Comparison of Transdermal Nitroglycerine Patch and Oral Nifedipine for Tocolysis in Preterm Labour: A Prospective Interventional Study

Abstract

Introduction: Preterm labour and delivery have a major contribution to perinatal mortality and morbidity. Tocolytic therapy reduces neonatal mortality and morbidity by prolonging gestation, allowing for corticosteroid administration and in-utero transfer to a tertiary care centre. There is a need to find out better tocolytic agent that is most effective and with the least side-effects. Aim: To compare oral Nifedipine and transdermal Nitroglycerine patch to achieve tocolysis in preterm labour. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, from January 2020 to June 2021. A total of 100 women presenting with signs and symptoms of preterm labour with live singleton pregnancy and intact membranes were included. All the women were divided into Group-A (n=50) and Group-B (n=50). Group-A received oral Nifedipine 20 mg of oral initially and 10 mg Nifedipine repeated after 30 minutes if the contractions persisted. Oral Nifedipine 10 mg was repeated every six hours till contractions subsided, and a transdermal Nitroglycerin patch (25 mg) was directly applied to the skin of the abdomen in Group-B. Demographic profile, the number of patients in which tocolysis was successful, improvement in Bishop score, prolongation in gestational age, maternal side-effects, and foetal outcomes in the form of birth weight, APGAR score, and NICU admission were recorded in both the groups on Excel sheet. Chi-square test and t-test were used to test the significance of the difference between categorical and continuous variables respectively. A p-value less than 0.05 were taken as significant. Results: In Group-A 94% (47 out of 50) achieved tocolysis while in Group-B 86% (43 out of 50) achieved tocolysis (p value-0.182). The mean prolongation of pregnancy was 17.70±13.04 and 13.14±11.03 in Groups A and B, respectively. The maternal complication was significantly higher in Group-B as compared to Group-A (22% Vs 6%, p-value-0.0097). In Group-A mean birth weight was 2.422 kg ±0.34 whereas in Group-B mean birth weight was 2.204±0.38 Kg (p-value-0.0032). Conclusion: Both drugs oral Nifedipine and transdermal Nitroglycerine were found to be effective in the treatment of preterm labour.

Keywords

• mortality
• pregnancy
• tocolysis