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.