Efficacy and Safety of Nifedipine as a Tocolytic Drug for the Treatment of Preterm Labour: Comparison with Levosalbutamol

Background: The rising prevalence of preterm birth is a significant public health concern. This study aimed to assess the efficacy and safety of the calcium channel blocker Nifedipine compared to the β2 agonist Levosalbutamol for inhibiting uterine contractions in early preterm labor, with a focus on maternal side effects and perinatal outcomes. Methods: A randomized clinical trial was conducted at Rajshahi Medical College Hospital over one year, involving pregnant women experiencing early preterm labor (24-36 weeks gestation, regular uterine contractions, cervical dilation 1-3 cm). a total N=66 patients were randomly assigned to receive either Nifedipine (Experimental group) or Levosalbutamol (Control group). Primary maternal outcomes included tocolysis, time to tocolysis, prolongation of pregnancy by ≥2 days, and delivery at term. Secondary perinatal outcomes included birth asphyxia, perinatal mortality, and the need for emergency NICU admission. Secondary maternal outcomes included side effects such as headache, hypotension, nausea/vomiting, and tachycardia. Results: Over 90% of patients in the Nifedipine group achieved tocolysis compared to 72.7% in the Levosalbutamol group (p = 0.054). Nifedipine achieved significantly faster tocolysis (8.7 hours vs. 29.3 hours, p < 0.001). The Experimental group showed higher rates of arresting preterm labor for ≥2 days and lower rates of preterm delivery. Maternal side effects were lower for headache but higher for hypotension and nausea/vomiting in the Nifedipine group. Tachycardia occurred in the Control group but not the Experimental group. Both groups had low rates of birth asphyxia. Perinatal mortality was lower in the Experimental group, and NICU admission was less frequent. Conclusion: Nifedipine demonstrated superior efficacy over Levosalbutamol in terms of tocolysis, time to tocolysis, prolongation of pregnancy, delivery at term, with fewer maternal side effects and improved perinatal outcomes in pregnant women .....