Effect of Nifedipine Used in the Treatment of the Threat of Preterm Labor on Total Uterine Artery Blood Volume Flow Rate

Abstract

Purpose Evaluation of the effect of maternal nifedipine treatment on total uterine artery blood volume flow rate (TVFR).

Methods In this prospective study, 43 women who were admitted to the Perinatology Department of the University of Health Sciences Etlik Zübeyde Hanım Gynecology Training and Research Hospital, with the diagnosis of the threat of preterm labor, and 40 healthy pregnant women, who were randomly selected as the control group, were evaluated between July 1, 2018, and September 1, 2018. A transabdominal ultrasound examination of uterine arteries was performed both before and 48 hours after administration of oral nifedipine for TVFR measurement. For the final analysis, the TVFR levels of the group diagnosed with the threat of preterm labor and the control group were compared.

Results There was no significant difference in either uterine artery pulsatility index or resistance index values as well as the diameters of the uterine arteries after nifedipine treatment (p>0.05 for all). Total uterine artery blood volume flow rate (TVFR) was 424.66±236.74 mL/min before and 543.39±309.68 mL/min after treatment with nifedipine and was statistically significantly higher (p < 0.05).

ConclusionsOur study showed a statistically significant increase in total uterine artery blood volume flow rate 48 hours after oral nifedipine treatment.

Key words

nifedipine - total uterine artery blood volume flow rate - preterm labor - pulsatility indeks - pulsatility indeks - uterine artery

• References

• 1 ACOG. practice bulletin no. 171: Management of preterm labor. Obstet Gynecol 2016; 128: 155-164
• 2 Romero R, Conde-Agudelo A, Da Fonseca E. et al. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. Am J Obstet Gynecol 2018; 218: 161-180
• 3 Goldenberg RL, Culhane JF, Iams JD. et al. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75-84
• 4 Menon R. Spontaneous preterm birth, a clinical dilemma: etiologic, pathophysiologic and genetic heterogeneities and racial disparity. Acta Obstet Gynecol Scand 2008; 87: 590-600
• 5 Beck S, Wojdyla D, Say L. et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Org 2010; 88: 31-38
• 6 Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371: 261-269
• 7 Pascal A, Govaert P, Oostra A. et al. Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review. Dev Med Child Neurol 2018; 60: 342-355
• 8 Psaty BM, Smith NL, Siscovick DS. et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. J Am Med Assoc 1997; 277: 739-745
• 9 Simhan HN, Caritis SN. Prevention of preterm delivery. N Engl J Med 2007; 357: 477-487
• 10 Flenady V, Wojcieszek AM, Papatsonis DN. et al. Calcium channel blockers for inhibiting preterm labour and birth. Cochrane Database Syst Rev 2014; 6: CD002255
• 11 Namazov A, Grin L, Karakus R. et al. An effect of maternal nifedipine therapy on fetoplacental blood flow: a prospective study. Arch Gynecol Obstet 2018; 298: 685-688
• 12 Cornette J, Duvekot JJ, Roos-Hesselink JW. et al. Maternal and fetal haemodynamic effects of nifedipine in normotensive pregnant women. BJOG 2011; 118: 510-540
• 13 McKelvey A, Pateman K, Balchin I. et al. Total uterine artery blood volume flow rate in nulliparous women is associated with birth weight and gestational age at delivery. Ultrasound Obstet Gynecol 2017; 49: 54-60
• 14 How HY, Khoury JC, Sibai BM. Cervical dilatation on presentation for preterm labor and subsequent preterm birth. Am J Perinatol 2009; 26: 1-6
• 15 Chawanpaiboon S, Pimol K, Sirisomboon R. Comparison of success rate of nifedipine, progesterone, and bed rest for inhibiting uterine contraction in threatened preterm labor. J Obstet Gynaecol Res 2011; 37: 787-791
• 16 Hawkins JS, Wells CE, Casey BM, McIntire DD, Leveno KJ. Nifedipine for acute tocolysis of preterm labor: A placebo-controlled randomized trial. Obstet Gynecol 2021; 138: 73-78
• 17 Harake B, Gilbert RD, Ashwal S, Power GG. Nifedipine: effects on fetal and maternal hemodynamics in pregnant sheep. Am J Obstet Gynecol 1987; 157: 1003-1008
• 18 Grin L, Laish-Farkash A, Shenhav S. et al. Safety of nifedipine in threatened preterm labor: Investigation by three-dimensional echocardiography. Echocardiography 2018; 35: 1164-1170
• 19 Karahanoglu E, Altinboga O, Akpinar F. et al. Nifedipine increases fetoplacental perfusion. J Perinat Med 2017; 45: 51-55
• 20 Lima MM, Souza AS, Diniz C. et al. Doppler velocimetry of the uterine, umbilical and fetal middle cerebral arteries in pregnant women undergoing tocolysis with oral nifedipine. Ultrasound Obstet Gynecol 2009; 34: 311-315
• 21 Maitland-van der Zee AH, de Boer A, Leufkens HG. The interface between pharmacoepidemiology and pharmacogenetics. Eur J Pharmacol 2000; 410: 121-130
• 22 Ingelman-Sundberg M. Pharmacogenetics: an opportunity for a safer and more efficient pharmacotherapy. J Intern Med 2001; 250: 186-200
• 23 Wang L, McLeod HL, Weinshilboum RM. Genomics and drug response. N Engl J Med 2011; 364: 1144-1153
• 24 Afrakhteh M, Moeini A, Taheri MS. et al. Uterine Doppler velocimetry of the uterine arteries in the second and third trimesters for the prediction of gestational outcome. Rev Bras Ginecol Obstet 2014; 36: 35-39
• 25 Velauthar L, Plana MN, Kalidindi M. et al. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet Gynecol 2014; 43: 500-507