Treatment of preterm labor with the oxytocin antagonist atosiban: a double-bind, randomized, controlled comparison with salbutamol

Objective: To compare the efficacy and safety of atosiban and salbutamol in the treatment of preterm labor. Study design: A multicenter, double-blind, double-placebo, randomized, controlled trial. Women (n=241) diagnosed with preterm labor at 23–33 gestational weeks were enrolled and received either atosiban (n=119) or salbutamol (n=122). At randomization, women were stratified by gestational age (≤28 weeks and >28 weeks). Atosiban (i.v. bolus dose of 6.75 mg, then 300 μg/min for 3 h and 100 μg/min for up to 48 h) and salbutamol (2.5–45 μg/min) were administered by i.v. infusion for up to 48 h. Retreatment with study drug or an alternative tocolytic agent was allowed. Main outcome measures included tocolytic effectiveness which was assessed in terms of the number of women undelivered after 48 h and 7 days. Tocolytic efficacy and tolerability were assessed in terms of the proportion of women undelivered and who did not require alternative tocolytic therapy at 48 h and 7 days of starting treatment. Safety was assessed in terms of maternal side effects and neonatal morbidity. Results: Tocolytic effectiveness at 48 h was 93.3 versus 95.0% (P=0.67) and after 7 days was 89.9 versus 90.1% (P=0.93) in the atosiban and salbutamol groups, respectively. Tocolytic efficacy and tolerability within 48 h was 79.8 versus 75.2% (P=0.15), and after 7 days was 58.8 versus 46.3% (P=0.021) in the atosiban and salbutamol groups, respectively. Maternal adverse events, including serious events, occurred more frequently in the salbutamol group. Neonatal outcomes were comparable between the study groups. Conclusions: The oxytocin antagonist atosiban was found to be better tolerated by both mother and fetus than salbutamol, with a comparable neonatal and infant safety profile, and atosiban was as effective as salbutamol in delaying threatened preterm birth. This study supports the clinical use of atosiban in the treatment of preterm labor.French/Australian Atosiban Investigators Grou

Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Part 2—steps to reduce adhesions

This consensus position represents the collective views of 35 gynaecologists with a recognised interest in adhesions. The first part of the position was presented in the previous issue of Gynecological Surgery and reviewed the published literature on the extent of the problem of adhesions. In this part, the opportunities to reduce their incidence are considered. Collective proposals on the actions that European gynaecologists should take to avoid causing adhesions are provided. Importantly, in this part, the need to now inform patients of the risks associated with adhesion-related complications during the consent process is discussed. With evidence increasing to support the efficacy of adhesion-reduction agents to complement good surgical practice, all surgeons should act now to reduce adhesions and fulfil their duty of care to patients

Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position

Adhesions are the most frequent complication of abdominopelvic surgery, yet many surgeons are still not aware of the extent of the problem and its serious consequences. While adhesions may cause few or no detrimental effects to patients, in a considerable proportion of cases there are major short- and long-term consequences, including small-bowel obstruction, infertility and chronic pelvic pain. Adhesions complicate future surgery with important associated morbidity and expense-and a considerable risk of mortality. Despite advances in surgical techniques in recent years, the burden of adhesion-related complications has not changed. Adhesions should now be considered the most common complication of abdominopelvic surgery. Adhesiolysis remains the main treatment, despite the fact that adhesions reform in most patients. Developments in adhesion-reduction strategies and new agents now offer a realistic possibility of reducing the risk of adhesions forming and can improve the outcomes for patients and the associated onward burden. This consensus position represents the collective views of 35 gynaecologists with a recognised interest in adhesions. The position is presented in two parts. The first part reviews the published literature on the extent of the problem of adhesions, and the second part considers the opportunities to reduce their incidence. It also provides collective proposals on the actions that European gynaecologists should take to avoid causing adhesions. Importantly it also advises that it is now time to inform patients of the risks associated with adhesion-related complications during the consent process. With increasing evidence to support the efficacy of adhesion-reduction agents to complement good surgical practice, all surgeons should act now to reduce adhesions and fulfil their duty of care to patients. © 2007 Springer-Verlag