Our objective was to compare the effectiveness and safety of
atosiban and
ritodrine, in pregnancies obtained by intracytoplasmic sperm injection (ICSI) undergoing
cervical cerclage. Data from a prospective study were compared with those from a retrospective study. Sixteen ICSI pregnant women, 20-24 weeks' gestation and maternal age >18 years, received
atosiban (bolus dose 6.75 mg i.v., followed by 300 microg/min i.v. for 3 h and 100 microg/min i.v. for 45 h).
Cervical cerclage was performed 3 h after starting
atosiban. The control group (group B) of 16 ICSI pregnant women were matched and received
ritodrine hydrochloride (100-350 microg/min) for 48 h.
Cervical cerclage was performed after 24 h. Pre-term
rupture of membranes occurred within 48 h of
cervical cerclage in one woman receiving
atosiban and in four women receiving
ritodrine. There was no significant difference in terms of pregnancies not delivered at 48 h (short-term
tocolysis) and at 7 days (long-term
tocolysis). However, there was a significantly higher incidence of maternal
tachycardia with
ritodrine compared with
atosiban (p < 0.001). The mean gestational age at delivery was significantly higher for
atosiban compared with
ritodrine (36 vs 33 weeks; p < 0.001). The neonatal outcome was poorer for
ritodrine than
atosiban, as there were very low birth weight infants (p = 0.008), resulting in lower Apgar scores (p = 0.005) and there were more neonates requiring a long stay in the neonatal intensive care unit (p = 0.005). We conclude that
atosiban is associated with a significantly lower incidence of maternal
tachycardia and improved neonatal outcome compared with
ritodrine.