Hatice Ender SOYDİNÇ, Gonca YILDIRIM, Metin NURLUOĞLU

Erken doğum eyleminin tedavisinde Magnezyum Sülfat ve Ritodrin Hidroklorürün karşılaştırılması

Amaç: Erken doğum eylemi tedavisinde kullanılan magnezyum sülfat ve ritodrinin etkinlik, maternal ve fetal sonuçlarının karşılaştırılmasını amaçladık. Gereç ve yöntem: Erken doğum eylemi tanısı ile yatırılan 28-36. gebelik haftaları arasında 80 gebe kadın rastgele iki gruba ayrıldı. Bir gruba magnezyum sülfat, ikinci gruba ritodrin hidroklorür tedavisi uygulandı. Erken doğum eylemi, servikal değişikliklerle birlikte 10 dakikada en az iki kontraksiyon olması şeklinde tanımlandı. Magnezyum sülfat 4,5 gr/saat bolus verildi ve 1-2gr/saat infüzyon hızında devam edildi. Ritodrin hidroklorür, 50 mcg/dakika infüzyon şeklinde başlanıldı ve kontraksiyonlar duruncaya veya ciddi yan etkiler oluşana kadar 15-20 dakikada bir 50 mcg/dakika arttırıldı. Tokolitik etki ve maternal-fetal sonuçlar istatistiksel olarak karşılaştırıldı. Bulgular: Her iki tokolitik tedavi grubu arasında doğumun ≥48 saat ve ≥7 gün uzatılması, gebeliğin 36. gebelik haftasından sonra sonlanması, kazanılan gün sayısı ve doğumdaki gebelik haftası açısından anlamlı fark bulunamadı. Her iki grupta yaşamı tehdit edici ciddi yan etki saptanmadı. Yan etkiler magnezyum sülfat grubunda ritodrin grubuna göre daha az gözlendi. Her iki grubun ortalama yenidoğan ağırlık ve apgar skorları arasında anlamlı fark saptanmadı. Sonuç: Magnezyum sülfat ve ritodrin hidroklorür, tedavilerinin etkinlik, fetal ve yenidoğan sonuçları arasında fark bulunmadı. Ancak maternal yan etkiler dikkate alındığında magnezyum sülfat tedavisi ritodrin hidroklorüre göre daha üstün bulundu.

The comparison of Magnesium Sulfate and Ritodrine Hydrochloride for management of preterm labor

Objectives: We aimed to compare the efficacy, and maternal and fetal outcomes of magnesium sulfate and ritodrine hydrochloride treatments in preterm labor. Materials and methods: Eighty pregnant women with premature labor between 28 and 36 weeks of pregnancy were divided into two groups randomly. One group received magnesium sulfate and the other received ritodrine hydrochloride. Preterm labor was defined as the occurrence of at least two contractions in 10 minutes accompanied by cervical changes. Magnesium sulfate was administered as a 4,5 gram bolus, then continued 1-2 gr/h infusion rate. Ritodrine hydrochloride was started 50 mcg/minute infusion, and was increased to 50 mcg/minute every 15-20 minutes until the contractions stops or occurs the serious side effects. The intravenous treatments with both agents were continued with oral maintenance therapy. Tocolytic effect and maternal-fetal outcomes were statistically compared. Results: There was no significant difference between both tocolytic treatment groups in terms of the prolongation of pregnancy ≥ 48 hours and ≥ 7 days, termination of pregnancy after 36 weeks, the delayed the number of days after onset of preterm labor and gestational weeks at the birth. Life-threatening serious adverse effects were not observed in both groups. Side effects were less observed in magnesium sulfate group. No significant difference was found in newborn weight and apgar scores between two groups. Conclusion: There is no difference between these two treatments for efficacy, fetal and neonatal outcomes. However, considering the maternal adverse effects, magnesium sulfate treatment is superior to ritodrine hydrochloride.

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