Discussion
In order to lessen the negative effects of infancy and improve survival and quality of life for infants, it is imperative that preterm labor be prevented and treated. The ultimate goal of controlling preterm labor is not only to extend the pregnancy but also to improve neonatal outcomes and reduce mortality rates. This attitude will have a significant long-term impact on the cost of health and social care. Although no tocolytic drug with minimal adverse effects on the mother and fetus and also improving neonatal outcomes has been introduced to date, this study aimed to compare the effect of concomitant administration of Magnesium Sulfate and Indomethacin suppository with Magnesium Sulfate alone on preterm delivery in Kosar hospital between 2019 and 2021.
The mean time interval between receiving the drug and delivery was longer in group A (Magnesium Sulfate + Indomethacin) than in group B (Magnesium Sulfate), indicating that type A intervention was more effective at inhibiting preterm delivery in patients than type B intervention. The relationship between the type of intervention and the time interval between receiving the drug and delivery was statistically significant.
Accordng to the findings of the Lewis et al. (1995) study, the combined group (Magnesium Sulfate and Indomethacin) had a greater effect on increasing the duration of tocolysis than the Magnesium Sulfate group alone, with a difference of more than 370 hours compared to 70 hours in the Magnesium Sulfate group only, a difference that was statistically significant.
Compared to patients in the group receiving Magnesium Sulfate and Indomethacin, more patients in the group receiving Magnesium Sulfate delivered within 48 hours and 7 days after receiving the drug In the first 48 hours, this difference was not statistically significant, but in the interval of seven days, this difference was significant. According to Borna and Saeedi (2007), Celecoxib was 81 percent effective at delaying delivery for more than 48 hours, while Magnesium Sulfate was 87 percent effective, neither of which was statistically significant (13). According to Abaasaelizadeh et al. (2014), 32% of pregnant women gave birth after 24 hours and 60% after 48 hours in the Magnesium Sulfate group, while 37% of pregnant women gave birth after 24 hours and 63% of patients gave birth after 48 hours in the Indomethacin group, indicating that no significant difference between the two groups existed (15).
Despite the fact that no significant difference was observed between the study groups within 48 hours of receiving the drug in each of the studies mentioned, the rate of delivery in the groups was higher than the results of our study, which was due to differences in entry criteria.
Additionally, contrary to our findings, when Mesdaghinia et al. (2012) compared the effects of Indomethacin and Magnesium Sulfate on preterm labor, labor delays were comparable in both groups, and no cases of preterm labor were admitted within 48 hours. (17). According to Taj Aramesh et al. (2012), when comparing the effects of Indomethacin and Magnesium Sulfate on delaying preterm delivery, 37 percent of patients treated with Indomethacin gave birth within the first 72 hours, while 9 percent of patients treated with Magnesium Sulfate gave birth within the first 72 hours, a significant difference between the two groups (18). In contrast to the preceding study, this distinction Seven days after initiating the drug was significant in our study.
There was no significant difference between the two groups in terms of adverse effects on mothers, and there was no significant relationship between the type of intervention and secondary outcomes such as NICU hospitalization, gestational age at the end of pregnancy, or neonatal Apgar score. According to the findings of the study conducted by Vermillion et al. (2000), there was no statistically significant difference in the mean gestational age between the Indomethacin group and the control group between the groups. (26). According to Klauser et al(2014) .’s study comparing the effects and side effects of Nifedipine (N), Magnesium Sulfate (M), and Indomethacin (I) for the treatment of preterm labor, the gestational age at delivery was comparable in all three groups. There were no significant differences in efficacy or maternal safety between the three tocolytic factors (16). The logistic regression model’s output indicated that the type of intervention had a significant relationship with the rate of spontaneous delivery within 7 days of receiving the drug. In this case, Magnesium Sulfate and Indomethacin suppository are more effective when administered together.
Data analysis revealed that concomitant administration of Magnesium Sulfate and Indomethacin had a greater effect on inhibiting and delaying preterm labor than Magnesium Sulfate alone. Other parameters (neonatal Apgar score, drug side effects, gestational age at the end of pregnancy, etc.) were slightly different between the two groups, and due to the significance of the average time interval between drug administration and delivery and the type of delivery in the two groups, prescribing Magnesium Sulfate and Indomethacin suppository have more beneficial effects in this field.