Management of Recurrent Preterm Labor in Twin Gestations with Nifedipine Tocolysis

ABSTRACT

We examined outcomes of twin pregnancies complicated by recurrent preterm labor receiving nifedipine tocolysis. In a retrospective study design, twin pregnancies receiving outpatient preterm labor surveillance services and oral nifedipine tocolysis following a diagnosis of preterm labor were identified from a database (n = 1421). Eligible for inclusion were patients subsequently rehospitalized with recurrent preterm labor symptoms (n = 862). Included were patients at < 35 weeks' gestation, having intact membranes, and remaining undelivered for > 48 hours after recurrent preterm labor (n = 656). Pregnancy outcomes of women resuming nifedipine tocolysis (n = 418) following hospitalization were compared with those having an alteration in treatment (n = 238) to continuous subcutaneous terbutaline. Alteration of tocolytic treatment versus resuming nifedipine resulted in increased pregnancy prolongation (34.7 ± 18.8 days versus 27.5 ± 19.9 days, p < 0.001), with delivery of fewer low birth weight (67.2% versus 78.3%, p < 0.001) and very low birth weight infants (6.5% versus 15.0%, p < 0.001) and a decreased incidence of neonatal intensive care unit admission (44.7% versus 52.9%, p = 0.005). In twin pregnancies receiving nifedipine tocolysis, alteration of tocolytic treatment to subcutaneous terbutaline following hospitalization for recurrent preterm labor symptoms had a positive impact on pregnancy prolongation and neonatal outcomes.

KEYWORDS

Preterm labor symptoms - tocolysis - twins - subcutaneous terbutaline - nifedipine

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