| Objective:To study effect of the Ritodrine Hydrochloride, Nifedipine and magnesium sulfate on the uterine contraction, and the heart rate,blood pressure,the final gestational age of the gravida with threatened premature labor, and the Apgar score of the neonates.Methods:Gravidas with the diagnoses of threatened premature labor in the outpatient department and then were admitted to the hospital for tocolysis were included in the study from Nov2011to Dec2013in the Peple’s Hospital of Dong’e couty. The inclusion criteria is as1. with the regular uterine contraction, that means the rate should more than10times in every10-min; and time lasts for more than30s;2. the cervix measured through the vagina:a:the lengh≤2cm, the internal opening≥1cm; b: the lengh≤2cm and the cervix is softening; c; internal opening≥1cm and the cervix is softening;3. fetal fibronectin (+) on admission; the first iterm is the prerequisites, the last two are as the referencecondition. Exclusion criteria:1. rupture of membranes;2. dilation of cerix>2cm;3. the gravidas with complications or co-morbidities couldn’t keep upregnant;4. be diagnosed with physiology uterine contraction.According to the admission order the subjects (informedtreatment programsto gettheir informedconsent)were divided into A, B, C three groups. The group A is with the Ritodrine Hydrochloride (n=46), treatment methods:Ritodrine100mg+5%glucose liquid500ml, from5drops/min starting contractions adjusted once every10minutes, every increase of5drops/min, the maximum number drops to35drops/min, contractions12-18hours after the disappearance continue medication; intravenously30minutes before the end of the beginning of oral ritodrine tablets, oral doses of the first24hours every two hours one (10mg),1-2tablets every4-6hours thereafter (10-20mg), the daily total no more than12(120mg). In case the course of medication heart rate>140beats/min or patients who can not tolerate flustered and other timely to magnesium treatment.The group B is with Nifedipine (n=44),Treatment methods:an initial dose of20mg sublingual nifedipine after30minutes as there is still the law of the first hour of contractions give20mg maximum dose of40mg,10mg after contractions weaken changed every eight hours, as course of medication can effectively inhibit the contractions, severe hypotension symptoms instead of magnesium sulfate therapy.The group C is with magnesium sulfate (n=46),Treatment methods:25%magnesium sulfate20ml+5%glucose liquid drops finished within100ml30minutes, after intravenous infusion of magnesium sulfate to2g/h, as the contractions disappeared to magnesium1g/h continuous intravenous infusion12hours after stopping drugs. Record the three groups:①times from using medicine to contractions disappeared;②extend the days of pregnancy;③medication after0.5h,1h,1.5h,2h,4h,8h blood pressure, heart rate and contractions;④other possible drug-related Vice reaction;⑤postpartum hemorrhage, neonatal birth weight, one minute after birth, such as Apgar score. In general, the subject is regarded as with the succeeded tocolysis with the extended gestational age to the14-day or more; and these with2to13days are regarded as effective, and those with less than2days as failed. The succeeded and the effective subjects are recorded as the available subjects.The SPSS17.0was used in the statistics, the quantitative data was expressed as (x±s); with the analysis method of variance (ANOVA), and the significant difference is showed with p<0.05.Results:1、Differences between the three groups of pregnant women in the age structure, gestational age, maternal times, admission contractions, blood pressure, heart rate and other terms were not statistically significant (P>0.05), clinical data comparable.2、Ritodrine group miscarriage rate was82.6percent, six cases of use of magnesium sulfate miscarriage, premature rupture of membranes in2patients miscarriage process; nifedipine miscarriage rate was79.5percent, six cases of use of sulfuric acid magnesium miscarriage, three cases of premature rupture of membranes in the process of miscarriage, magnesium group miscarriage rate was86.9percent, six cases of premature rupture of membranes occurs in the process of miscarriage, miscarriage total efficiency of the three groups after treatment no significant difference3、Ritodrine group contractions disappeared after treatment the mean time is14.45h, prolonged gestation days for22.5d; contractions disappeared after treatment with nifedipine group mean time to15.48h, prolonged gestation days for21.84d; magnesium contractions disappeared after treatment group mean time to15.2h, prolonged gestation days for23.19d; three groups in the medication to prolong pregnancy contractions disappeared a few days time, and there was no difference (P>0.05)4、Ritodrine1h blood pressure medication after the group appeared a slight decrease in amplitude11-13/9-12mmHg, but does not have the admission compare differences in blood pressure, heart rate occurred immediately after treatment0.5h increasing trend of increase of17-23times/min, heart rate compared with the admission was a significant difference in heart rate increased4hours after administration reached a peak.After1h blood pressure medication nifedipine group declined, dropping to12-15/8-13mmHg, but there was no difference between admission blood pressure, heart rate1hour after treatment began to increase, the rate of increase of9-13times/min, and admission heart rate does not have a difference compared.After themagnesium sulfategroupnosignificant effecton blood pressuremedication, lheffecton heart ratehasslightly increased,the rate of increaseof7-9beats/min,andadmissionblood pressure,heart rate,compared withno significant difference.After three treatment groups relative Ritodrine significantly increased heart rate (P<0.05), while the nifedipine group, magnesium sulfate group had no significant effect on blood pressure, heart rate (P>0.05).5、Ritodrine group eventually mean gestational age was36.0weeks postpartum hemorrhage volume number246.51ml, the average birth weight of newborns2731.41g,1minute Apgar score mean was8.54; nifedipine group were eventually gestational age the number was35.8weeks postpartum hemorrhage volume number239.84ml, the average weight of newborn birth2752.40g,1minute Apgar score was8.56; magnesium group eventually mean gestational age was36.2weeks, the number of postpartum hemorrhage volume240.32ml, the average birth weight of newborns2674.6g,1minute Apgar score was8.48.The totalmiscarriageafterthreetreatmentefficiency, and ultimatelygestational age, extendingthe number of daysduring pregnancy, postpartum hemorrhage, birth weight,birthafterone minuteApgar scoreswere not significantly different(P>0.05).Conclusions:1、Ritodrine, nifedipine, magnesium sulfate in the treatment of premature labor are effective for inhibiting uterine contractions, and ultimately gestational age, no significant difference (P>0.05) treatment effect.2、Ritodrine hydrochloride side effects of increased heart rate in patients with threatened premature miscarriage process, the foundation can be used in patients with heart unhappy;3、No threatened preterm nifedipine reduced blood pressure miscarriage process for threatened preterm pregnancy induced hypertension in pregnant women can be used as the first choice, either to suppress contractions and can lower blood pressure;4、Ritodrine hydrochloride, nifedipine, magnesium in the of postpartum hemorrhage, neonatal birth weight,1min Apgar score, etc have no significant difference (P>0.05). |
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