Adverse and beneficial effects of tocolytic therapy.
In addition to questions raised about the efficacy of many tocolytics, appropriate concern has been voiced about the safety of these potent drugs. Although some degree of risk for adverse effects with drugs promising a strong therapeutic effect can be accepted, caution needs to be exercised when benefits are marginal or unproven. Unfortunately, some of the tocolytics, most notably the betamimetics and magnesium sulfate, have been found to have considerable potential for adverse maternal cardiovascular and respiratory effects. Although less clearly established, the use of indomethacin appears to be associated with increased fetal and neonatal risks. Concerning magnesium sulfate, in addition to the well-known maternal effects, the accumulating evidence showing an increased frequency of adverse outcomes in the fetus and neonate has led to the recommendations to abandon its use entirely as a tocolytic. Given the limitations of our current state of knowledge, nifedipine would appear to be among the more efficacious and safer tocolytics available to use when properly indicated.
Pryde
P G
PG
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, USA.
Besinger
R E
RE
Gianopoulos
J G
JG
Mittendorf
R
R
D000318:Adrenergic beta-Agonists / Q000009:adverse effects / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005313:Fetal Death / Q000139:chemically induced; D005315:Fetal Diseases / Q000139:chemically induced; D006801:Humans; D008278:Magnesium Sulfate / Q000009:adverse effects / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D010121:Oxytocin / Q000037:antagonists & inhibitors; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D015149:Tocolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D014668:Vasotocin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D002121:Calcium Channel Blockers; D016861:Cyclooxygenase Inhibitors; D015149:Tocolytic Agents; C047046:atosiban; D010121:Oxytocin; D008278:Magnesium Sulfate; D014668:Vasotocin