Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome.

To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL.

This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20 mg of rapid release nifedipine orally. If uterine contraction continued, a 10 mg dose was repeated every 20 min with a maximum of 40 mg within the first hour. After completing the first hour, 20 mg was given every 4-6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200 mg daily.

Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13±5.08 days in group A while 29.73±3.10 days in group B. (p≤ 0.001)

Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions.