treatment groups with regard to incidence of recurrent bleeding, interval from admission to first recurrent bleeding, and need for transfusion. There was a trend for patients with multiple bleeding episodes to have been receiving tocolytic therapy (p < 0.10). A trend for requiring a postpartum transfusion was also noted in the tocolysis group (p < 0.09). Treated pregnancies receiving long-term maintenance tocolysis with oral or subcutaneous terbutaline exhibited a greater degree of pregnancy prolongation than those treated with short-term intravenous magnesium alone (43.7 vs 15.3 days, p < 0.02). Conclusions: This retrospective analysis suggests that tocolytic intervention in cases of symptomatic preterm previa may be associated with clinically significant prolongation of pregnancy and increased birth weight. Tocolytic therapy in these cases does not appear to have an impact on frequency or severity of recurrent vaginal bleeding. Further prospective analysis may delineate the role of tocolysis in the aggressive expectant management of symptomaticf placenta previa. 1995; 172:1770–1778.)

Original languageEnglish (US)
Pages (from-to)1770-1778
Number of pages9
JournalAmerican Journal of Obstetrics and Gynecology
Volume172
Issue number6
DOIs
StatePublished - Jan 1 1995

Fingerprint

Tocolytic Agents
Tocolysis
Placenta Previa
Pregnancy
Hemorrhage
Uterine Hemorrhage
Birth Weight
Gestational Age
Terbutaline
Uterine Contraction
Magnesium Sulfate
Premature Obstetric Labor
Patient Admission
Parity
Magnesium
Postpartum Period
Therapeutics
Students

Keywords

  • Tocolysis
  • placenta previa

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

The effect of tocolytic use in the management of symptomatic placenta previa. / Besinger, Richard E.; Moniak, Charles W.; Paskiewicz, Linda S.; Fisher, Susan G.; Tomich, Paul G.

In: American Journal of Obstetrics and Gynecology, Vol. 172, No. 6, 01.01.1995, p. 1770-1778.

Research output: Contribution to journalArticle

Besinger, Richard E. ; Moniak, Charles W. ; Paskiewicz, Linda S. ; Fisher, Susan G. ; Tomich, Paul G. / The effect of tocolytic use in the management of symptomatic placenta previa. In: American Journal of Obstetrics and Gynecology. 1995 ; Vol. 172, No. 6. pp. 1770-1778.
@article{ccd6051a9bd24eac9554b9d58822278d,
title = "The effect of tocolytic use in the management of symptomatic placenta previa",
abstract = "Objective: The null hypothesis is that tocolysis has no effect on pregnancy prolongation in the aggressive expectant management of symptomatic preterm placenta previa. Study design: One hundred twelve preterm pregnancies with confirmed placenta previa and an initial episode of acute vaginal bleeding were selected for this retrospective analysis. Exclusion criteria included gestational age ≥ 35 weeks, delivery within 24 hours of admission, prior treatment for bleeding or preterm labor, and containdications to tocolytic use. Tocolysis was prescribed, at the discretion of the treating clinical staff, in selected pregnancies with significant uterine contractions after admission of the patient. The majority of treated patients (85{\%}) received intravenous magnesium sulfate and/or oral or subcutaneous β-sympathormimetics within 24 hours of admission. Most patients remained hospitalized until delivery under this aggressive expectant management protocol. Both treated and untreated control study groups were similar at inclusion with regard to parity, gestational age, contraction frequency, and degree of initial bleeding. Outcome variables for each treatment group were obtained from final chart review. Continuous and categoric variables were compared with Student t test or x2 analysis—Fisher's exact test, respectively. Results: The clinical use of tocolysis in symptomatic placenta previa was associated with a clinically significant delay of preterm delivery. Significant improvement in clinical parameters such as interval from admission to delivery (39.2 vs 26.9 days, p < 0.02) and birth weight (2520 vs 2124 gm, p < 0.03) was observed in the tocolysis group. There was no observed statistical difference between the two treatment groups with regard to incidence of recurrent bleeding, interval from admission to first recurrent bleeding, and need for transfusion. There was a trend for patients with multiple bleeding episodes to have been receiving tocolytic therapy (p < 0.10). A trend for requiring a postpartum transfusion was also noted in the tocolysis group (p < 0.09). Treated pregnancies receiving long-term maintenance tocolysis with oral or subcutaneous terbutaline exhibited a greater degree of pregnancy prolongation than those treated with short-term intravenous magnesium alone (43.7 vs 15.3 days, p < 0.02). Conclusions: This retrospective analysis suggests that tocolytic intervention in cases of symptomatic preterm previa may be associated with clinically significant prolongation of pregnancy and increased birth weight. Tocolytic therapy in these cases does not appear to have an impact on frequency or severity of recurrent vaginal bleeding. Further prospective analysis may delineate the role of tocolysis in the aggressive expectant management of symptomaticf placenta previa. 1995; 172:1770–1778.)",
keywords = "Tocolysis, placenta previa",
author = "Besinger, {Richard E.} and Moniak, {Charles W.} and Paskiewicz, {Linda S.} and Fisher, {Susan G.} and Tomich, {Paul G.}",
year = "1995",
month = "1",
day = "1",
doi = "10.1016/0002-9378(95)91410-2",
language = "English (US)",
volume = "172",
pages = "1770--1778",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - The effect of tocolytic use in the management of symptomatic placenta previa

AU - Besinger, Richard E.

AU - Moniak, Charles W.

AU - Paskiewicz, Linda S.

AU - Fisher, Susan G.

AU - Tomich, Paul G.

PY - 1995/1/1

Y1 - 1995/1/1

N2 - Objective: The null hypothesis is that tocolysis has no effect on pregnancy prolongation in the aggressive expectant management of symptomatic preterm placenta previa. Study design: One hundred twelve preterm pregnancies with confirmed placenta previa and an initial episode of acute vaginal bleeding were selected for this retrospective analysis. Exclusion criteria included gestational age ≥ 35 weeks, delivery within 24 hours of admission, prior treatment for bleeding or preterm labor, and containdications to tocolytic use. Tocolysis was prescribed, at the discretion of the treating clinical staff, in selected pregnancies with significant uterine contractions after admission of the patient. The majority of treated patients (85%) received intravenous magnesium sulfate and/or oral or subcutaneous β-sympathormimetics within 24 hours of admission. Most patients remained hospitalized until delivery under this aggressive expectant management protocol. Both treated and untreated control study groups were similar at inclusion with regard to parity, gestational age, contraction frequency, and degree of initial bleeding. Outcome variables for each treatment group were obtained from final chart review. Continuous and categoric variables were compared with Student t test or x2 analysis—Fisher's exact test, respectively. Results: The clinical use of tocolysis in symptomatic placenta previa was associated with a clinically significant delay of preterm delivery. Significant improvement in clinical parameters such as interval from admission to delivery (39.2 vs 26.9 days, p < 0.02) and birth weight (2520 vs 2124 gm, p < 0.03) was observed in the tocolysis group. There was no observed statistical difference between the two treatment groups with regard to incidence of recurrent bleeding, interval from admission to first recurrent bleeding, and need for transfusion. There was a trend for patients with multiple bleeding episodes to have been receiving tocolytic therapy (p < 0.10). A trend for requiring a postpartum transfusion was also noted in the tocolysis group (p < 0.09). Treated pregnancies receiving long-term maintenance tocolysis with oral or subcutaneous terbutaline exhibited a greater degree of pregnancy prolongation than those treated with short-term intravenous magnesium alone (43.7 vs 15.3 days, p < 0.02). Conclusions: This retrospective analysis suggests that tocolytic intervention in cases of symptomatic preterm previa may be associated with clinically significant prolongation of pregnancy and increased birth weight. Tocolytic therapy in these cases does not appear to have an impact on frequency or severity of recurrent vaginal bleeding. Further prospective analysis may delineate the role of tocolysis in the aggressive expectant management of symptomaticf placenta previa. 1995; 172:1770–1778.)

AB - Objective: The null hypothesis is that tocolysis has no effect on pregnancy prolongation in the aggressive expectant management of symptomatic preterm placenta previa. Study design: One hundred twelve preterm pregnancies with confirmed placenta previa and an initial episode of acute vaginal bleeding were selected for this retrospective analysis. Exclusion criteria included gestational age ≥ 35 weeks, delivery within 24 hours of admission, prior treatment for bleeding or preterm labor, and containdications to tocolytic use. Tocolysis was prescribed, at the discretion of the treating clinical staff, in selected pregnancies with significant uterine contractions after admission of the patient. The majority of treated patients (85%) received intravenous magnesium sulfate and/or oral or subcutaneous β-sympathormimetics within 24 hours of admission. Most patients remained hospitalized until delivery under this aggressive expectant management protocol. Both treated and untreated control study groups were similar at inclusion with regard to parity, gestational age, contraction frequency, and degree of initial bleeding. Outcome variables for each treatment group were obtained from final chart review. Continuous and categoric variables were compared with Student t test or x2 analysis—Fisher's exact test, respectively. Results: The clinical use of tocolysis in symptomatic placenta previa was associated with a clinically significant delay of preterm delivery. Significant improvement in clinical parameters such as interval from admission to delivery (39.2 vs 26.9 days, p < 0.02) and birth weight (2520 vs 2124 gm, p < 0.03) was observed in the tocolysis group. There was no observed statistical difference between the two treatment groups with regard to incidence of recurrent bleeding, interval from admission to first recurrent bleeding, and need for transfusion. There was a trend for patients with multiple bleeding episodes to have been receiving tocolytic therapy (p < 0.10). A trend for requiring a postpartum transfusion was also noted in the tocolysis group (p < 0.09). Treated pregnancies receiving long-term maintenance tocolysis with oral or subcutaneous terbutaline exhibited a greater degree of pregnancy prolongation than those treated with short-term intravenous magnesium alone (43.7 vs 15.3 days, p < 0.02). Conclusions: This retrospective analysis suggests that tocolytic intervention in cases of symptomatic preterm previa may be associated with clinically significant prolongation of pregnancy and increased birth weight. Tocolytic therapy in these cases does not appear to have an impact on frequency or severity of recurrent vaginal bleeding. Further prospective analysis may delineate the role of tocolysis in the aggressive expectant management of symptomaticf placenta previa. 1995; 172:1770–1778.)

KW - Tocolysis

KW - placenta previa

UR - http://www.scopus.com/inward/record.url?scp=0029031857&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029031857&partnerID=8YFLogxK

U2 - 10.1016/0002-9378(95)91410-2

DO - 10.1016/0002-9378(95)91410-2

M3 - Article

C2 - 7778631

AN - SCOPUS:0029031857

VL - 172

SP - 1770

EP - 1778

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 6

ER -