Safety of Nifedipine in Threatened Preterm Labour: Investigation by Three-Dimensional Echocardiography

Chaim Yosefy Department of Cardiology, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Leonti Grin Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Avishag Laish-Farkash Department of Cardiology, Assuta University Medical Center, Ashdod, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Simon Shenhav Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Xavier Piltz Department of Cardiology, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Liah Ganelin Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Mark Rabinovich Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel Eyal Anteby Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel

Objective: To evaluate atrial parameters, using real time three-dimensional transthoracic echocardiography (RT3DTTE) in women treated with nifedipine in the early third trimester (III-T) of pregnancy.

Methods: A prospective single-subject design study in a university-affiliated hospital, where each participant served as her own control. We studied 25 pregnant women at a gestational age of 25–33 weeks with TPTL prior to versus 48 hours post nifedipine treatment. Two-dimensional trans-thoracic echocardiography (2DTTE) and RT3DTTE were used to study 3D left atrial (LA) volumes and indexes, emptying fraction, left ventricular and LA cavities and total vascular resistance (TVR).

Results: 2DTTE showed a significant increase in LA area (from 15.2±2.62 to 16.16±2.21 mm², p=0.02) before versus after nifedipine; RT3DTTE showed a signiﬁcant change in LA end diastolic volume index (from 23.7±4.2 to 26.75±3.8 mL/m², p=0.008). LA end systolic volume and index were not significantly different before versus after nifedipine (from 24.56±8 to 25.3±5.5 ml, from 13.6±5.3 to 14.8±3.4 mL/m2); p>0.05, respectively. E/a ratio, E-tdi, E/E-tdi did not change significantly [(from 2.54±4.46 to 2.54±4.1), (from 11.9±1.9 to 11.9±2), (from 7.8±1.4 to 7.6±1.1), respectively, p>0.05]. TAPSE did not change significantly from 23.77±4.2 to 23.9±3.3, p=0.1.There was a significant decrease in pulmonary pressure (from 25.4±4.2 to 23±2.5 mmHg, p=0.02), in mean arterial pressure (from 80±4 to 76±3 mmHg, p<0.001), and in TVR (from 1160±260 to 1050±206 dyne s/cm ⁵, p=0.04).

Conclusions: According to RT3DTTE measurements, maternal cardiovascular function did not show adverse effect during 48 hours post nifedipine treatment. RT3DTTE could show favourable hemodynamic changes in these patients.

Chaim Yosefy