Use of tocolytics: what is the benefit of gaining even more time?
- 19 December 2006
- journal article
- review article
- Published by Wiley in BJOG: An International Journal of Obstetrics and Gynaecology
- Vol. 113 (s3), 78-80
- https://doi.org/10.1111/j.1471-0528.2006.01128.x
Abstract
Today's dogma states that tocolytics can be used to prolong pregnancy for just 48 hours, allowing corticosteroids to be administered and transportation of the mother to a tertiary care centre. Surveys have shown that up to 30% of practitioners use maintenance tocolysis. Theoretically, maintenance tocolysis should be able to improve neonatal outcome by avoiding preterm birth and allowing delivery in the community maternity hospital or even at home, minimising social difficulties created by long distances between the mother and/or her baby and the rest of the family. This should result in fewer neonatal intensive care unit admissions, less respiratory distress syndrome and fewer long-term neurological sequelae. Such an effect has never been proven, probably because we do not know which women benefit from treatment, which do not require treatment because they are not in labour and which babies would better be born because chorioamnionitis and other insults jeopardize intrauterine development. Most studies on long-term tocolysis have been performed with beta-agonists. No improvement has been shown. On the contrary, a trend towards fetal harm with an increased risk for periventricular leucomalacia exists. Results from studies of one tocolytic should not be generalised; one published study on maintenance therapy with atosiban showed prolonged uterine quiescence and prolonged gestation, but was too small to detect differences in neonatal outcome. In the future, we need larger studies, not only to detect whether long-term tocolysis with newer tocolytics (oral oxytocin antagonists, prostaglandin receptor blockers) results in better neonatal outcome, especially at the lower gestational ages but also to discover methods that allow us to identify those women who will benefit from treatment and those for whom prolongation of pregnancy may cause harm.Keywords
This publication has 20 references indexed in Scilit:
- Assessing the Neonatal Safety of Indomethacin TocolysisObstetrics & Gynecology, 2005
- Cyclo-oxygenase (COX) inhibitors for treating preterm labourPublished by Wiley ,2005
- Lung and brain damage in preterm newborns, and their association with gestational age, prematurity subgroup, infection/inflammation and long term outcomeBJOG: An International Journal of Obstetrics and Gynaecology, 2005
- Maintenance tocolysisBJOG: An International Journal of Obstetrics and Gynaecology, 2005
- The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in BelgiumPEDIATRICS, 2004
- Survey of the management of preterm labour in Australia and New Zealand in 2002Australian and New Zealand Journal of Obstetrics and Gynaecology, 2004
- Maintenance treatment of preterm labor with the oxytocin antagonist atosibanAmerican Journal of Obstetrics and Gynecology, 2000
- Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory diseasePublished by Wiley ,2000
- Obstetric risk factors for periventricular leukomalacia among preterm infantsBJOG: An International Journal of Obstetrics and Gynaecology, 1998
- Efficacy of oral beta-agonist maintenance therapy in preterm labor: A meta-analysisObstetrics & Gynecology, 1995