Nifedipine versus magnesium sulfate in preterm labor management

Preterm labor is a major contributor to perinatal morbidity and mortality globally, with preterm birth responsible for 75% of neonatal deaths and 50% of long-term morbidity. Tocolysis – aimed at inhibiting uterine contractions, is employed to mitigate associated risks. 

A recent randomized controlled trial compared the efficacy of Nifedipine and Magnesium sulfate in managing preterm labor.

Overall, 80 women between 28 and 37 weeks of gestation were selected for the comparison. Patients were randomly assigned to receive either MgSO4 or nifedipine. The study assessed the successful prolongation of pregnancy, primary tocolytics effects at 48 hours, and secondary tocolytics effects beyond seven days.

The results indicated no significant differences between the two groups in labor pain suppression at various time points. While there were no statistically significant variations in Apgar scores and neonatal respiratory distress syndrome, infants exposed to MgSO4 had more NICU admissions. 

It was inferred that oral nifedipine is as effective as MgSO4 in inhibiting preterm labor. Although neonates exposed to MgSO4 had more NICU admissions, there was no significant difference in the incidence of respiratory distress syndrome. The authors suggested that nifedipine could be a preferred option for managing preterm labor due to its easy availability, minimal side effects, low cost, and ease of administration. 

The need for large randomized studies to further validate tocolytic efficacy was emphasized. Regardless of the chosen tocolytic agent, evidence supported short-term tocolysis to allow for antenatal steroids and maternal transport to a tertiary care facility.

Source: Bhat S, Jain A, Sunil K S. Indian J ObstetGynecol Res. 2023;10(4):460-468