Preterm labour (PTL) is defined as the onset of labour in pregnancy from 28 weeks to 36weeks and 6 days. One of the most challenging problem of obstetrician in the era of modern obstetrics is the management of preterm labour and preterm births (PTB); Being the most common cause of perinatal morbidity and mortality PTB accounts for 70-80% of perinatal deaths. More than a million preterm infants die per year, worldwide.
Aim: To Compare the Tocolytic effect of Oral Nifedipine tablet and Transdermal Nitroglycerin (TDN) patch in preterm labour and its effect on maternal and fetal outcome.
Materials and Methods: It was a Double Blinded placebo controlled study conducted at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, from November 2018 to April 2019. The study population comprised of patients who attended the casualty and outpatient department. Eighty-eight women with singleton pregnancy from 28weeks to 36weeks 6 days in preterm labour with intact membranes and cervical dilatation from 1 up to 3 cm; without contraindication for tocolysis were enrolled in the study. After taking the informed consent, subjects were randomised into two groups; 46 subjects in group A received oral Nifedipine tablet, out of which 4 left the study and 46 in group B received TDN patch. The variables analysed were, delay in delivery for 48 hours, 7 days or more than 7 days, period of gestation at delivery, effect on maternal and fetal outcome and side-effect profile of drugs.
Result: The percentage of women delivering after 48 hours of administration of oral Nifedipine were 66.67% and TDN patch were 76%. Failure of tocolysis, defined as delivery within 48 hours, was significantly more with Nifedipine group (8/42-19.05%) as compared to TDN patch group (3/46-6.5%). Headache was significantly higher in group B as compared to group A (p< 0.001). Maternal tachycardia was more common in group A compared to group B (p< 0.001).
Conclusion: Transdermal Nitroglycerin (TDN) patch is more effective than oral tablet Nifedipine in suppression of preterm labour and prolonging pregnancy. Although the rate of side effects were more with Nitroglycerin, most common was headache which can be controlled with analgesics. Cardiovascular side effect were nil compared with Nifedipine. Nitroglycerin is well tolerated and safe for the mother and fetus.