Revista Brasileira de Ginecologia e Obstetrícia (Feb 2008)
O atosibano como agente tocolítico: uma nova proposta de esquema terapêutico Atosiban as a tocolytic agent: a new proposal of a therapeutic approach
Abstract
OBJETIVO: avaliar um novo esquema terapêutico de emprego do atosibano quanto ao efeito tocolítico, eficácia e efeitos colaterais maternos e fetais. MÉTODOS: Estudo prospectivo com 80 gestantes em trabalho de parto prematuro admitidas para tocólise. Critérios de inclusão: gestação única, presença de contrações uterinas regulares, dilatação cervical >1 cm e 50%, idade gestacional entre 23 e 33 semanas e seis dias, membranas ovulares íntegras, índice de líquido amniótico >5 e PURPOSE: to test a therapeutic approach using atosiban for tocolysis, evaluating its safety and maternal and fetal side effects. METHODS: prospective study with 80 pregnant women with preterm labor admitted for tocolysis. Inclusion criteria: singleton pregnancy, regular uterine activity, cervical dilatation between 1 to 3 cm, cervical enfacement greater than 50%, 23 to 33 weeks and six days of gestational age, intact membranes, amniotic fluid index between 5 and 25, no maternal, fetal or placental diseases, no fetal growth restriction, no cervical incompetence, no fever. Exclusion criteria: chorioamnionitis or fever during tocolysis. Atosiban group: women received 6.75 mg atosiban iv in bolus, 300 mcg/min for three hours, then 100 mcg/min for three hours and thirty minutes. If uterine activity persisted, it was maintained iv infusion of 100 mcg/min for 12.5 hand that so for as long as 45 hours. Control group: women received terbutaline (five ampoules, 500 mL crystalloid solution) iv infusion, 20 mL/h. If uterine activity persisted, infusion velocity was raised (20 mL/h) until uterine contractions were absent. The dose was maintained for 24 hours. RESULTS: gestational age at birth was 29 weeks and five days to 40 weeks and six days. In atosiban group, the proportion of women who had not delivered at 48 hours was 97.5%, mean interval between tocolysis and birth of 28.2 days. In control group, birth occurred before 48 hours in 22.5% of the cases; mean interval between tocolysis and birth of 5.3 days. Maternal side effects were observed in 27.5% of cases of the atosiban group, none with tachycardia, dyspnea or tachypnea. In the control group, 75% of the cases referred palpitations, tachycardia, tachypnea or headache (drug infusion was interrupted in four cases). Fetal tachycardia was observed in 22.5% of the cases (n=9). No early neonatal death was observed. CONCLUSIONS: the therapeutic approach used showed to be effective for tocolysis, with low incidence of maternal, fetal and neonatal side effects.
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