Comparison of Efficacy of Nifedipine Alone and Nifedipine with Progesterone Depot for Tocolysis of Preterm Labour

Background: Preterm labor poses significant challenges to obstetric practice, with preterm births contributing to a substantial portion of infant morbidity and mortality worldwide. Although various pharmacological agents are employed to manage preterm labor, the effectiveness of different therapeutic combinations remains a topic of ongoing research. Calcium channel blockers like nifedipine are increasingly favored for their efficacy in reducing uterine contractions, while progestins have been shown to reduce the recurrence of preterm births. Objective: The objective of this study was to compare the efficacy of nifedipine monotherapy versus the combination of nifedipine with progesterone depot in the management of preterm labor, evaluating the cessation of uterine contractions within 48 hours as the primary outcome. Methods: This randomized controlled trial was conducted at the Department of Obstetrics & Gynecology, Unit III, at Ganga Ram Hospital, Lahore, with a sample size of 92 patients experiencing preterm labor between 28 and 36 weeks of gestation. Patients were randomly assigned to Group A (nifedipine monotherapy) or Group B (nifedipine plus progesterone depot). Group A received an initial dose of 20 mg nifedipine followed by 20 mg twice daily for two days. Group B received the same nifedipine regimen with a single intramuscular injection of 250 mg of 17-alpha-hydroxyprogesterone caproate. The efficacy of the treatment was defined as the cessation of uterine contractions within 48 hours. Data were analyzed using SPSS version 25, with significance set at p ≤ 0.05. Results: The study found that 71.74% (33/46) of patients in Group B achieved cessation of uterine contractions within 48 hours compared to 47.83% (22/46) in Group A. This difference was statistically significant (p = 0.019), indicating that the addition of progesterone depot to nifedipine enhanced its effectiveness in managing preterm labor. Conclusion: The combination of nifedipine with progesterone depot proved significantly more effective than nifedipine alone in the cessation of uterine contractions associated with preterm labor. This combined therapy approach presents a promising strategy for improving maternal and neonatal outcomes in the management of preterm labor