There is no published trial and it might be an option for pregnancies extremely premature with uterine activity or modified cervix
I have several cases - about 10. In urgent situation I'd prefer beta-mimetics infusion. Atosiban wouldn't stop or decrease intensity of uterine contractions. I guess the goal of atosiban application is rather prophylactical. Probably for IVF pregnancies.
I wanted to to a RCT on this topic but power calculation made it clear that it was not possible during a ph.d. We have used combined maintenance therapy at our department at Odense University Hospital in very special cases with women at risk of spontaneous preterm birth (GA 24-28) with promising results - but again, the material is limited in numbers, so I wouldn´t jump to conclusions.
I performed an early study in the 80s with atosiban. The few pt side effects were clearly evident. Now with atiosiban available outside the US studies preliminarily indicate it is equal to nifedipine in prolonging pregnancies for 48 hours to give steroids, But the data seem to support fewer pt side effects with atosiban.
Hello Ernesto. There is a RCT of Atosiban V Ritodrine {see below}, you are right in that most published work is via systematic reviews which indirectly compare Atosiban with other Tocolytic agents. Here in the UK, the 1st line tocolytic of choice is Nifedipine. I am aware that some of our local NHS Trusts do not use Atosiban thrapy due to its cost compared with other agents.
Atosiban was comparable in clinical effectiveness to conventional ritodrine therapy but was better tolerated than ritodrine, with no evidence of significant maternal or fetal adverse events. Neonatal morbidity, which was similar between the two treatment arms, was apparently related to the gestational age of the infant rather than to the exposure to either tocolytic agent. (Am J Obstet Gynecol 2000;182:1191-9.)
Hello Ermesto:
In Spain I saw a job Orense Hospital in contributing 3 cases. I am attaching the same reference. Clin Invest Gin Obst. 2011;38(3):109—113. They report the cases of three patients with threatened preterm labor in which tractocile treatment was maintained for between 9 and 38 days until 32-week pregnancies were achieved.
There were no adverse effects. The pregnancies were prolonged for 11, 8 and 7 weeks.
There is any evidence that maintanance tocolysis (independently of chosen tocolytic) helps, neider for prolonging of gestational age, or regardinng fetal morbidity and mortality.
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