International Journal of Engineering Business
and Social Science
Vol. 2 No. 04, March-April 2024, pages: 1256-1262
e-ISSN: 2980-4108, p-ISSN: 2980-4272
https://ijebss.ph/index.php/ijebss
The Usage of Tocolytic Drugs in Pregnant Women With the
Threat or Preterm Labor in PKU Muhhamadiyah Gamping
Hospital Yogyakarta
Akhmad Edy Purwoko
1
*, Dirwan Suryo Soularto
2
, Rafli Alfanda Laksmana
3
Universitas Muhammadiyah Yogyakarta, Indonesia
Keywords
Abstract
PKU Muhammadiyah
Gamping Hospital;
Partus Prematrus
Imminens; Tokolitik
Drugs.
Partus Prematurus Imminens (PPI) is a threat to pregnancy caused by contractions
in the uterus at a gestational age that has not reached 37 weeks, or what is
commonly called preterm labour. According to the WHO, there are around 10-11%
of preterm births in the world each year, while in Indonesia, the WHO explains that
there are around 16% of preterm deliveries, which places Indonesia in fifth place
with the largest preterm deliveries in the world. Management and prevention
efforts with tocolytic therapy is a therapy used to suppress uterine contractions.
This research used analytic descriptive observational with a cross-sectional
approach where these observations were made within the past 5 years. The sample
in this study was conducted on pregnant women who experienced the threat of
preterm labour. This research found that most of the samples recovered as many
as 23 (95.8%) people, and the most used drug was Nifedipine, with a recovery
status of 12 (50.0%) people, while the rest were Hystolan. However, there was no
significant relationship between drug use and recovery in pregnant women with
imminent premature labour, as shown by the Fisher Exact Test, p value> 0.05.
Tocolytic drugs are effective to be given to pregnant women with Partus
Prematurus Imminens (PPI). However, there was no significant relationship
between the drug (Nifedipine and Hystolan) and the recovery of pregnant women
with imminent preterm labour (PPI) at PKU Muhammadiyah Gamping Hospital,
Yogyakarta.
© 2024 by the authors. Submitted
for possible open-access publication
under the terms and conditions of the Creative Commons Attribution (CC BY SA)
license (https://creativecommons.org/licenses/by-sa/4.0/).
1. Introduction
Partus Prematurus Imminens (PPI) is a threat to pregnancy caused by contractions in the uterus at a
gestational age that has not reached 37 weeks or is commonly referred to as a premature copy (Fitria, Prawita,
& Yana, 2021). Low birth weight babies often follow this. Low birth weight infants cause significant neonatal
morbidity and mortality events. Preterm labour is a major threat worldwide for mothers who are experiencing
pregnancy; preterm labour can occur if the baby is born less than 32 weeks or weighs less than 1,500 grams
(Marsubrin, Rohsiswatmo, & Sjarif, 2021).
IJEBSS e-ISSN: 2980-4108 p-ISSN: 2980-4272 1257
IJEBSS Vol. 2 No. 04, March-April 2024, pages: 1256-1262
Preterm labour is a problem experienced by every country in the world. According to WHO, there are
around 10-11% of preterm labour in the world every year. At the same time, in Indonesia itself, the WHO
explains that there are around 16% of preterm labour, which places Indonesia ranked fifth with the largest
preterm labour in the world (Maharani, 2021). The prevalence of preterm labour in Indonesia was 14 per 1,000
live births in 2016, 13.8 per 1,000 live births in 2017, and 29.5 per 1,000 live births in 2018 (Dimyati, Fauzy,
Chabib, Rafif, & Putra, 2020).
The main signs or symptoms of the presence of preterm labour itself are contractions in the uterus; the
use of tocolytic therapy can inhibit uterine contractions aimed at prolonging gestational life and delaying labour.
Given the advantages, giving Nifedipine can reduce blood pressure for 24 hours and Through / Peak ratio (T/P
ratio) (Sudarwanto, 2017). The side effects of Nifedipine were relatively small; from studies that have been
done, 35 people who get Nifedipine therapy, only 4 people experience weakness after therapy. (Hamzah,
Manggau, & Nasruddin, 2017).
Does this study aim to determine whether tocolytic drugs are effective for management in pregnant
women with the threat of parts premature imminent at PKU Muhammadiyah Gamping Hospital Yogyakarta.
2. Materials and Methods
In this study, the method used was analytical descriptive observational with a cross-sectional approach.
This observation was carried out by taking medical record data at PKU Muhammadiyah Gamping Hospital
Yogyakarta within the past 5 years.
The research sample taken was data on 53 pregnant women who experienced preterm labour at PKU
Muhammadiyah Gamping Hospital Yogyakarta and received tocolytic therapy.
The sampling process is carried out non-randomly (nonprobability sampling) with the quota sampling
technique by determining certain inclusion and exclusion criteria with a predetermined amount.
Inclusion criteria include:
1. Pregnant women aged 20 – 40 years.
2. Pregnant women with gestational age trimester II and trimester III.
3. Getting tocolytic therapy.
4. Pregnant women who are diagnosed with Partus Prematurus Imminens (PPI).
Exclusionary criteria, including:
1. Have a history of surgery.
2. Pregnant women with severe preeclampsia/eclampsia.
3. Have a history of heart disease.
4. Have a history of hypotension.
5. Have a history of anaemia.
3. Results and Discussions
Based on the results of research that has been conducted on 24 samples:
Table 1
Characteristics of Age Samples of Pregnant Women at PKU Muhammadiyah Gamping Hospital
Yogyakarta
Sample Characteristics
Age of
Pregnant
Women (th)
Frequency
(n)
Percentage
(%)
Reproductive
(20-35 years)
22
91,7
Risk (< 20 and
> 35 years)
2
8,3
1258 e-ISSN: 2980-4108 p-ISSN: 2980-4272 IJEBSS
IJEBSS Vol. 2 No. 04, Merch-April 2024, pages:
Sum
24
100
Table 1 shows that this study's samples were mostly of people of reproductive age (20-35 years), as many
as 22 (91.7%) people.
Table 2
Gestational Age of Pregnant Women with Partus Prematurus Imminens at PKU Muhammadiyah
Gamping Hospital Yogyakarta
No
Gestational
Age
Frequency
(n)
Percentage
(%)
1
Trimester
2 (14-28
mg)
2
8,3
2
Trimester
3 (28-40
mg)
22
91,7
Total 24 100
Table 2 shows that most samples with gestational age in the 3rd trimester (28-40 mg) are 22 (91.7%)
people.
Table 3
Use of Drugs in Pregnant Women with Partus Prematurus Imminens at PKU Muhammadiyah Gamping
Hospital Yogyakarta
No
Drug Use
Frequency
(n)
Percen
tage
(%)
1
Nifedipine
13
54,2
2
Isoxuprine
11
45,8
Total 24 100
Based on Table 3, it is known that most samples used Nifedipine drugs, as many as 13 (54.2%) people.
Table 4.
Effectiveness of Drugs Given to Pregnant Women with Partus Prematurus Imminens at PKU
Muhammadiyah Gamping Hospital Yogyakarta
No
Effectiveness
Frequency
(n)
Percentage
(%)
1
Succeed
23
95,8
2
Unsuccessful
(Moved RS)
1
4,2
Total 24 100
Based on Table 4, it is known that most of the sample succeeded as many as 23 (95.8%) people.
Table 5
Relationship between Age Sample Characteristics of Pregnant Women with Drug Use in Pregnant
Women with Partus Prematurus Imminens at PKU Muhammadiyah Gamping Hospital Yogyakarta
Age of
Pregnant
Women
Drug Use
X2
(p-value)
Nifedipin
e
n (%)
Isoxupr
ine
n (%)
Total
n (%)
IJEBSS e-ISSN: 2980-4108 p-ISSN: 2980-4272 1259
IJEBSS Vol. 2 No. 04, March-April 2024, pages: 1256-1262
Reproduct
ive (20-35
years)
12
10
22
0,015
(0,717)
At risk (<
20 and >
35 years)
1
1
2
Total
13
11
24
Based on Table 5, it is known that most pregnant women are of reproductive age (20-35 years) with the
use of Nifedipine drugs as many as 12 (50%) samples (Jesica & Friadi, 2019). The Fisher Exact Test obtained a
value = 0.717 where p >0.05. This means that there is no significant relationship between the age characteristics
of pregnant women and the use of drugs in pregnant women with premature parts imminent.
Table 6
The Relationship between Gestational Age and Drug Use in Pregnant Women with Partus Prematurus
Imminens at PKU Muhammadiyah Gamping Hospital Yogyakarta
Gestational
Age
Drug Use
X2
(p-value)
Nifedipin
e
n (%)
Isoxupr
ine
n (%)
Total
n (%)
Trimester 2
2
0
2
1,846
(0,283)
Trimester 3
11
11
22
Total
13
11
24
Based on Table 6, it is known that the most gestational age in Trimester 3 with the use of Nifedipine drugs as
many as 11 (45.8%) samples. The Fisher Exact Test obtained a value = 0.283 where p >0.05. This means that there
is no significant relationship between gestational age and drug use in pregnant women with premature parts imminent.
Table 7
The Relationship between Gestational Age and Drug Effectiveness in Pregnant Women with
Partus Prematurus Imminens at PKU Muhammadiyah Gamping Hospital Yogyakarta
Gestatio
nal Age
Effectiveness
X2
(p-value)
Succee
d
n (%)
It
didn't
work
n (%)
Total
n (%)
Trimeste
r 2
2
0
2
0,095
(0,917)
Trimeste
r 3
21
1
22
Total
23
1
24
Table 7 shows that most of the gestational age in the 3rd trimester with cured status recovered as many as 21
(87.5%) samples. The Fisher Exact Test obtained a value = 0.917 where p >0.05. This means that there is no significant
relationship between gestational age and cure in pregnant women with premature parts imminent.
1260 e-ISSN: 2980-4108 p-ISSN: 2980-4272 IJEBSS
IJEBSS Vol. 2 No. 04, Merch-April 2024, pages:
Table 8
Relationship between Drug Use and Drug Effectiveness in Pregnant Women with Partus Prematurus
Imminens at PKU Muhammadiyah Gamping Hospital Yogyakarta
Drug Use
Effectiveness
X2
(p-value)
Succee
d
n (%)
It
didn't
work
n (%)
Total
n (%)
Nifedipine
12
1
13
0,883
(0,542)
Isoxuprine
11
0
11
Total
23
1
24
Based on Table 8, it is known that the most use of Nifedipine drugs with cured status was 12 (50.0%)
samples. The Fisher Exact Test obtained a value = 0.542 where p >0.05. This means that there is no significant
relationship between drug use and cure in pregnant women with premature parts imminent (Widiana, Putra,
Budiana, & Manuaba, 2019).
Sample Characteristics
Pregnant women with the threat of preterm labour or Partus Prematurus Imminens (PPI) at PKU
Muhammadiyah Gamping Hospital Yogyakarta for 5 years (2016 – 2021) were found to have as many as 53
people as research subjects. The patient's medical records found with data were quite complete, as many as 24,
so only 24 subjects could be taken for this study. Twenty-four subjects were studied, and most pregnant women
were classified as productive age group (20-35 years), namely as many as 22 people (91.7%). This shows that
in terms of age, pregnant women at PKU Muhammadiyah Gamping Hospital Yogyakarta, the research subjects,
are the productive age group. High-risk pregnancies are pregnancies that can cause pregnant women and babies
to become ill and die before delivery takes place (Nuryanti, 2021)v. Babies die or are disabled, and even mothers
die during childbirth, often in pregnancies aged 35 years and over. There are many risk factors for pregnant
women, and one of the important factors is age. Pregnant women at the age of more than 35 years are at higher
risk of getting pregnant than when pregnant at a normal age, which usually occurs around 21-30 years. Aged
35 years and over, babies born are susceptible to genetic disorders. At reproductive age (25-35 years), the risk
of babies experiencing genetic disorders is 1:1000, while in mothers over 35 years old, the risk increases to 1:4.
Therefore, the age of the mother for childbirth should be in the range of 25-35 years (Shibuya et al., 2013). In
addition, a person's age can also affect a person's information and experience, which this study is about the use
of tocolytic therapy in pregnant women with premature parts imminent. Someone who gets more information
will add broader knowledge, while experience, which is something someone has done, will increase knowledge
about something informal (Maharani, 2021).
Incidence of Preterm Labor
The incidence of preterm labour or Partus Prematurus Imminens (PPI) at PKU Muhammadiyah Gamping
Hospital Yogyakarta, which was recorded for 5 years (2016 – 2021), was 55 people. Partus Prematurus
Imminens (PPI) or preterm labour is a threat of labour that occurs in the third trimester (28-40 weeks). This
arises due to uterine contractions at <37 weeks gestation caused by many factors from the mother. The main
signs or symptoms of the presence of preterm labour itself are contractions in the uterus; the use of tocolytic
therapy can inhibit uterine contractions aimed at prolonging gestational life and delaying labour. Another
problem that can occur during preterm labour lies in the baby; babies born prematurely will have a higher risk
of death compared to babies born normally (Zulaikha & Minata, 2021). Preterm labour is dangerous because it
has the potential to increase perinatal mortality by 60-80%; usually, preterm labour is associated with low birth
weight (BBLR). Low birth weight (BBLR) is caused by premature birth and stunted fetal growth (POGI, 2011;
Clinical Practice Guideline, 2015). Some risk factors that play a role in parts premature imminent include
multiple pregnancies, polyhydramnios, uterine anomalies, cervical dilation at 32 weeks gestation, history of
abortion 2 or more times in the second trimester, history of previous preterm labour, history of undergoing
surgical procedures on the cervix, cervical flattening/shortening of less than 1 cm in 32 weeks of pregnancy,
and abdominal surgery after the first trimester (Andalas et al., 2018).
The effectiveness of tocolytic therapy
IJEBSS e-ISSN: 2980-4108 p-ISSN: 2980-4272 1261
IJEBSS Vol. 2 No. 04, March-April 2024, pages: 1256-1262
Twenty-three (95.8%) pregnant women with Partus Prematurus Imminens were hospitalised and
recovered. This shows that effective tocolytic therapy given to pregnant women with preterm labour or Partus
Prematurus Imminens (PPI) at PKU Muhammadiyah Gamping Hospital Yogyakarta is effective. The results of
this study are supported by Refisari (2020) and Yasa et al. (2019), where the results showed that effective
tocolytic therapy was given to pregnant women with preterm labour. Tocolytic is a pharmacological agent given
to prevent premature birth; this agent will relax the uterine myometrium and inhibit uterine contractions to
prolong pregnancy and reduce neonatal complications. Tocolytic therapy is contraindicated if the prolongation
of gestational age may cause harm or harm to the mother or fetus. Contraindications of tocolytic therapy itself
include antepartum haemorrhage, chorioamnionitis, advanced cervical dilatation, placental insufficiency,
abnormal CTG, lethal congenital/chromosomal malformation, preeclampsia/eclampsia, maternal allergy to
tocolytics (Simhan, 2017).
Tocolytic Therapy Class
The drug given to pregnant women with Partus Prematurus Imminens is Nifedipine for as many as 13
(54.2%) people, while others get Isoxuprine. This shows that the group of tocolytic therapy that is widely given
to pregnant women with preterm labour or Partus Prematurus Imminens (PPI) at PKU Muhammadiyah
Gamping Hospital Yogyakarta is Nifedipine. The results of this study are supported by (Suff, Story, & Shennan,
2019), who showed that Nifedipine is the group of tocolytic therapy widely given to pregnant women with
preterm labour. There are many classes of tocolytic drugs other than magnesium sulfate (MgSO4), such as
Calcium Channel Blockers, betamimetics, and NSAIDs. The most widely used tocolytic drug class in Indonesia is
the Calcium Channel Blocker class, such as Nifedipine. According to the Food and Drug Administration (FDA),
Nifedipine is included in category C in the drug safety category. However, in Indonesia itself, research on the
success rate of Nifedipine drugs as a tocolytic therapy to prevent preterm labour is still rarely done. Nifedipine
administration can reduce blood pressure for 24 hours and Through / Peak ratio (T/P ratio) (Sudarwanto,
2017). Side effects of Nifedipine are relatively small; from studies that have been conducted, 35 people who get
Nifedipine therapy, only 4 people experience weakness after therapy (Hamzah et al., 2017).
Duration of drug administration
The duration of drug administration recorded in medical records only existed in 7 research projects. The
duration of tocolytic administration in the seven subjects was <2 x 24 hours. This is supported by (Prawiharjo,
2014), where a meta-analysis proves that tocolytic drugs can extend the latent phase of preterm labour for 2x24
hours or 24-48 hours.
4. Conclusion
There were 23 subjects (95.8%) pregnant women with preterm labor or Partus Prematurus Imminens
(PPI) at PKU Muhammadiyah Gamping Hospital Yogyakarta recovered by giving tocolytic therapy. There was
no significant relationship between gestational age and the administration of Nifedipine and Isoxuprine drugs
in the recovery of pregnant women with Partus Prematurus Imminens (PPI) at PKU Muhammadiyah Gamping
Hospital Yogyakarta.
Overall, there was no significant relationship between gestational age and drug use in pregnant women
with parts prematurely imminent. There was no significant relationship between gestational age and drug use
with cure in pregnant women with partus prematurus imminens or Partus Prematurus Imminens (PPI) at PKU
Muhammadiyah Gamping Hospital Yogyakarta (p-value > Level of Significant = 0.05). The results of this study
are supported by Refisari (2020) and Yasa et al. (2019), which showed that there was no relationship between
gestational age and drug use with cure in pregnant women with premature infants.
1262 e-ISSN: 2980-4108 p-ISSN: 2980-4272 IJEBSS
IJEBSS Vol. 2 No. 04, Merch-April 2024, pages:
5. References
Dimyati, M., Fauzy, A., Chabib, L., Rafif, M. F., & Putra, A. S. (2020). Evaluation of Risbang Strengthening Program
2015-2019 for Development of Renstra Strengthening Structure 2020-2024. IOP Conference Series: Earth
and Environmental Science, 448(1), 12083. IOP Publishing.
Fitria, Aida, Prawita, Ade Ayu, & Yana, Sari. (2021). Pengaruh Aromaterapi Lemon terhadap Emesis Gravidarum
Trimester I. Jurnal Bidan Cerdas, 3(3), 96–102.
Hamzah, Suhartina, Manggau, Marianti A., & Nasruddin, A. M. (2017). Analisis Efektifitas Dan Efek Samping
Penggunaan Off-Label Rute Pemberian Dari Nifedipine Sebagai Tokolitik Pada Partus Preterm Imminens
di Rumah sakit Makassar. Majalah Farmasi Dan Farmakologi, 21(3), 75–79.
Jesica, Fanny, & Friadi, Andi. (2019). Hubungan Kadar Kortisol Dan Prostaglandin Maternal Dengan Persalinan
Preterm Dan Aterm. Jurnal Ilmu Keperawatan Dan Kebidanan, 10(1), 21–29.
Maharani, Sri. (2021). Manfaat Senam Hamil Selama Kehamilan Trimester III di Puskesmas Putri Ayu Kota
Jambi. Jurnal Abdimas Kesehatan (JAK), 3(2), 126–130. https://doi.org/10.33860/jbc.v3i3.467
Marsubrin, Putri Maharani Tristanita, Rohsiswatmo, Rinawati, & Sjarif, Damayanti R. (2021). Preterm human
milk composition and dietary intake of breastfeeding mothers in the Indonesian population. Paediatrica
Indonesiana, 61(1), 20–24.
Nuryanti, Yayuk. (2021). Upaya Perawatan Kehamilan Dengan Senam Hamil Pada Ibu Hamil Trimester Iii Di
Puskesmas Amban Manokwari. Jurnal EMPATI (Edukasi Masyarakat, Pengabdian Dan Bakti), 2(1), 29–34.
https://doi.org/10.26753/empati.v2i1.519
Suff, Natalie, Story, Lisa, & Shennan, Andrew. (2019). The prediction of preterm delivery: What is new? Seminars
in Fetal and Neonatal Medicine, 24(1), 27–32. Elsevier.
Widiana, I. Kadek Oka, Putra, I. Wayan Artana, Budiana, I. Nyoman Gede, & Manuaba, IBGF. (2019). Karakteristik
Pasien Partus Prematurus Imminens di RSUP Sanglah Denpasar Periode 1 April 2016-30 September
2017. E-Jurnal Medika, 8(3), 1–7.
Zulaikha, Nanik, & Minata, Fika. (2021). Analisa Determinan Kejadian Kelahiran Prematur Di RSIA Rika Amelia
Palembang. Jurnal Kesehatan Saelmakers PERDANA (JKSP), 4(1), 24–30.
