Case Report: Assessment of the Success of Tocolytic Therapy with Tocolytic Index in a patient G1P0A0 28 Weeks Pregnant with PROM


  • Alvira Balqis Soraya FK Unila
  • Dinda Annisa Fitria Fakultas Kedokteran Universitas Lampung
  • Ratna Dewi Puspita Sari Bagian Obstetri dan Ginekologi, Fakultas Kedokteran, Universitas Lampung


Pretermlabor, PROM, Tocolytics


Premature rupture of membranes is a rupture of the amniotic membrane before delivery. It occurs in 3% of pregnancies and carries a risk of preterm delivery. Each year there are 15 million babies born and more than 1 in 10 babies born prematurely (gestation less than 37 weeks). Obtained patient Mrs. IR, 36 years old, came with complaints of preterm pregnancy accompanied by water-discharge. This complaint was felt since two days before entered the hospital, clear color, odor less and changed sanitary napkins three times a day. The patient appeared to be moderately ill, consciousness compos mentis, blood pressure 118/87 mmHg, pulse 83x/minute, breathing 23x/minute and, temperature 36 ° C. The generalist status of the patient was within normal limits. On obstetric examination, there was a TFU of 3 fingers above the umbilicus (24 cm). The lower part of the mother's fetus was round, bouncy, hard with the impression of the head, not yet in PAP. His (-), fetal heart rate 148x/minute. Inspeculo examination found closed OUE, fluorine -, fluxus: +, amniotic (+) inactive, erosion / laceration / poly (-), red litmus (+) to blue. The patient was diagnosed as 28 weeks pregnant G1P0A0 with promiscuity of single live fetal head presentation and oligohydramnios. To prevent preterm labor in this case, conservative therapy is given in the form of antibiotics (prevent in increase dinfection), corticosteroids (fetal lung maturation), and tocolytics (suppress in uterine contractions). To assess the success of tocolytic therapy, the tocolytic index was used.



Prawirohardjo S. Ilmu kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo. 2016.

POGI. Ketuban pecah dini: Pedoman Nasional Pelayanan Kedokteran. 2016.

Medina TM, & Hill DA. Preterm Premature Rupture of Membranes : Diagnosis and Management.2006; 73(4):1-5

World Health Organization. Born too soon: the global action report on preterm birth. 2012.

Mercer, BM & Frcs C. Is There a Role for Tocolytic Therapy During Conservative Management of Preterm Premature Rupture of the Membranes ?. 2007; 50(2): 487–96.

Ross MG, Smith CV, Trupin SR.. Preterm labor: Obstetircs & Gynecology. [Medscape]. 2018.

Directorate of Strategy and Clinical Care Health Service Executive. Tocolytic treatment in pregnancy: Clinical Practice Guideline. 2015; 22 (1): 121.

Essed GGM. Aspects of human tocolysis with adrenergic agents: with accent on the prevention of preterm labor; University of California. Leiter-Nypels. 2007.

Lewis DF, Major CA, Towers CV, Asrat T, Harding JA, Garite TJ. Effects of digital vaginal examination on latency period in preterm premature rupture of membranes. Obstet Gynecol. 1999; 80(4): 630–4.

Alexander JM, Mercer BM, Miodovnik M, Thurnau GR, Goldenburg RL, Das AF. The impact of digital cervical examination on expectantly managed preterm rupture of membranes. Am J Obstet Gynecol. 2000; 183(4): 1003-7.

Meller CH, Carducci M, Cernadas J & Otano L. Preterm premature rupture of membranes. Arch Argent Pediatr. 2018; 116 (4): 575–81.

Agudelo AC, Romero R, & Kusanovic JP. Nifedipine for the management of preterm labor: A Systematic review and metanalysis. Am J Obstet Gynecol. 2012; 204 (2): 1–31.

Haas D M, Benjamin T, Sawyer R, & Quinney S. Short-term tocolytics for preterm delivery–current perspectives. 2014. 7(6): 343–9.

Abdellateef SS, El Shorbagy SH, Hagras AM, Ghareeb AE. Assesment of maternal nifedipine as tocolytic agent on the doppler inices of uterine and fetal umbilical and middle cerebral ateries. Gyneco Obstet Res Open J. 2018. 4(2): 44-9.

Baumgarten K, Gruber W. Tocolyse index. In Duden Hausen JW, Saling E, eds, Perinatale medizin. Stuttgart, Germany: Georg Thieme Verlag. 1974; 7(4): 197-9.

Takagi K and Satoh K. Is long-term tocolysis threatened premature labor?. The Journal of International Medical Research. 2009. 8(37): 227-39.

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