A prospective randomized trial of acute tocolysis in term labour with atosiban or ritodrine

Abstract 

Objective

To study the effects of the tocolytics atosiban and ritodrine in term labour.

Study design

Women in term labour, requiring acute tocolysis, were prospectively randomized for treatment with either atosiban i.v. (n=70) or ritodrine i.v. (n=70). There were three indications for acute tocolysis: (1) fetal distress followed by continuation of labour, (2) fetal distress followed by emergency caesarean section (CS), and (3) arrest of contractions in women waiting for a secondary CS in the absence of fetal distress. Primary endpoints were maternal blood pressure (MBP) and maternal heart rate (MHR). Secondary endpoints were intra-uterine pressure, fetal heart rate (FHR), 5′-Apgar score and umbilical arterial pH.

Results

Baseline characteristics did not differ between the study groups. The ritodrine group showed a significant rise in MHR (p<0.001), MHR remained unaltered in the atosiban group (p=0.31). No significant changes occurred in systolic and diastolic BP in either group. FHR rose by a maximum of 11.6bpm (8.5%) in the ritodrine group (p<0.001) compared to a rise of 4.9bpm (4.8%) in the atosiban group (p=0.27). No differences were found in blood loss and fetal outcome. Compared to baseline, uterine pressure was reduced by a maximum of 55% (p<0.001) after ritodrine administration, compared to a maximal reduction of 54% (p<0.001) after atosiban administration. These effects did not differ between the two treatment groups.

Conclusion

Considering the maternal effects, our results suggest a possible role for atosiban bolus in acute tocolysis in term labour.

Keywords: Tocolysis, Atosiban, Ritodrine, Intra-uterine resuscitation, Term labour