Current selection for

tocolytic drugs

Adviser :
Prof. Dr. H. I. O. Marsis, spOG

Compiled by:
Isnawaty Mohamad
(1161050259)

OBSTETRI AND GYNECOLOGY

HOSPITAL CHRISTIAN UNIVERSITY OF INDONESIA
PERIOD
 INTRODUCTION

PRETERM DELIVERY IS DEFINED AS

DELIVERY BEFORE 37 WEEKS GESTATION.
PREMATURE BIRTH CAN CAUSE
DISTURBANCES IN NEURAL
DEVELOPMENT AND AN INCREASED RISK
FOR RESPIRATORY PROBLEMS AND CAUSE
COMPLICATIONS IN GASTROINTESTINAL

1. Janella R. Bolden, MD. Acute and Chronic Tocolysis. Clinical obstetrics and gynecology. 57 (3).
 BY 2010 ITS ESTIMATED INCIDENCE WAS
11.99% IN THE UNITED STATES, 8.0% IN
CANADA, AND 9.6%

STUDY IN MALANG, INDONESIA (1996-1998)

54 MOTHERS WHO GIVE BIRTH TO BABIES
WITH CONGENITAL ABNORMALITIES 57.7%
SHOWED POSITIVE TOXOPLASMA IGG3

2. Dhakal R, et all. Significance of a Positive Toxoplasma Immunoglobulin M Test Result in United State
Journal of Clinical microbiology. Vol: 53. 2015
3. Sardjono, TW. Strategi Penanggulangan Penyakit Parasitik di Masyarakat. Laboratorium Parasitolog
Fakultas Kedokteran Universitas Brawijaya, Malang. Maj Kedokt Indononesia. Vol: 59, N: 7. 2009.
 THE PURPOSE OF THIS LITERATURE REVIEW WAS TO
DETERMINE THE BEST MANAGEMENT OF THE
TOXOPLASMOSIS IN PREGNANCY, SO THAT THE
POSSIBILITY OF CONGENITAL ABNORMALITIES CAN BE PREVENTED.

ACCORDING TO A STUDY FROM THE JOURNAL OF

CLINICAL MICROBIOLOGY, USA (2015) OF 451
PATIENTS WITH POSITIVE IGM AND IGG IN THE SERUM
T.GONDII,
22% SHOWED AN ACUTE INFECTION A
74% SHOWED CHRONIC INFECTION
2% WERE NOT SHOWS INFECTION
 MANAGEMENT TOXOPLASMOSIS IN
PREGNANCY

TOXOPLASMA SEROLOGY
PERFORMED AT THE FIRST
ANTENATAL EXAMINATION ON FIRST
TRIMESTER OF PREGNANCY (BEFORE
WEEK 16),
ACUTE INFECTION
CHARACTERIZED BY IGM AND IGG
POSITIVE
Rodrigues IM et all. AssesmentOR NEGATIVE,
of Laboratory WITH
Method Used in The Diagnosis ofLOW
Congenital
Toxoplasmosis after Maternal Treatment with Spiramycin in Pregnancy. BMC Infectious Diseases
14:349. 2014
 INSTITUTE FOR MEDICAL MICROBIOLOGY, UNIVERSITY
MEDICAL CENTER GOETTINGEN, GERMANY (2012)
THERAPY START AT WEEKS 16 OF GESTATION
SPIRAMISIN 3X106 IU FOUR TIMES DAILY FOLLOWED BY A
COMBINATION OF A PIR (THE FIRST DAY 50 MG; AFTER 25
MG / DAY) PLUS WITH SULFADIAZINE (WEIGHT <80 KG: 3 G
/ DAY; WEIGHT WEIGHT> 80 KG: 4G / DAY) PLUS FOLIC
ACID (10-15 MG / DAY) FOR 4 WEEKS.

Hotop A, Hibi H and Grob U. Efficacy of Rapid Treatment Initiation Following Primary Toxoplasma
gondii Infection During Pregnancy. Institute for medical Microbiology, German National consulting
for Toxoplasmosis, Univesity Medical Center Goettingen.2012
 DEPARTMENT OF OBSTETRIC AND GYNECOLOGIC
CATHOLIC UNIVERSITY OF THE SACRED HEART, A. GEMELLI
HOSPITAL, ROMEITALY (2015)
SPIRAMISIN (SPI) GIVEN AFTER THE DIAGNOSIS
OF MATERNAL INFECTION
SPIRAMISIN PYRIMETHAMINE-SULFONAMIDE
( WHEN OCCURRED INFECTION OF THE FETUS )
PYRIMETHAMINE-SULFONAMIDE SPIRAMISIN
(AFTER 15 WEEKS OF GESTATION)

Valentini P et all. Spiramycin /Cotrimoxazole versus Pyrimethamine /Sulfonamide and Spiramycin

Alone for The Treatment of Toxoplasmosis in Pregnancy. Journal of Perinatology. Vol:35. pp 90-94.
 ALTERNATIVE PROTOCOL
SPIRAMISIN / CO-TRIMOXAZOLE (SPI
/ KO) USED AND PROVIDE
PROMISING RESULTS IN A
RETROSPECTIVE STUDY.

DOSES OF COTRIMOXAZOLE GIVEN

COMBINATION WITH SPI IS 960 MG
(SULFAMETHOXAZOLE 800 MG +
TRIMETROPIN 160 MG) 2 TIMES A
DAY + FOLIC ACID 4 MG / DAY
GIVEN STARTING FROM WEEK 14 OF
PREGNANCY UNTIL A WEEK BEFORE
THE BABY IS BORN.

Valentini P et all. Spiramycin /Cotrimoxazole versus Pyrimethamine /Sulfonamide and Spiramycin

Alone for The Treatment of Toxoplasmosis in Pregnancy. Journal of Perinatology. Vol:35. pp 90-94.
PEDIATRICS AND CHILDCARE DEPARTMENT OF THE MEDICAL SCHOOL
OF FEDERAL UNIVERSITY OF GOIS (UFG), GOINIA, BRAZIL

THE SUCCESS OF THERAPY CAN BE MONITORED BY

PERFORMING PCR OF AMNIOCENTESIS AT 18 WEEKS OF GESTATION
BEFORE, A POSITIVE RESULT SHOWS ALREADY AN INFECTION IN THE
FETUS.
ULTRASOUND TO SEE WHETHER THERE IS ANY CONGENITAL
ABNORMALITIES
CHECKS CAN BE CONTINUED AFTER THE BABY IS BORN, THE SERUM IGM
AND IGG DETECTION IN NEONATES.
NEONATES SAID TO HAVE AN INFECTION IGM AND / OR IGA SPECIFIC POSITIVE IN
THE FIRST 6 MONTHS OF LIFE, INCREASE IN SPECIFIC IGG AND IGG PERSISTENT
VALUE IN THE FIRST 12 MONTHS OF LIFE WITH OR WITHOUT CLINICAL SIGNS.

1. Valentini P et all. Spiramycin /Cotrimoxazole versus Pyrimethamine /Sulfonamide and

Spiramycin Alone for The Treatment of Toxoplasmosis in Pregnancy. Journal of Perinatology.
Vol:35. pp 90-94. 2015
 DISCUSSION

TREATMENT WITH SPIRAMYCIN IS STILL A CONTROVERSIAL ISSUE TODAY.

IN A PROSPECTIVE STUDY THAT EVALUATED 3 TYPES OF THERAPY GROUPS (SPI

MONOTHERAPY, COMBINATION THERAPY PIR / SUL, AND UNTREATED GROUPS) IN
1208 CASE, THE REGULATION OF PRENATAL DOES NOT SHOW THE EFFECT ON THE
PREVENTION OF PRENATAL TRANSMISSION.

RETROSPECTIVE STUDY WHICH INCLUDED 120 PREGNANT WOMEN WITH ONE ANOTHER,
CONGENITAL TOXOPLASMOSIS OCCURS MORE IN PATIENTS RECEIVING MONOTHERAPY SPI.

SPI MAY EFFECTIVELY PREVENT

INFECTION OF THE FETUS IN I
TRISMESTER OF PREGNANCY
Avci ME et all. Role of Spiramycin in Prevention of Fetal
Toxoplasmosis. The Journal of Maternal-Fetal and
Neonatal Medicine. 2015
 PIR / SUL HAVE TERATOGENIC PROPERTIES
AND HEMATOLOGIC SIDE EFFECTS AND
CAN CAUSE SYMPTOMS OF NAUSEA IN THE
MOTHER. ADDITION OF FOLINIC ACID IN THE
TREATMENT NECESSARY TO PREVENT
DRUG TOXICITY WITHOUT AFFECTING
THE ACTIVITY OF DRUGS AGAINST
TOXOPLASMA.

PATIENTS SHOULD BE MONITORED DURING

TREATMENT AND PCR ON AMNIOTIC FLUID
NEEDS TO BE DONE REGULARLY.
Bernardo WM, Chinzon M and Chaves FGB. Is Sulfadiazine alone equivalent ( benefit and harm ) to
Spiramycin To Treat Acute Toxoplasmosis in the First Trismester of Pregnancy. Association Medicine
 UNTIL NOW THERE IS NO IDEAL DRUG THAT CAN BE GIVEN
FOR THE TREATMENT OF PREGNANT WOMEN WITH
TOXOPLASMOSIS.

THE IDEAL DRUG :

SHOW PENETRATION WITH AN EFFICIENT CONCENTRATION OF
THE PLACENTA
EFFECTIVE AGAINST VARIOUS FORMS OF THE PARASITE
NOT PROVIDE TOXICITY EFFECTS ON THE FETUS

ENCOURAGING RESULTS HAVE BEEN FOUND USING A

COMBINATION OF SPIRMICIN - COTRIMOXAZOLE

Serranti D, Buonsenso D, and Valentini P. Congenital Toxoplasmosis. European Review fot Medical
and Pharmacological Sciences. Departement of Pediatrics , Catholic University of Sacred Heart,
DEPARTMENT OF OBSTETRIC
GYNECOLOGIC CATHOLIC
UNIVERSITY OF THE SACRED
HEART, A. GEMELLI HOSPITAL,
ROMEITALY (2015)
THE ASSOCIATION OF TRIMETROPIN /
SULFAMETHOXAZOLE SELECTED FOR
THE PHARMACOLOGICAL EFFECT IS
GOOD, BECAUSE IT SHOWS
SATISFACTORY RESULTS IN INVITRO, IN
ANIMAL AND HUMAN STUDIES, AS
WELL AS SAFE IN PREGNANCY AND
HAVE A LOW COST SO EASY TO REACH
BYfor The
THE PUBLIC.
Valentini P et all. Spiramycin /Cotrimoxazole versus Pyrimethamine /Sulfonamide and Spiramycin
Alone Treatment of Toxoplasmosis in Pregnancy. Journal of Perinatology. Vol:35. pp 90-94.
 CONCLUSION
1. TOXOPLASMA SEROLOGICAL EXAMINATION PERFORMED AT THE FIRST
ANTENATAL EXAMINATION ON TRISMESTER FIRST PREGNANCY (BEFORE
WEEK 16), AN ACUTE INFECTION CHARACTERIZED BY IGM AND IGG
POSITIVE OR NEGATIVE, WITH IGG AVIDITY IS LOW (<30%)
2. THE BEST THERAPY IS A COMBINATION SPIRAMISIN 3X106 IU FOUR TIMES
DAILY AT THE START AT THE BEGINNING WITH COTRIMOXAZOLE 960 MG
GIVEN TWO TIMES A DAY + FOLIC ACID 4 MG / DAY WITH FIGURES MOTHER
TO FETUS TRANSMISSION TOXOPLASMOSIS MOST LOW AT 5.7%,
COMPARED WITH PENGGUNANAAN PYRIMETHAMINE COMBINED WITH
SULFADIAZINE 10% AND 20.9% SPIRAMISIN MONOTHERAPY WITH P <0.014
3. THE THERAPY IS GIVEN TO PATIENTS WITH AKUT.SPIRAMISIN INFECTION
CAN BEGIN AS SOON AS POSSIBLE SINCE THE FIRST WEEK OF GESTATION
AND COTRIMOXAZOLE START FROM WEEK 14 OF PREGNANCY UNTIL ONE
WEEK BEFORE THE BABY IS BORN.
4. THE SUCCESS OF THERAPY CAN BE MONITORED BY PERFORMING PCR OF
AMNIOCENTESIS AT 18 WEEKS OF GESTATION BEFORE, ULTRASOUND, AND
FOLLOW-UP SERUM IGM, IGG AND IGA SPECIFIC AND CLINICAL
MANIFESTATIONS IN NEONATES UP TO THE AGE OF 12 MONTHS.
5. THE NEONATE SAID TO HAVE CONGENITAL TOXOPLASMOSIS IF IGM AND /
OR IGA SPECIFIC POSITIVE IN THE FIRST 6 MONTHS OF LIFE, INCREASE IN
SPECIFIC IGG AND IGG PERSISTENT VALUE IN THE FIRST 12 MONTHS OF
LIFE WITH OR WITHOUT CLINICAL SIGNS.
 REFERENCE
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TOCATINS, BRAZIL, FROM 2012-2014. JOURNAL PONE. 2015
2. DHAKAL R, ET ALL. SIGNIFICANCE OF A POSITIVE TOXOPLASMA IMMUNOGLOBULIN M TEST RESULT IN UNITED
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