Preterm labour. The present and future of tocolysis.
This chapter discusses the tocolytic agents currently in use for the treatment of preterm labour and considers them in light of the evidence base. These agents are the beta2 sympathomimetic agonists, magnesium sulphate (MgSO(4)), indomethacin, nifedipine and atosiban. The available evidence for these agents shows that the beta2 agents are effective but have significant maternal side effects and no effect on perinatal outcome. MgSO(4) and glyceryl trinitrate are clearly ineffective. Nifedipine is effective with a low maternal side effect profile and is associated with improved perinatal outcomes. Meta-analyses of the several randomized controlled trials of atosiban show that it is no more effective than other tocolytic therapies. Possible directions for the future will be discussed.
Giles
Warwick
W
Faculty of Health, University of Newcastle, Australia. warwick.giles@hnehealth.nsw.gov.au
Bisits
Andrew
A
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D008278:Magnesium Sulfate / Q000627:therapeutic use; D009543:Nifedipine / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D015149:Tocolytic Agents / Q000627:therapeutic use*; D017211:Treatment Failure; D014668:Vasotocin / Q000031:analogs & derivatives / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D015149:Tocolytic Agents; C047046:atosiban; D008278:Magnesium Sulfate; D009543:Nifedipine; D014668:Vasotocin; D007213:Indomethacin