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Preterm Labour

Calcium channel blockers and atosiban are the most recommended tocolytics, but alternatives such as beta-mimetics, indomethacin and magnesium sulphate remain recommended alternatives in some national guidelines.

Available guidelines

 

Region Country Date Source url Recommendations for tocolytic treatment
Europe Austria 2005 OEGGG 1. Atosiban
2. Beta-mimetics or calcium channel blockers
Europe Belgium 2014

GGOLFB

 

 

KCE

 

VVOG

GGOLFB:
1. Atosiban (with the option of three repetitive treatments)

KCE:
1. Calcium channel blockers or oxytocin antagonists

Fetal fibronectin, phosphorylated insulin-like growth factor binding protein-1 and cervical length measurement tests recommended

VVOG:
1. Atosiban

Europe Czech Republic 2012 ČGPS ČLS JEP No first-line recommendation
• Beta-mimetics or atosiban
Europe Denmark 2013 DSOG 1. Atosiban
2. Calcium channel blockers, beta-mimetics or non-steroidal anti-inflammatory dru

 

Europe Finland 2011 Link No first-line recommendation
• Calcium channel blockers or atosiban
Europe France 2002 CNGOF

No first-line recommendation
• Atosiban, beta-mimetics or calcium channel blockers

Europe Germany n/a DGGG No first-line recommendation
• Atosiban, fenoterol or nifedipine
Europe Greece 2014 HSOG No first-line recommendation
• Nifedipine or atosiban
Europe Hungary 2010 Link

No first-line recommendation
Atosiban similar effective as beta mimetics, however it has fewer AE’s beta-mimetics ((salbutamol, terbutalin, ritodrin) calcium channel blockers more effective than beta-mimetics, and it has fewer AE’s (nifedipine-off label use!) indometacine is less effective than other tocolytics, however it hes fewer AE’s

Europe Italy 2016 Link

• > 28 g. weeks: atosiban or nifedipine (off-label) can be used due to same efficacy profile. Avoid nifedipine use in case of maternal hypotension or cardiopathy. Atosiban has a better fetal safety profile than nifedipine.

• Atosiban shows less adverse events than other tocolytic from maternal and fetal point of view thanks to utero-specific action.

• Avoid b-mimetics use in case of multiple pregnancy, hyperthyroidism, maternal cardiopathy, diabetes

• Indomethacin could be used till 32 weeks

• MgSO4 is not reccomended as tocolytic therapy.

• Avoid tocolytics association

• Tocolysis for manteinance is not reccomanded. b-mimetics use has proven to determinate adverse events

Europe The Netherlands 2012 NVOG

No first-line recommendation
• Atosiban or nifedipine

Atosiban has a slight preference in complicated pregnancies

Europe Norway 2014 NGF 1. Atosiban
2. Nifedipine
3. Indomethacin
Europe Portugal n/a n/a 1. Atosiban
2. Nifedipine
3. Indomethacin
Europe Romania 2010 Link 1. Atosiban
2. Nifedipine
3. Hexoprenaline, terbutaline or ritodrine
4. Indomethacin
5. Magnesium sulphate
6. Nitroglycerin
7. Betamethasone or dexamethasone
Europe Russia

2013

 

2015

Link

 

Link

1. Nifedipine in 50% cases of PTL
2. Atosiban in 20% cases of PTL
3. Hexoprenaline in 20% of PTL

 

Atosiban is included in the EDL 2015. EDL is list of vital and essential medicines that includes 608 drugs from diversified areas and which guided all hospitals in Russia

 

Europe Spain 2014 SEGO No first-line recommendation
• Atosiban has fewer failures within 48 hours
• Nifedipine may be associated with a longer postponement of delivery
• Nifedipine has a higher risk of adverse events compared with atosiban
• Atosiban is the choice of treatment for twin deliveries
Europe Sweden n/a n/a • Atosiban is used as first-line treatment at university hospitals and most regional hospitals
Europe United Kingdom 2011 RCOG

• Atosiban or nifedipine

Atosiban is 500 times more expensive than nifedipine

South America Argentina 2015 Link

Draft guidelines
1. Atosiban or beta-mimetics (hexoprenaline)

Nifedipine is not considered

South America Brazil 2013 FEBRASGO • Beta-mimetics are preferred but have a high risk of side effects that compromise efficacy
• Atosiban has high efficacy and low risk of adverse events, but is expensive
• Nifedipine requires more evidence to be considered as a recommendation, and there is a need for standardised dosage
South America Chile 2015 Link

First-line recommendation

  • Nifedipine
  • Indomethacin

Second line recommendation

  • Fenoterol

*Atosiban does not appear in any position of choice, only referred as tocolítca as effective and safe alternative vs placebo, but high cost.

South America Mexico 2008 CENETEC Atosiban is recommended to be used as follows:
• Initial dose of 6.7 mg
• Followed by an infusion of 300 mcg/min for 3 hours
• Followed by 100 mcg/min until 48 hours of treatment
Asia China 2014 RANZCOG Follow RANZCOG guidelines
1. Magnesium sulphate
2. Beta-mimetics
3. Nifedipine
4. Indomethacin
5. Atosiban
Asia Hong Kong 2011 RCOG Follow RCOG guidelines
Asia Japan 2011 n/a

1st line:
1. Ritodrine beta-mimetics hydrochloride
2. Magnesium sulphate

Note: Added additional alert regarding long-term administration

Asia Malaysia n/a n/a 1. Terbutaline
2. Ritodrine
Asia Singapore 2011 RCOG Follow RCOG guidelines
1. Beta-mimetics
2. Other pharmacological agents, including: nitric oxide donors, magnesium sulphate, indomethacin, nifedipine and atosiban
Asia South Korea 2014 KSOG Ritodrine or Atosiban
* Reimbursement criteria for atosiban treatment are strict.
Asia Thailand n/a n/a 1. Beta-mimetics (terbutaline)
2. Calcium channel blockers (nifedipine)
3. Magnesium sulphate
Asia The Philippines 2014 n/a 1. Calcium Channel Blockers
2. Progesterone
3. Indomethacin
4. Atosiban
Asia Vietnam 2012

n/a

1. Nifedipine
2. Salbutamol
3. Atosiban
Australasia New Zealand 2011 RANZCOG • Nifedipine
Middle east Lebanon 2014

CNGOF

RCOG

• CNGOF: Atosiban, beta-mimetics or calcium channel blockers
• RCOG: Atosiban or nifedipine

Choice of therapy  depends on which guidelines (France or UK) each hospital follows

Middle east Israel 2014 Link No first-line recommendation
• Treatment options include: calcium channel blockers, prostaglandins inhibitors, atosiban and beta-mimetics
Middle east Saudi Arabia 2011 Link

• Nifedipine and atosiban have comparable effectiveness in delaying birth for up to seven days

Tocolysis should not be used where there is a contraindication to prolonging pregnancy

Africa South Africa n/a n/a No first-line recommendation
• Atosiban
• Nifedipine