European Journal of Obstetrics & Gynecology and Reproductive Biology
Elsevier

早产分娩

钙通道阻滞剂和催产素拮抗药阿托西班是最值得推荐的宫缩抑制剂,但备选药品诸如beta-mimetic,消炎痛和硫酸镁在一些国家的指引里面是仍然推荐的。

Available guidelines

RegionCountryDateSource urlRecommendations for tocolytic treatment
EuropeAustria2005OEGGG1. Atosiban
2. Beta-mimetics or calcium channel blockers
EuropeBelgium2014

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

EuropeCzech Republic2012ČGPS ČLS JEPNo first-line recommendation
• Beta-mimetics or atosiban
EuropeDenmark2013DSOG1. Atosiban
2. Calcium channel blockers, beta-mimetics or non-steroidal anti-inflammatory dru

 

EuropeFinland2011LinkNo first-line recommendation
• Calcium channel blockers or atosiban
EuropeFrance2014CNGOF

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

EuropeGermanyn/aDGGGNo first-line recommendation
• Atosiban, fenoterol or nifedipine
EuropeGreece2014HSOGNo first-line recommendation
• Nifedipine or atosiban
EuropeItaly2013n/a

No first-line recommendation, treatments recommended according gestational week
• 24–28 weeks: Indomethacin
• 28–32/34 weeks: Atosiban
• 32/34–37 weeks: Nifedipine
• High risk or twins: Atosiban
• Neuroprotection: Magnesium sulphate

Beta-mimetics are strongly not recommended

EuropeThe Netherlands2012NVOG

No first-line recommendation
• Atosiban or nifedipine

Atosiban has a slight preference in complicated pregnancies

EuropeNorway2014NGF1. Atosiban
2. Nifedipine
3. Indomethacin
EuropePortugaln/an/a1. Atosiban
2. Nifedipine
3. Indomethacin
EuropeRomania2010Link1. Atosiban
2. Nifedipine
3. Hexoprenaline, terbutaline or ritodrine
4. Indomethacin
5. Magnesium sulphate
6. Nitroglycerin
7. Betamethasone or dexamethasone
EuropeRussia2013Link1. Nifedipine in 50% cases of PTL
2. Atosiban in 20% cases of PTL
3. Hexoprenaline in 20% of PTL
EuropeSpain2014SEGONo 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
EuropeSwedenn/an/a• Atosiban is used as first-line treatment at university hospitals and most regional hospitals
EuropeUnited Kingdom2011RCOG

• Atosiban or nifedipine

Atosiban is 500 times more expensive than nifedipine

South AmericaArgentinan/an/a

Draft guidelines
1. Atosiban or beta-mimetics

Nifedipine is not considered

South AmericaBrazil2013FEBRASGO• 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 AmericaMexico2008CENETECAtosiban 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
AsiaChina2014RANZCOGFollow RANZCOG guidelines
1. Magnesium sulphate
2. Beta-mimetics
3. Nifedipine
4. Indomethacin
5. Atosiban
AsiaHong Kong2011RCOGFollow RCOG guidelines
AsiaJapan2011JSOG1. Ritodrine hydrochloride
2. Magnesium sulphate
AsiaMalaysian/an/a1. Terbutaline
2. Ritodrine
AsiaSingapore2011RCOGFollow RCOG guidelines
1. Beta-mimetics
2. Other pharmacological agents, including: nitric oxide donors, magnesium sulphate, indomethacin, nifedipine and atosiban
AsiaSouth Korea2014KSOG1. Ritodrine
2. Atosiban
AsiaThailandn/an/a1. Beta-mimetics (terbutaline)
2. Calcium channel blockers (nifedipine)
3. Magnesium sulphate
AsiaThe Philippines2014n/a1. Beta-mimetics
2. Nifedipine
3. Progesterone
4. Atosiban
AsiaVietnam2012

n/a

1. Nifedipine
2. Salbutamol
3. Atosiban
AustralasiaNew Zealand2011RANZCOG• Nifedipine
Middle eastLebanon2014

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 eastIsrael2014LinkNo first-line recommendation
• Treatment options include: calcium channel blockers, prostaglandins inhibitors, atosiban and beta-mimetics
Middle eastSaudi Arabia2011Link

• 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

AfricaSouth African/an/aNo first-line recommendation
• Atosiban
• Nifedipine