Comparison of salbutamol and nifedipine as a tocolytic agent in the treatment of preterm labour

Abstract

OBJECTIVES: To compare the efficacy and safety of beta agonist salbutamol and calcium channel blocker nifedipine in inhibiting uterine contractions for prolongation of pregnancy and to evaluate the maternal side effects and neonatal outcome of the two drugs. DESIGN: Quasi experimental study from November 2007 to March 2008. SETTING: Maajee private hospital of Hyderabad and Department of Obstetrics & Gynecology (Unit -II), Liaquat University Hospital Hyderabad, Sindh - Pakistan. Total deliveries conducted in both settings were 6,360 per year. METHODS: One hundred pregnant women having single fetus, with preterm labour (<37 weeks) were studied. A proforma was filled from each patient that included information regarding history, findings of clinical examination and investigations. These patients were divided into two groups. Group A received salbutamol (beta-agonist) treatment and group B nifedipine (calcium channel blocker). Salbutamol was given 4mg intravenously in 500cc of 5% dextrose solution, started at 10 drops per minute and increased at interval of 15-20 minutes until the contractions were stopped, then maintained with 4mg oral dose while nifedipine was given as 20mg oral tablets. Results were analyzed by SPSS version 10.0. RESULTS: Total 100 patients were divided into two groups of 50 each. Mean age in group A was 27.64 ± 6.006 (20-33 years) and in group B, 27.84±6.60 (22-36 years). Mean parity in group A was 2.34± 1.97 (1-3) and group-B was 2.58 ± 1.99 (1-3). Mean gestational age in group A was 31.14±2.43 (28-36 weeks) and in group B, 32.34 ± 2.68 (28.36 weeks). In group A 35 (70%) of patients had stopped contraction in 1 st hour as compared to group B where only 10 (20%) were tocolysed for the treatment, 40% of patients had no contraction in 3rd hour of treatment in this group. Two (4%) women suffered from hypotension and headache with nifedipine as compared to salbutamol group where 9 (18%) women had nausea, vomiting, palpitation and tachycardia. Neonatal outcome and pregnancy prolongation till 36 weeks were similar in both groups. CONCLUSION: This study shows that tocolytic effect of prolongation of the pregnancy and the neonatal outcome of the two drugs are the same. However, calcium channel blockers are associated with less frequent side effects.